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Bernasconi S, Angelucci A, De Cesari A, Masotti A, Pandocchi M, Vacca F, Zhao X, Paganelli C, Aliverti A. Recent Technologies for Transcutaneous Oxygen and Carbon Dioxide Monitoring. Diagnostics (Basel) 2024; 14:785. [PMID: 38667431 PMCID: PMC11049249 DOI: 10.3390/diagnostics14080785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/27/2024] [Accepted: 04/07/2024] [Indexed: 04/28/2024] Open
Abstract
The measurement of partial pressures of oxygen (O2) and carbon dioxide (CO2) is fundamental for evaluating a patient's conditions in clinical practice. There are many ways to retrieve O2/CO2 partial pressures and concentrations. Arterial blood gas (ABG) analysis is the gold standard technique for such a purpose, but it is invasive, intermittent, and potentially painful. Among all the alternative methods for gas monitoring, non-invasive transcutaneous O2 and CO2 monitoring has been emerging since the 1970s, being able to overcome the main drawbacks of ABG analysis. Clark and Severinghaus electrodes enabled the breakthrough for transcutaneous O2 and CO2 monitoring, respectively, and in the last twenty years, many innovations have been introduced as alternatives to overcome their limitations. This review reports the most recent solutions for transcutaneous O2 and CO2 monitoring, with a particular consideration for wearable measurement systems. Luminescence-based electronic paramagnetic resonance and photoacoustic sensors are investigated. Optical sensors appear to be the most promising, giving fast and accurate measurements without the need for frequent calibrations and being suitable for integration into wearable measurement systems.
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Persson A, Seton R. Modeling and Evaluation of a Rate-Based Transcutaneous Blood Gas Monitor. IEEE Trans Biomed Eng 2023; 70:3178-3186. [PMID: 37224374 DOI: 10.1109/tbme.2023.3279514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE Current methods for transcutaneous blood gas monitoring (TBM) - a common health monitoring method in neonatal care - comes with a suite of challenges like limited attachment opportunities, and risks of infections from burning and tearing of the skin, which limits its use. This study presents a novel system and method for rate-based transcutaneous CO2 measurements with a soft, unheated skin-interface that can address many of these problems. Additionally, a theoretical model for the gas transport from the blood to the system's sensor is derived. METHODS By simulating CO2 advection and diffusion through the cutaneous microvasculature and epidermis to the system's skin interface, the effect of a wide range of physiological properties on the measurement has been modeled. Following these simulations, a theoretical model for the relationship between the measured CO2 concentration and that in the blood was derived and compared to empirical data. RESULTS Applying the model on measured blood gas levels, even when the theory was based solely on the simulations, produced blood CO2 concentrations within ∼35% of empirical measurements from a state-of-the-art device. Further calibration of the framework, also using the empirical data, yielded an output with a Pearson correlation of 0.84 between the two methods. CONCLUSION Compared to the state-of-the-art device the proposed system measured the partial CO2 pressure in the blood with an average deviation of 0.04 kPa and 1.97σ of ±1.1 kPa. However, the model indicated that this performance could be hampered by different skin properties. SIGNIFICANCE Given its soft and gentle skin interface and lack of heating, the proposed system could significantly decrease health risks like, burns, tears, and pain, currently associated with TBM on premature neonates.
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Tufan TB, Guler U. A Transcutaneous Carbon Dioxide Monitor Based on Time-Domain Dual Lifetime Referencing. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2023; 17:795-807. [PMID: 37195846 DOI: 10.1109/tbcas.2023.3277398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
The partial pressure of arterial carbon dioxide plays a critical role in assessing the acid-base and respiratory status of the human body. Typically, this measurement is invasive and can only be taken momentarily when an arterial blood sample is drawn. Transcutaneous monitoring is a noninvasive surrogate method that provides a continuous measure of arterial carbon dioxide. Unfortunately, current technology is limited to bedside instruments mainly used in intensive care units. We developed a first-of-its-kind miniaturized transcutaneous carbon dioxide monitor that utilizes a luminescence sensing film and a time-domain dual lifetime referencing method. Gas cell experiments confirmed the monitor's ability to accurately identify changes in the partial pressure of carbon dioxide within the clinically significant range. Compared to the luminescence intensity-based technique, the time-domain dual lifetime referencing method is less prone to measurement errors caused by changes in excitation strength, reducing the maximum error from ∼ 40% to ∼ 3% and resulting in more reliable readings. Additionally, we analyzed the sensing film by investigating its behavior under various confounding factors and its susceptibility to measurement drift. Finally, a human subject test demonstrated the effectiveness of the applied method in detecting even slight changes in transcutaneous carbon dioxide, as small as ∼ 0.7%, during hyperventilation. The prototype, which consumes 30.1 mW of power, is a wearable wristband with compact dimensions of 37 mm× 32 mm.
