US20200178780A1 - Video Laryngoscope Systems - Google Patents

Abstract

Video laryngoscope system including a video laryngoscope having a laryngoscope handle and a laryngoscope blade. The video laryngoscope system includes an image capture module with at least two stationary imaging units spaced apart along the laryngoscope blade for providing real-time video streams of a patient's airway passage during an intubation and a controller for enabling a clinician performing the intubation to select one or more of the real-time video streams for real-time display on a display screen to assist intubation of a patient.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS
• This application is a continuation of U.S. patent application Ser. No. 14/891,137, filed on Nov. 13, 2015, which is a National Stage Application of International Application No. PCT/IL2014/050426, filed on May 15, 2014, which claims priority to foreign Israel Patent Application No. IL 226379, filed on May 16, 2013, the disclosures of which are incorporated herein by reference in their entirety.
FIELD OF THE INVENTION
• The present disclosure is directed toward video laryngoscope systems.
BACKGROUND OF THE INVENTION
• Video laryngoscopy for assisting tracheal intubation is a commonplace medical procedure alongside traditional direct view laryngoscopy and indirect view laryngoscopy using optical view tubes. Tracheal intubation can be further facilitated by the use of a video stylet in conjunction with a video laryngoscope.
• Video laryngoscopy includes a handheld video laryngoscope and a display screen for instantaneously displaying an anatomically defined sequence of progressively imaged physiological structures during the manipulation of a laryngoscope blade from an initial blade insertion into a patient's mouth to a final blade position for assisting tracheal intubation. The anatomically defined sequence of progressively imaged physiological structures includes the following intubation significant landmarks: (1) the tongue and uvula, (2) the epiglottis, (3) the posterior cartilages and interarytenoid notch, (4) the glottic opening, and (5) the vocal cords.
• Challenges often arise to hinder recognition of progressively imaged physiological structures. For example, recognition of the epiglottis may be hindered owing to its visual similarity to the mucosa of the posterior pharynx, and accumulation of blood, secretions, and/or vomitus in the posterior pharynx. Improper identification of certain landmarks can lead to errors in intubations. For example, if the esophagus and glottic opening are confused, esophageal, rather than tracheal, intubation may occur.
• US Patent Application Publication No. US 2012/0190929 to Patel et al. (hereinafter the Patel disclosure) discloses a laryngoscope including a handle, a blade holding element, a detachable blade, means for viewing the laryngeal inlet of a patient and means for adjusting the viewing field. The Patel disclosure discloses the laryngoscope is configured to be usable with at least two different detachable blades including inter alia straight blades, curved blades, and so-called difficult intubation blades.
• Patel paragraph [0013] discloses a blade holding element with a multi-camera system including two adjacent fixed cameras directed to two different viewing fields and intended to be used with different blades. Patel paragraph [0013] also discloses means for switching from one camera to the other so that a clinician may select to use the first camera for when the laryngoscope is fitted with a standard blade and the second camera when a difficult intubation blade is used.
• Patel paragraph [0014] discloses a blade holding element with a single movable or tiltable camera and mechanical or electronic means for remotely changing the position of the camera for positioning in a desired position to provide a clear, non-distorted view of a patient's laryngeal inlet.
• U.S. Pat. No. 5,800,344 to Wood, Sr. et al, (hereinafter the Wood disclosure) discloses a video laryngoscope having an image sensor assembly mounted thereon for providing video imaging of a patient's airway passage. The Wood disclosure discloses a fixed position image sensor and an image sensor assembly slidably mounted on a track formed on a curved section of a laryngoscope body so that sliding of the image sensor assembly along the track adjusts the distance of the assembly from a target and the orientation angle of the image sensor assembly.
• U.S. Pat. No. 8,398,545 to Chen et al. (hereinafter the Chen disclosure) discloses a video laryngoscope with a movable image capturing unit similar to the Wood disclosure. The Chen disclosure discloses a laryngoscope with a side mounted display and also a laryngoscope with an external display for reducing the volume and size of the laryngoscope.
• U.S. Pat. No. 8,652,033 to Berci et al. (hereinafter the Berci disclosure) discloses a video intubation system that provides multiple streams to be simultaneously presented to a user. A video laryngoscope provides a first image stream and a video stylet provides a second image stream. The two image streams may be presented to the user on two different side-by-side monitors or a single monitor provided with a split screen. The video intubation system presents a user with a view of the upper portion of a patient's anatomy via the laryngoscope as well as being presented with a view in front of the video stylet as the stylet is advanced through the trachea.
