Ventilation monitoring
A ventilation monitoring system for assisting in proper placement of an endotracheal tube in a subject includes: a capnography sensor configured to be placed in fluid communication with the endotracheal tube and to provide information representative of the subject's breath; and a processor in communication with the capnography sensor. The processor is configured to provide an indication of proper endotracheal tube placement when (1) a first indication of the subject's breath and a positive result of a first auscultation are identified within a first predetermined time period, and (2) a second indication of the subject's breath and a positive result of a second auscultation are identified within a second predetermined time period. The first auscultation includes auscultation of a subject's left lung, right lung, left axillary region, right axillary region, or abdomen. The second auscultation includes auscultation of another region of the subject different from the first auscultation.
1 . A ventilation monitoring system, comprising:
at least one capnography sensor configured to provide information representative of a breath of a subject; and
a ventilation monitoring device comprising at least one processor in communication with the at least one capnography sensor, the at least one processor configured to:
prompt a user to execute ventilation monitor testing using the ventilation monitoring device to determine if an endotracheal tube positioned in a trachea of the subject has become dislodged;
during the ventilation monitor testing, within a first predetermined time period, cause the ventilation monitoring device to provide at least one prompt to the user to perform at least one first manual auscultation of at least one of a left lung, right lung, left axillary region, right axillary region, or abdomen of the subject, receive by a user interface of the ventilation monitoring device at least one indication of a positive result of the at least one first manual auscultation of at least one of the left lung, right lung, left axillary region, right axillary region, or abdomen of the subject, receive and process signals from the at least one capnography sensor obtained during the first predetermined time period, and analyze the received and processed signals to identify at least one breath by the subject occurring during the first predetermined time period;
during the ventilation monitor testing, within a second predetermined time period occurring after the first predetermined time period, cause the ventilation monitoring device to provide at least one prompt to the user to perform at least one second manual auscultation of another of the left lung, right lung, left axillary region, right axillary region, or abdomen of the subject, receive by the user interface of the ventilation monitoring device a positive result of the at least one second manual auscultation, receive and process signals from the at least one capnography sensor obtained during the second predetermined time period, and analyze the received and processed signals to identify at least one breath by the subject occurring during the second predetermined time period; and
provide an indication of a failure status of the ventilation monitor testing when the positive result of the at least one first manual auscultation is not received within the first predetermined time period, the at least one breath by the subject occurring during the first predetermined time period is not identified within the first predetermined time period, the positive result of the at least one second manual auscultation is not received within the second predetermined time period, or the at least one breath by the subject occurring during the second predetermined time period is not identified within the second predetermined time period.
2 . The ventilation monitoring system of claim 1 , wherein the at least one capnography sensor is configured to measure a concentration or partial pressure of carbon dioxide in respiratory gases of the subject.
3 . The ventilation monitoring system of claim 1 , wherein the at least one capnography sensor is configured to measure at least one of carbon dioxide (CO 2 ) concentration, end-tidal CO 2 , inspired CO 2 , or respiratory rate of the subject.
4 . The ventilation monitoring system of claim 1 , further comprising the endotracheal tube configured to be positioned in the subject's trachea, wherein the at least one capnography sensor is in fluid communication with the endotracheal tube.
5 . The ventilation monitoring system of claim 4 , further comprising a ventilation bag fluidly coupled to the endotracheal tube and to the at least one capnography sensor for providing air into lungs of the subject through the endotracheal tube.
6 . The ventilation monitoring system of claim 1 , further comprising at least one vibration sensor in communication with the at least one processor configured to detect movement of the at least one endotracheal tube, the at least one capnography sensor, or the subject.
7 . The ventilation monitoring system of claim 6 , wherein, in order to prompt the user to execute the ventilation monitor testing, the at least one processor is configured to:
receive and process signals from the at least one vibration sensor;
determine a value representative of movement of the endotracheal tube, the at least one capnography sensor, or the subject based on the received and processed signals from the at least one vibration sensor; and
generate the prompt to execute the ventilation monitor testing when the determined value representative of movement is greater than a predetermined threshold vibration value.
8 . The ventilation monitoring system of claim 6 , wherein the at least one vibration sensor comprises an accelerometer.
9 . The ventilation monitoring system of claim 1 , further comprising at least one transthoracic impedance sensor in communication with the at least one processor configured to measure a transthoracic impedance of the subject.
10 . The ventilation monitoring system of claim 9 , wherein the at least one processor is configured to: receive and process signals from the at least one transthoracic impedance sensor, and wherein the confirmation of the subject's breath occurring during the second predetermined time period of the ventilation monitor testing is based, at least in part, on the received and processed signals from the at least one transthoracic impedance sensor.