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Schweizer T, Hartwich V, Riva T, Kaiser H, Theiler L, Greif R, Nabecker S. Limitations of transcutaneous carbon dioxide monitoring in apneic oxygenation. PLoS One 2023; 18:e0286038. [PMID: 37262066 DOI: 10.1371/journal.pone.0286038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/24/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND High-flow nasal oxygenation is increasingly used during sedation procedures and general anesthesia in apneic patients. Transcutaneous CO2 (ptcCO2)-monitoring is used to monitor hypercapnia. This study investigated ptcCO2-monitoring during apneic oxygenation. METHODS We included 100 patients scheduled for elective surgery under general anesthesia in this secondary analysis of a randomized controlled trial. Before surgery, we collected ptcCO2 measured by TCM4 and TCM5 monitors and arterial blood gas (ABG) measurements every two minutes during 15 minutes of apnea. Bland-Altman plots analyzed agreement between measurement slopes; linear mixed models estimated the different measuring method effect, and outlined differences in slope and offset between transcutaneous and arterial CO2 partial pressures. RESULTS Bland-Altman plots showed a bias in slope (95% confidence intervals) between ABG and TCM4-measurements of 0.05mmHg/min (-0.05 to 0.15), and limits of agreement were -0.88mmHg/min (-1.06 to -0.70) and 0.98mmHg/min (0.81 to 1.16). Bias between ABG and TCM5 was -0.14mmHg/min (-0.23 to -0.04), and limits of agreement were -0.98mmHg/min (-1.14 to -0.83) and 0.71mmHg/min (0.55 to 0.87). A linear mixed model (predicting the CO2-values) showed an offset between arterial and transcutaneous measurements of TCM4 (-15.2mmHg, 95%CI: -16.3 to -14.2) and TCM5 (-19.1mmHg, -20.1 to -18.0). Differences between the two transcutaneous measurements were statistically significant. CONCLUSIONS Substantial differences were found between the two transcutaneous measurement systems, and between them and ABG. Transcutaneous CO2 monitoring cannot replace arterial CO2-monitoring during apneic oxygenation. In clinical settings with rapidly changing CO2-values, arterial blood gas measurements are needed to reliably assess the CO2-partial pressure in blood. TRIAL REGISTRATION ClinicalTrials.gov (NCT03478774).
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Affiliation(s)
- Thilo Schweizer
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Thomas Riva
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Unit for Research and Innovation, Department of Paediatric Anaesthesia, Istituto Giannina Gaslini, Genova, Italy
| | - Heiko Kaiser
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Centre for Anaesthesiology and Intensive Care Medicine, Hirslanden Klinik Aarau, Hirslanden Group, Aarau, Switzerland
| | - Lorenz Theiler
- Department of Anesthesiology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Robert Greif
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
| | - Sabine Nabecker
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Anesthesiology and Pain Management, Sinai Health System, University of Toronto, Toronto, Canada
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Tipparaju VV, Mora SJ, Yu J, Tsow F, Xian X. Wearable Transcutaneous CO 2 Monitor Based on Miniaturized Nondispersive Infrared Sensor. IEEE SENSORS JOURNAL 2021; 21:17327-17334. [PMID: 34744520 PMCID: PMC8570579 DOI: 10.1109/jsen.2021.3081696] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Transcutaneous oxygen and carbon dioxide provide the status of pulmonary gas exchange and are of importance in diagnosis and management of respiratory diseases. Though significant progress has been made in oximetry, not much has been explored in developing wearable technologies for continuous monitoring of transcutaneous carbon dioxide. This research reports the development of a truly wearable sensor for continuous monitoring of transcutaneous carbon dioxide using miniaturized nondispersive infrared sensor augmented by hydrophobic membrane to address the humidity interference. The wearable transcutaneous CO2 monitor shows well-behaved response curve to humid CO2 with linear response to CO2 concentration. The profile of transcutaneous CO2 monitored by the wearable device correlates well with the end-tidal CO2 trend in human test. The feasibility of the wearable device for passive and unobstructed tracking of transcutaneous CO2 in free-living conditions has also been demonstrated in field test. The wearable transcutaneous CO2 monitoring technology developed in this research can be widely used in remote assessment of pulmonary gas exchange efficiency for patients with respiratory diseases, such as COVID-19, sleep apnea, and chronic obstructive pulmonary disease (COPD).