• US Patent Application Publication No. US 2011/0263935 to Qiu (hereinafter the Qui disclosure) discloses an intubation system for intubations based on an airway pattern indicating a trachea opening. The airway pattern is determined from analysis of airway data detected by a trachea identifying device disposed on a movable guide stylet of the intubation system. Qui FIG. 4 shows a guide stylet 46 with light sources 62, image capture devices 64a and 64b on either side of a laser pointer 70, gas exchange detectors 66 and control cable 68. Qiu para [0050] discloses the image capture devices may be a video camera to continually capture images or a still camera to capture still images. In another example, the image capture devices may be a thermal camera or an infrared camera to capture thermal images.
• US Patent Application Publication No. US 2012/0116156 to Lederman (hereinafter the Lederman disclosure) discloses a medical device includes a tube, at least one imaging sensor coupled to an endoscope in the tube, and a monitor application to monitor positioning of the tube in a medical patient by identifying expected anatomical features in images provided by the at least one sensor. The Lederman disclosure also discloses a method for endotracheal intubation including receiving imaging frames from a sensor located in an endotracheal tube inserted through a patient's and processing the image frames to identify progression of anatomical features consistent with a proper placement of the endotracheal tube. In particular, the Lederman disclosure discloses image processing to identify vocal cords, trachea, the esophagus, carina, and the like.
SUMMARY OF THE INVENTION
• The present invention is directed toward video laryngoscope systems including an image capture module with at least two stationary imaging units longitudinally deployed along a laryngoscope blade for generating a corresponding number of different real-time video streams during manipulation of a laryngoscope blade from an initial blade insertion into a patient's mouth to a final blade position for assisting intubations of patients. The present invention is based on the notion that a clinician performing an intubation will be assisted by the ability to select at least one real-time video stream from at least two different real-time video streams at a series of continuous locations of a laryngoscope blade along a patient's airway passage to orient the location of a laryngoscope blade tip in the patient's airway passage and recognize the aforesaid intubation significant landmarks.
• The video laryngoscope systems of the present invention include a controller for controlling operation of the imaging module including inter alia real-time video display during intubation procedures, real-time video recording of intubation procedures, and the like. The controller preferably includes user controls which can be readily operated by a clinician performing an intubation, for example, for selecting which one or more real time video streams he wants to be view at a particular instance on a display screen. Such user controls can be preferably provisioned on a laryngoscope handle for finger/thumb operation during an intubation. Alternatively, video laryngoscope systems of the present invention can include touch display screens for touch screen operation similar to a smartphone. Alternatively, one or more real time video streams can be displayed on a display screen in accordance with a default setup which can be overridden by a clinician.
• The video laryngoscope systems of the present invention can include image processing software for processing the captured real time video streams prior to their display as disclosed in inter alia the aforementioned Lederman disclosure, the aforementioned Qui disclosure, and the like. Such processing includes inter alia improving contour definition, improving boundary definition, automatic recognition of intubation significant landmarks, and the like.
• The video laryngoscope systems of the present invention preferably employ conventional imaging units. Such imaging units preferably include an illumination source, for example, a LED, and the like, for illuminating a patient's airway passage during intubation. Such imaging units include a digital imaging sensor, for example, a CCD, a CMOS chip, and the like. The laryngoscope blades can be provisioned with anti-fogging arrangements for preventing fogging of the digital imaging sensors. One or more of the digital imaging sensors can be tiltable similar to the aforementioned Patel disclosure. Also, the video laryngoscope systems of the present invention can include mechanical or electronic means for remotely changing the tilt of a tiltable digital imaging sensor for positioning in a desired position.
• The video laryngoscope systems of the present invention can include a laryngoscope mounted display screen similar to the aforementioned Chen disclosure or an external display screen similar to the aforementioned Berci disclosure. Laryngoscope mounted display screens can be mounted to enable traditional direct view laryngoscopy as well as video laryngoscopy. Alternatively, laryngoscope mounted display screens can be mounted to enable video laryngoscopy only. The display screens can display side-by-side image streams similar to aforementioned Berci disclosure.
