Miniature acoustic guidance system for endotracheal tubes

Ensuring that the distal end of an endotracheal tube (ETT) is properly located within the trachea, and that the tube is not obstructed by mucus deposition, is a major clinical concern in patients that require mechanical ventilation. A novel acoustic system was developed to allow for the continuous monitoring of ETT position and patency. A miniature sound source and two sensing microphones are placed in-line between the ventilator hose and the proximal end of the ETT. Reflections of an acoustic pulse emitted into the ETT lumen and the airways are digitally analyzed to estimate the location and degree of lumen obstruction, as well as the position of the distal end of the tube in the airway. The system was evaluated through in vitro studies and in a rabbit model. The system noninvasively estimated tube position in vivo to within roughly 4.5 mm, and differentiated between proper tracheal, and erroneous bronchial or esophageal intubation in all cases. In addition, the system estimated the area and location of lumen obstructions in vitro to within 14% and 3.5 mm, respectively. These findings indicate that this miniature technology could improve the quality of care provided to the ventilated adult and infant.