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Barneck M, Papa L, Cozart A, Lentine K, Ladde J, Nguyen L, Mayfield J, Thundiyil J. The utility of transcutaneous carbon dioxide measurements in the emergency department: A prospective cohort study. J Am Coll Emerg Physicians Open 2021; 2:e12513. [PMID: 34296208 PMCID: PMC8286116 DOI: 10.1002/emp2.12513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/23/2021] [Accepted: 06/25/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Rapid identification of patients with occult injury and illness in the emergency department can be difficult. Transcutaneous carbon dioxide (TCO2) and oxygen (TO2) measurements may be non-invasive surrogate markers for the identification of such patients. OBJECTIVES To determine if TCO2 or TO2 are useful adjuncts for identifying severe illness and the correlation between TCO2, lactate, and end tidal carbon dioxide (ETCO2). METHODS Prospective TCO2 and TO2 measurements at a tertiary level 1 trauma center were obtained using a transcutaneous sensor on 300 adult patients. Severe illness was defined as death, intensive care unit (ICU) admission, bilevel positive airway pressure, vasopressor use, or length of stay >2 days. TCO2 and TO2 were compared to illness severity using t tests and correlation coefficients. RESULTS Mean TO2 did not differ between severe illness (58.9, 95% CI 54.9-62.9) and non-severe illness (58.0, 95% CI 54.7-61.1). Mean TCO2 was similar between severe (34.6, 95% CI 33-36.2) vs non-severe illness (35.9, 95% CI 34.7-37.1). TCO2 was 28.7 (95% CI 24.0-33.4) for ICU vs. 35.9 (95% CI 34.9-36.9) for non-ICU patients. The mean TCO2 in those with lactate > 2.0 was 29.8 (95% CI 25.8-33.8) compared with 35.7 (95% CI 34.9-36.9) for lactate < 2.0. TCO2 was not correlated with ETCO2 (r = 0.32, 95% CI 0.22-0.42). CONCLUSION TCO2 could be a useful adjunct for identifying significant injury and illness and patient outcomes in an emergency department (ED) population. TO2 did not predict severe illness. TCO2 and ETCO2 are only moderately correlated, indicating that they are not equivalent and may be useful under different circumstances.
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Affiliation(s)
| | - Linda Papa
- Department of Emergency MedicineOrlando HealthOrlandoFloridaUSA
| | - Ashley Cozart
- College of MedicineUniversity of Central FloridaOrlandoFloridaUSA
| | - Kain Lentine
- College of MedicineUniversity of Central FloridaOrlandoFloridaUSA
| | - Jay Ladde
- Department of Emergency MedicineOrlando HealthOrlandoFloridaUSA
| | - Linh Nguyen
- College of MedicineFlorida State UniversityTallahasseeFloridaUSA
| | - Jeremy Mayfield
- College of MedicineUniversity of Central FloridaOrlandoFloridaUSA
| | - Josef Thundiyil
- Department of Emergency MedicineOrlando HealthOrlandoFloridaUSA
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Toussaint M, Buggenhoudt L, Pelc K. Nocturnal Transcutaneous Blood Gas Measurements in a Pediatric Neurologic Population: A Quality Assessment. Dev Neurorehabil 2021; 24:303-310. [PMID: 33423573 DOI: 10.1080/17518423.2020.1869336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: To assess the quality of SpO2 and PCO2 recordings via transcutaneous monitoring in children with neurological conditions.Methods: Overnight transcutaneous SpO2 and PCO2 were analyzed. The presence of drift and drift correction was noted, and the rate of disrupted recordings scored (0: absence, 1; presence). The quality of recordings was also scored (0, 1, 2 for poor, medium, and high).Results: A total of 228 recordings from 64 children aged 9.7 ± 6 years were analyzed of which 42 used positive pressure respiratory support. The mean quality of the recordings was scored as 1.27 (0-2). PCO2 drift, drift correction, and disrupted recordings were present in 25%, 58%, and 26% of recordings, respectively. Satisfactory clinical decisions were taken in 91% of cases.Conclusion: The quality of transcutaneous sensor recordings was acceptable and clinical findings were deemed as satisfactory in the large majority of cases. Correction of PCO2 drift was challenging.
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Affiliation(s)
| | | | - Karine Pelc
- Rehabilitation Hospital Inkendaal, Vlezenbeek, Belgium
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Costanzo I, Sen D, Adegite J, Rao PM, Guler U. A Noninvasive Miniaturized Transcutaneous Oxygen Monitor. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2021; 15:474-485. [PMID: 34232891 DOI: 10.1109/tbcas.2021.3094931] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Transcutaneous monitoring is a noninvasive method to continuously measure the partial pressures of oxygen and carbon dioxide that diffuse through the skin and correlate closely with changes in blood gases. However, the contemporary commercially available electrochemical-based technology requires a heating mechanism and a bulky, corded, and expensive sensing unit. This study aims to demonstrate a prototype noninvasive, miniaturized monitor that uses luminescence-based technology to measure the partial pressure of transcutaneous oxygen, a surrogate of the partial pressure of arterial oxygen. To be able to build a robust measurement system, we conducted experiments to understand the temperature and humidity dependence of oxygen-sensitive platinum-porphyrin films. We performed a detailed analysis of both intensity and lifetime measurement techniques. To verify the performance, we tested the prototype in a small ex-vivo experiment involving three healthy human volunteers. We measured variations in the partial pressure of transcutaneous oxygen values due to pressure-induced arterial and venous occlusions on the volunteers' fingertips. The system resolves changes in the partial pressure of oxygen from 0 to 418 mmHg in the lab bench-top testing, covering the medically relevant range of 50-150 mmHg. Under fixed humidity, temperature, and the partial pressure of oxygen conditions, the sensor shows a 2% drift over 60 hours. The prototype consumes 9 mW of power from a 2.2 V external DC power supply.