• Also, as similar to the aforementioned Berci disclosure, the video laryngoscope systems of the present invention can also be used with a video stylet for providing a stylet video stream for display on the display monitor. The video stylets can be re-usable items or disposable single use items. The clinician can select to display a real time video stream from a video stylet on the display screen either by itself or together with a real time video stream from one of the blade mounted imaging units.
• The present invention can be readily applied to the differing approaches regarding re-usable components and disposable single use components as exemplified in commercially available video laryngoscope systems. Such commercially available video laryngoscope systems include inter alia the C-MAC by Karl Storz Endo vision, Inc., Charlton, Mass., USA, the Glidescope by Verathon, and the like. In some implementations, disposable single use components include electronic sub-components. In other implementations, disposable single use components are employed for sterility purposes only and do not include electronic sub-components. The present invention can also be readily applied to disposable laryngoscope blades for detachable attachment to laryngoscope handles. The disposable laryngoscope blades can be made from metal or plastic. Suitable metal laryngoscope blades are disclosed in commonly assigned U.S. Pat. No. 7,736,304 to Pecherer. Suitable plastic laryngoscope blades are disclosed in commonly assigned U.S. Pat. No. 5,879,304 to Shucman et al.
• The video laryngoscope systems of the present invention can be implemented with a wide range of conventional laryngoscope blade shapes and sizes for assisting in regular intubation and so-called difficult intubations. The laryngoscope blade shapes include inter alia Miller blades, Macintosh blades, Foregger-Magill blades, and the like. The laryngoscope blades can be optionally provided with a guide channel for guiding an endotracheal tube.
BRIEF DESCRIPTION OF DRAWINGS
• In order to understand the invention and to see how it can be carried out in practice, preferred embodiments will now be described, by way of non-limiting examples only, with reference to the accompanying drawings in which similar parts are likewise numbered, and in which:
• FIG. 1 is a combined pictorial view and block diagram of a video laryngoscope system for use with an endotracheal tube for intubation of a patient;
• FIG. 2 is a pictorial view of a laryngoscope blade including a daisy chain of four imaging units of an image capture module of a video laryngoscope;
• FIG. 3 is an enlarged view of the daisy chain of the image capture module;
• FIG. 4 is a schematic diagram showing three Field Of View (FOV) arrangements of the image capture module;
• FIG. 5 is a pictorial view of a laryngoscope handle including finger/thumb operated controls; and
• FIGS. 6A to 6C show the use of the video laryngoscope system for assisting an intubation of a patient.
DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS OF THE INVENTION
• FIGS. 1 to 5 show avideo laryngoscope system100 for use with anendotracheal tube200 and avideo stylet300 for assisting tracheal intubations of patients. Thevideo laryngoscope system100 is preferably in communication with a healthcarefacility computer system400 including ahealthcare facility database401 for storing computer files402. Thevideo laryngoscope system100 can generate patient intubation files compatible with standard Electronic Medical Record (EMR) programs. Thevideo laryngoscope system100 can be in wired or wireless communication with the healthcarefacility computer system400.
• Thevideo laryngoscope system100 includes ahandheld video laryngoscope101 having alaryngoscope handle102 and alaryngoscope blade103 transversely extending from thelaryngoscope handle102 and terminating at a distallaryngoscope blade tip104. The laryngoscope handle102 includes apower source106 preferably in the form of a rechargeable battery and anonboard display screen107. Thelaryngoscope blade103 has anunderside blade surface108 for deploying against a patient's tongue on insertion of thelaryngoscope blade103 into his mouth and anupperside blade surface109 opposite theunderside blade surface108.
• Thevideo laryngoscope101 includes animage capture module111 includingstationary imaging units112 deployed along thelaryngoscope blade103 at increasing lengths from the distallaryngoscope blade tip104. Theimaging units112 are each capable of independently and simultaneously generating a real-time video stream of a patient's airway passage during an intubation for selective display on thedisplay screen107.
• Thevideo laryngoscope system100 includes acontroller113 for controlling the operation of theimage capture module111 including inter alia real-time video display during intubation procedures, real-time video recording of intubation procedures, and the like. Thecontroller113 can also control the operation of thevideo stylet300. Thecontroller113 is preferably in wireless communication with thevideo stylet300.