11 . The ventilation monitoring system of claim 10 , wherein the at least one processor is configured to provide the indication of the failure status of the ventilation monitor testing when all of the following conditions are satisfied: (i) the indication that the endotracheal tube remains positioned in the trachea of the subject is not received within the first predetermined time period, (ii) the confirmation of the subject's breath is not identified in the signals from the at least one capnography sensor within the second predetermined time period, and (iii) the confirmation of the subject's breath is not identified in the signals from the signals from the at least one transthoracic impedance sensor within the second predetermined time period.
12 . The ventilation monitoring system of claim 9 , wherein the at least one transthoracic impedance sensor comprises a first electrode configured to be positioned on a first side of a thoracic cavity of the subject and a second electrode configured to be positioned on a second opposing side of the thoracic cavity of the subject to measure the transthoracic impedance of the subject.
13 . The ventilation monitoring system of claim 1 , further comprising a display coupled with the at least one processor, wherein the prompt to execute the ventilation monitoring testing, the at least one prompt to perform the at least one first manual auscultation, and the at least one prompt to perform the at least one second manual auscultation comprise visual indication provided on the display.
14 . The ventilation monitoring system of claim 1 , wherein the first manual auscultation and the second manual auscultation are of at least one of the left lung, right lung, left axillary region, or right axillary region, and
wherein the at least one processor is further configured to during the ventilation monitor testing, within a third predetermined time period occurring after the second time period, cause the ventilation monitoring device to provide at least one prompt to the user to perform at least one third manual auscultation of the abdomen of the subject and receive by the user interface of the ventilation monitoring device a result of the at least one third manual auscultation.
15 . The ventilation monitoring system of claim 14 , wherein the at least one processor is configured to provide the indication of the failure status of ventilation monitor testing when the positive result of the at least one first manual auscultation is not received within the first time period, the at least one breath by the subject occurring during the first predetermined time period is not identified within the first predetermined time period, when the positive result of the at least one second manual auscultation is not received within the second time period, the at least one breath of the subject occurring during the second predetermined time period is not identified within the second predetermined time period, or when the received result of the at least one third manual auscultation indicates that breath sounds were detected in the abdomen.
16 . A method for monitoring placement of an endotracheal tube positioned in a trachea of a subject performed by at least one processor of a ventilation monitoring device, the method comprising:
prompting a user to execute ventilation monitor testing using the ventilation monitoring device to determine if the endotracheal tube positioned in the trachea of the subject has become dislodged;
during the ventilation monitor testing, within a first predetermined period of time, prompting the user to perform at least one first manual auscultation of at least one of a left lung, right lung, left axillary region, right axillary region, or abdomen of the subject, receiving by a user interface of the ventilation monitoring device at least one indication of a positive result of the at least one first manual auscultation of at least one of the left lung, right lung, left axillary region, right axillary region, or abdomen of the subject, receiving and processing signals representative of the breath of the subject from at least one capnography sensor in fluid communication with the endotracheal tube obtained during the first predetermined time period, and analyzing the received and processed signals to identify at least one breath by the subject occurring during the first predetermined time period;
during the ventilation monitor testing, within a second predetermined time period occurring after the first predetermined time period, prompting the user to perform at least one second manual auscultation of another of the left lung, right lung, left axillary region, right axillary region, or abdomen of the subject, receiving by the user interface of the ventilation monitoring device at least one indication of a positive result of the at least one second manual auscultation, receiving and processing signals from the at least one capnography sensor obtained during the second predetermined time period, and analyzing the received and processed signals to identify at least one breath by the subject occurring during the second predetermined time period; and
providing an indication of a failure status of the ventilation monitor testing when the positive result of the at least one first manual auscultation is not received within the first predetermined time period, the at least one breath by the subject occurring during the first predetermined time period is not identified during the first predetermined time period, the positive result of the at least one second manual auscultation is not received within the second predetermined time period, or the at least one breath by the subject occurring during the second predetermined time period is not identified during the second predetermined time period.
17 . The method of claim 16 , wherein the at least one first manual auscultation and the second at least one manual auscultation are of at least one of the left lung, right lung, left axillary region, or right axillary region, the method further comprising, during the ventilation monitor testing and within a third predetermined time period occurring after the second time period, prompting the user to perform at least one third manual auscultation of the abdomen of the subject and receiving by the user interface of the ventilation monitoring device a result of the at least one third manual auscultation.
18 . The method of claim 17 , wherein the indication of the failure status of the ventilation monitoring testing is provided when the positive result of the at least one first manual auscultation is not received within the first predetermined time period, the at least one breath by the subject occurring during the first predetermined time period is not identified within the first predetermined time period, the positive result of the at least one second manual auscultation is not received within the second time period, the at least one breath by the subject occurring during the first predetermined time period is not identified within the second predetermined time period, or the received result of the at least one third manual auscultation indicates that breath sounds were detected in the abdomen.