Optical confirmation and monitoring of endotracheal tube position in pediatric patients

儿科患者气管插管位置的光学确认和监测

• 批准号: 10371200
• 负责人: JOSEPH E KERSCHNER
• 金额: $ 20.78万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10371200
• 关键词: Age; Anatomy; Animals; COVID-19; Caring; Cessation of life; Characteristics; Chest wall structure; Child; Childhood; Clinical; Critical Illness; Data; Delivery Rooms; Detection; Development; Devices; Endoscopes; Ensure; Family suidae; Fiber; Fiber Optics; Fright; Gases; Goals; Head; Human Resources; Impairment; Intensive Care Units; Interruption; Intratracheal Intubation; Intubation; Life; Light; Lighting; Lung; Manpower Need; Measurement; Measures; Mechanical Ventilators; Mechanical ventilation; Methods; Monitor; Monte Carlo Method; Morbidity - disease rate; Movement; Neonatal Intensive Care Units; Newborn Infant; Operative Surgical Procedures; Optics; Output; Patients; Pattern; Positioning Attribute; Procedures; Publications; Quality of Care; Radiation exposure; Rotation; Side; Signal Transduction; Site; Skin; Stress; System; Techniques; Technology; Testing; Thick; Thoracic Radiography; Time; Tissues; Trachea; Tube; Ultrasonography; Validation; Variant; aged; carina; clinical practice; cost; cost effective; detector; effectiveness testing; endotracheal; experimental study; improved; in vivo; in vivo Model; infectious disease treatment; light intensity; light transmission; mortality; novel; optical fiber; optical sensor; pediatric patients; prevent; sensor; usability; ventilation; vocal cord

Endotracheal tube (ETT) intubation is an important airway management procedure to enable appropriate ventilation and gas exchange in the lungs of critically ill patients or patients recovering from a major surgical intervention. Given that patients are not able to breathe and ventilate on their own, one of the most feared and life-threatening occurrences for apatient with an ETT is to have this tube displaced or dislodged so that adequate ventilation is no longer possible. The occurrenceof ETT misplacement is particularly high in newborns and young children due to their shorter trachea. Currently, there is no clinical system that can be utilized to provide accurate and real-time information to care teams about the appropriate position of the ETT and no previous publications of a system that is easily employed in an efficient and inexpensive manner. The current proposal will enable the next logical steps in the development of a novel, easily scalable, new device which will allow care teams to continuously monitor ETT position, limit complications from ETT movement or dislodgement, and substantively improve overall quality of care for any patient with an ETT by allowing this to occur without interruption to the workflow, high cost, and/or need of additional expertise or personnel on-site. Specifically, we propose to develop a near-infrared optical sensor (Opt-ETT) for noninvasive and continuous assessment of ETT position. Opt-ETT uses a side-firing optical fiber embedded in the ETT for tracheaillumination and a sticker with five photodetectors taped on the skin for light detection. Once the tube is precisely placed in the trachea, its position is displayed on the screen of the Opt-ETT in real-time and care teams are immediately notified if the tube moves beyond apreset limit. A proof-of-concept Opt-ETT system will be constructed and characterized on ex vivo porcine tracheal tissues, and the results will be compared and calibrated to that of Monte Carlo simulations in Aim 1. In Aim 2, in vivo studies with piglets will be conducted to test our central hypotheses that Opt-ETT will detect displacement up to ±20 mm with an accuracy of ±0.5 mm and this system is capable of accurately generating an alarm with different chest wall thickness and depth of the trachea. Opt-ETT is mass producible and cost effective, thus can be widely used in neonatal intensive care units and delivery rooms, particularly where a chest X-ray or ultrasonography is not available.

气管内管（ETT）插曲是一个重要的气道管理程序，可实现适当的 重症患者或从主要手术中康复的患者的肺部通风和气体交换 干涉。鉴于患者无法自行呼吸和通风，这是最假的， ETT的Apatient危及生命的发生是将此管移位或移位，以便足够 通风已不再可能。 ETT错位的发生在新生儿和年轻人中尤为高 孩子由于气管较短。当前，尚无临床系统可用来提供准确的 和实时信息来照顾团队有关ETT的适当位置，没有以前的出版物 以高效且廉价的方式容易使用的系统。当前的建议将使 开发小说，易于扩展的新设备的下一个逻辑步骤，这将使护理团队能够 连续监测ETT位置，限制ETT运动或披露的并发症，并实质上 通过允许这种情况发生而不会中断，以提​​高任何ETT患者的总体护理质量 工作流程，高成本和/或需要其他专业知识或现场人员。具体来说，我们建议开发 用于非侵入性和连续评估ETT位置的近红外光传感器（OPT-ETT）。 OPT-ETT 使用嵌入在ETT中的侧面发射光纤进行气管缩影，并带有五个光电视 贴在皮肤上以进行光检测。一旦管将管精确放在气管中，其位置就会显示在 如果管的移动超过Apreset，请立即在实时和护理团队中的Opt-ETT屏幕通知 限制。概念验证的OPT-ETT系统将在离体猪气管上构建和表征 组织，结果将与AIM 1中的Monte Carlo模拟进行比较和校准。在AIM 2中 将对小猪进行体内研究，以测试我们的中心假设，即Opt-ETT将检测到位移 高达±20 mm，精度为±0.5 mm，该系统能够准确地发出警报 不同的胸壁厚度和气管深度。 Opt-Ett是质量产生的，具有成本效益，因此可以 被广泛用于新生儿重症监护室和送货室，尤其是胸部X射线或 超声检查不可用。