• FIG. 2 shows theupperside blade surface109 has a stepped configuration for forming anelongated guide channel114 for supporting anendotracheal tube200 during an intubation. Theupperside blade surface109 includes amajor blade surface116 parallel and opposite theunderside blade surface108, anupright blade surface117 generally perpendicular to themajor blade surface116 and anuppermost blade surface118 generally parallel to themajor blade surface116 and tapering thereto wards.
• Theimage capture module111 preferably includes a so-called imagingunit daisy chain119 of a series of at least two longitudinally spaced apart rigidly mountedimaging units112 and in this case fourimaging units112 stationary mounted on thelaryngoscope blade103. The imagingunit daisy chain119 is preferably deployed on theupright blade surface117. Alternatively, it can be deployed on theuppermost blade surface118 as shown in dashed lines. The imagingunit daisy chain119 can be permanently or detachably mounted on thelaryngoscope blade103.
• FIG. 2 also shows adisplay screen107 remote from thevideo laryngoscope101 and simultaneously displaying two different real-time video streams captured by twodifferent imaging units112.
• FIG. 3 shows eachimaging unit112 includes one ormore illumination sources121 and adigital imaging sensor122. Thedigital imaging sensors122 include inter alia a camera and one or more lenses. An exemplary wafer level CMOS camera is the 1.3M pixel camera cube from Kushan Q Technology Ltd which has a maximum diagonal FOV of 66°. Theimaging units122 can have the same magnification and Field of View (FOV). Alternatively, theimaging units122 can have different magnifications and FOVs.
• Theimage capture module111 includes at least a pair ofimaging units112 having a leadingimaging unit123 proximate the distallaryngoscope blade tip104 and a trailingimaging unit124 behind the leadingimaging unit123 relative to the distallaryngoscope blade tip104. The length denoted L the trailingimaging unit124 is behind the leadingimaging unit123 relative to the distallaryngoscope blade tip104 depends on blade size and is at least 1 cm. In view of their longitudinal spaced apart configuration and theimaging units123 and124 can also have different magnifications and therefore different FOVs,FIG. 4 shows three exemplary FOV arrangements as follows: First, theimaging units123 and124 have anon-overlapping FOV arrangement126. Second, theimaging units123 and124 have a partially overlappingFOV arrangement127. And third, theimaging units123 and124 have a fully overlappingFOV arrangement128 with one FOV within the other FOV.
• Based on a particular implemented FOV arrangement and taking into account theimaging units123 and124 can be at different distances from the internal structures of a patient's airway passage that they are imaging at a particular location of thelaryngoscope blade103 therealong during an intubation, the leadingimaging unit123 and the trailingimaging unit124 image different sized areas of different locations of a patient's airway passage at a particular location of thelaryngoscope blade103.
• FIG. 5 shows thecontroller113 preferably includes finger/thumb operatedcontrols129 on thevideo laryngoscope101 for enabling a clinician performing an intubation to readily operate thecontroller113 to select which one or more real-time video streams he wants to view on thedisplay screen107 during the intubation. The finger/thumb operatedcontrols129 can include inter alia push buttons, rotatable thumbscrews, and the like. Also, thedisplay screen107 can be a touchscreen for touchscreen operation. A clinician can also select to display the real time video stream from thevideo stylet300 on thedisplay screen107. A clinician typically selects to display the real time video stream from thevideo stylet300 after thelaryngoscope blade103 is in its final blade position and the clinician has introduced theendotracheal tube200 along theguide channel114 thereby obstructing the blade mountedimaging units112.
• The use of avideo laryngoscope system100 with a leadingimaging unit123 and a trailingimaging unit124 is now described with reference toFIGS. 6A to 6C.
• FIG. 6A shows that on initial blade insertion into a patient's mouth, the leadingimaging unit123 obtains a close-up view of the vallecula region of a patient while the trailingimaging unit124 obtains a view of the patient's uvula and posterior pharynx.
• FIG. 6B shows that as thevideo laryngoscope101 is advanced down the patient's airway passage, the views obtained by the imaging units change.FIG. 4B shows that as laryngoscope handle102 is tilted upward, thereby advancing thelaryngoscope blade103, the leadingimaging unit123 is positioned to obtain a close up view of a patient's vocal cords while the trailingimaging unit124 is positioned to obtain a view of his interarytrnoid notch.
• FIG. 6C shows that as thelaryngoscope handle102 is further tilted upward, thereby further advancing thelaryngoscope blade103, the leadingimaging unit123 may be advanced so as to obtain a closer view of vocal cords of the patient, while the trailingimaging unit124 may be positioned so as to maintain a view of the interarytrnoid notch and the esophagus thereby increasing the certainty of correct endotracheal tube placement.
• While the invention has been described with respect to a limited number of embodiments, it will be appreciated that many variations, modifications, and other applications of the invention can be made within the scope of the appended claims.

