Reducing Harm In Ventilated Patients: First In-patient Evaluation Of A Smart Endotracheal Tube

在健康的情况下，人们可以保持呼吸道畅通，自然呼吸。然而，重病或麻醉的患者无法做到这一点，因此临床医生经常在气管(气管)中使用气管内管(ETT)来维持开放的呼吸道，并允许空气通过机械呼吸机输送到肺部。管子被放入呼吸道，气囊在气管充气，形成一个气体密封，使空气有效地输送到肺部。为了最大限度地减少伤害和疾病，重要的是要正确平衡这种压力，以避免泄漏和保护肺部免受污染。不幸的是，由于需要常规的压力测量，气管损伤和呼吸机相关性肺炎很常见。如果袖带压力太高，可能会导致半数患者术后喉咙中度至重度疼痛(英国每年50万人)，到终身气管狭窄(插管后气管狭窄，PITS)，在英国每年约有2000人发生。如果袖带压力太低，就会导致液体泄漏到肺部，从而导致呼吸机相关性肺炎(VAP)。VAP影响多达五分之一的重症监护患者，使住院时间增加6天，每一集花费NHS GB 12000英镑，并增加死亡的可能性。我们的目标是通过创造一种基于这项世界第一技术的新医疗设备，使全球插管患者受益。iTraXS(气管内多路传输传感)是一种在袖带中使用精细光纤传感器的新型气管内导管。传感器使用光来测量袖带和气管交界处的压力和血流量。保持正确的袖带压力有助于减少气管损伤和呼吸机相关性肺炎。传感器测量心率和血氧饱和度等生命体征。传感器还可以识别ETT何时错误地放置在食道中，这是一个潜在的致命情况。我们认为iTraXS能够改善全球患者的日常手术体验，并将显著减少VAP或PITS造成的痛苦。在这个项目中，我们将对这项新技术进行首次临床评估，40名成年参与者接受选择性手术。

In health, people can keep their airway open and breathe naturally. Seriously ill or anaesthetised patients however cannot do this, so clinicians often use an endotracheal tube (ETT) in the trachea (windpipe) to maintain an open airway and allow air to be delivered to the lungs via a mechanical ventilator. The tube is placed into the airway and a cuff (balloon) is inflated at the trachea to create a gas seal that allows air to be delivered to the lungs effectively. To minimise injury and illness, it is important that this pressure is balanced correctly to avoid leaks and to protect the lungs from contamination. Unfortunately, due to the need for routine pressure measurements, tracheal injuries and ventilator associated pneumonia are common.If the cuff pressure is too high this can cause injuries that range from moderate to severe sore throat in half of all patients after surgery (500,000 per year in the UK), to lifelong tracheal narrowing (Post Intubation Tracheal Stenosis, PITS) which occurs in around 2,000 patients per year in England. If the cuff pressure is too low this results in fluids leaking into the lungs which can lead to ventilator associated pneumonia (VAP). VAP affects as many as one in five people in intensive care, increases hospital stay by 6 days, costs the NHS £12,000 per episode and increases the likelihood of death. We aim to benefit intubated patients worldwide by creating a new medical device based on this world first technology.iTraXS (intra tracheal multiplexed sensing) is a new endotracheal tube which uses fine optical fibre sensors in the cuff. The sensors use light to measure the pressure and blood flow at the interface between the cuff and trachea. Maintaining the correct cuff pressure can help to reduce tracheal injury and ventilator associated pneumonia. The sensors measure vital signs such as heart rate and oxygen saturation. The sensors can also identify when the ETT is incorrectly placed in the oesophagus, a potentially fatal situation. We think iTraXS is capable of improving the everyday experience of surgery for patients worldwide and will significantly reduce the suffering caused by VAP or PITS Within this project we will conduct the first clinical evaluation of this new technology with 40 adult participants undergoing elective surgery.