Claims (20)

1. A method for assisting tracheal intubation of a patient, the method comprising:

providing a video laryngoscope system comprising a video laryngoscope having a laryngoscope handle, a laryngoscope blade extending from the laryngoscope handle and terminating at a distal laryngoscope blade tip, and an image capture module including a pair of stationary imaging units, each stationary imagining unit of the pair of stationary imaging units being deployed along the laryngoscope blade at increasing lengths from the distal laryngoscope blade tip;

independently and simultaneously generating a real-time video stream from each stationary imaging unit of the patient's airway passage during the intubation, each real-time video stream being different;

simultaneously displaying on a display screen the different real-time video streams captured by each respective imaging unit of the pair of stationary imaging units;

selecting, via a controller, one or more of the real-time video streams to view on the display screen during the intubation; and

displaying the selected one or more real-time video streams on the display screen during the intubation.

2. The method for assisting tracheal intubation of a patient according toclaim 1, wherein the stationary imaging units are longitudinally spaced apart and mounted on the laryngoscope blade.

3. The method for assisting tracheal intubation of a patient according toclaim 2, wherein the pair of imaging units include a leading imaging unit proximate the distal laryngoscope blade tip, and a trailing imagining unit behind the leading imaging unit relative to the distal laryngoscope blade tip.

4. The method for assisting tracheal intubation of a patient according toclaim 3, wherein said leading imaging unit and said trailing imaging unit have a non-overlapping Field of View (FOV) arrangement.

5. The method for assisting tracheal intubation of a patient according toclaim 3, wherein said leading imaging unit and said trailing imaging unit have an at least partially overlapping Field of View (FOV) arrangement.

6. The method for assisting tracheal intubation of a patient according toclaim 3, wherein said leading imaging unit and said trailing imaging unit have a fully overlapping Field of View (FOV) arrangement.

7. The method for assisting tracheal intubation of a patient according toclaim 1, wherein the laryngoscope blade has an underside blade surface for deploying against the patient's tongue on insertion of the laryngoscope blade into the patient's mouth, and an upperside blade surface opposite the underside blade surface.

8. The method for assisting tracheal intubation of a patient according toclaim 7, wherein the upperside blade surface is configured to support an endotracheal tube during intubation.

9. The method for assisting tracheal intubation of a patient according toclaim 8, wherein the upperside blade surface includes a major blade surface parallel and opposite the underside blade surface, an upright blade surface generally perpendicular to the major blade surface, and an uppermost blade surface generally parallel to the major blade surface.

10. The method for assisting tracheal intubation of a patient according toclaim 9, wherein the pair of stationary imagining units are deployed on the upright blade surface.

11. The method for assisting tracheal intubation of a patient according toclaim 9, wherein the pair of stationary imagining units are deployed on the uppermost blade surface.

12. The method for assisting tracheal intubation of a patient according toclaim 1, further comprising communicating, via the video laryngoscope system, with a healthcare facility computer system including a healthcare facility database to store files.

13. The method for assisting tracheal intubation of a patient according toclaim 12, further comprising generating, via the laryngoscope system, patient intubation files.

14. The method for assisting tracheal intubation of a patient according toclaim 13, wherein the video laryngoscope system communicates with the healthcare facility computer system via a wired communication.

15. The method for assisting tracheal intubation of a patient according toclaim 13, wherein the video laryngoscope system communicates with the healthcare facility computer system via a wireless communication.

16. The method for assisting tracheal intubation of a patient according toclaim 1, further comprising a video stylet in wireless communication with the controller.

17. The method for assisting tracheal intubation of a patient according toclaim 1, wherein the laryngoscope handle includes a power source.

18. The method for assisting tracheal intubation of a patient according toclaim 1, wherein the display screen is onboard the laryngoscope handle.

19. The method for assisting tracheal intubation of a patient according toclaim 1, wherein the display screen is remote from the video laryngoscope.

20. A video laryngoscope system for assisting tracheal intubation of a patient, the video laryngoscope system comprising:

a video laryngoscope including a laryngoscope handle, a laryngoscope blade transversely extending from said laryngoscope handle and having a distal laryngoscope blade tip remote from said laryngoscope handle, and an image capture module having a leading imaging unit proximate said distal laryngoscope blade tip and a trailing imaging unit behind said leading imaging unit relative to said distal laryngoscope blade tip, the leading imaging unit and the trailing imaging unit being spaced apart along said laryngoscope blade relative to said distal laryngoscope blade tip, the leading imaging unit and the trailing imaging unit configured to generate different real-time video streams during a manipulation of said laryngoscope blade from an initial blade insertion into the patient's airway passage to a final blade position; and

a controller configured to enable a clinician performing an intubation to select a real-time video stream during the intubation for real-time display on a display screen to assist intubation of the patient.

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