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De Braekeleer K, Toussaint M. Transcutaneous Carbon Dioxide Measurement in Adult Patients with Neuromuscular Disorders: A quality Level Assessment. J Neuromuscul Dis 2021; 8:305-313. [DOI: 10.3233/jnd-200516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Carbon dioxide tension (PCO2) monitoring during sleep, is crucial to identify respiratory failure in patients with neuromuscular disorders (NMD). Transcutaneous PCO2 monitoring is an available technique to measure PCO2. Objectives: To assess the quality level of transcutaneous blood gas measurements via SenTec monitor. Methods: A 12-month analysis of SenTec measurements was conducted in a Belgian Centre for Home Mechanical Ventilation (HMV). Over two consecutive nights; SpO2 and PCO2 measurements, the presence of PCO2 drift and drift correction with SenTec, were reviewed and scores (0, 1, 2 for poor, medium and high level) were assigned to estimate the quality of measurements. Results: Sixty-nine NMD patients met the inclusion criteria, of which 48/69 used HMV. PCO2 drift and drift correction were present in 15% and 68% of the 138 recordings, respectively. The quality level of measurements throughout night 1, scored 1.55 (0–2). The relevance of our clinical findings from SenTec scoring 1.94 (1–2); was considered highly satisfactory. HMV was ineffective in 24/48 patients. Among 12 patients with hypercapnia, 8 patients improved PCO2 between night 1 and 2. Among 12 patients with hypocapnia, PCO2 improved in 4/12 patients, who reached the range of normal PCO2 (35–47 mmHg). Conclusions: The quality of SenTec measurements was acceptable in the majority of recordings and clinical findings were deemed satisfactory in all cases. A single SenTec measurement was sufficient to determine the need for NIV. However, two SenTec registrations were insufficient to both improve NIV effectiveness in 50% of cases, and, to ensure follow-up of our interventions.
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Affiliation(s)
- Katrien De Braekeleer
- Centre for Home Mechanical Ventilation and Neuromuscular Disorders, Department of Rehabilitation, Rehabilitation Hospital Inkendaal, Vlezenbeek, Belgium
| | - Michel Toussaint
- Centre for Home Mechanical Ventilation and Neuromuscular Disorders, Department of Rehabilitation, Rehabilitation Hospital Inkendaal, Vlezenbeek, Belgium
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Sur A, Paria A. Histogram analysis for bedside respiratory monitoring in not critically ill preterm neonates: a proposal for a new way to look at the monitoring data. Eur J Pediatr 2021; 180:283-289. [PMID: 32638099 PMCID: PMC7340773 DOI: 10.1007/s00431-020-03732-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/22/2020] [Accepted: 07/03/2020] [Indexed: 12/17/2022]
Abstract
Despite robust evidence in favour of maintaining optimal oxygen saturation targets in the preterm infants, the titration of oxygen is largely dependent on manual observations and transcription. Similarly, notwithstanding the gaining popularity of non-invasive modalities like high-flow nasal therapy, the practices of weaning and escalating support are largely individualized and based on point of care observations. These are often erroneous and lack objectivity. Histogram analysis from patient monitors is an easy and objective way of quantifying vital parameters and their trends. We review the technology and evidence available behind this practice.Conclusions: Though there are no randomized controlled trials on this practice solely, we identify several quality improvement studies implementing this into practice with benefit. We also cite studies which have implemented histogram analysis in methodology, thus concluding that this is a useful clinical tool worth incorporating into clinical practice to reduce manual errors and bring more objectivity into decisions. What is Known: • The data from NeOProM (Neonatal Oxygenation Prospective Meta-analysis Collaboration study protocol) indicates that optimal saturation targets for preterm infants born < 28 weeks should be between 91 and 95%. • The most "failsafe" way of maintaining strict compliance to these limits is automated oxygen titration but this is not widely used or available and manual transcription and monitoring are susceptible to error and fatigue. What is New: • Histogram analysis from patient monitors can provide intelligent data on respiratory monitoring and can be incorporated into algorithm to decide on weaning or escalation of respiratory support. • With appropriate training, histogram monitoring by nursing staff can limit fatigue of manual recording of data.
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Affiliation(s)
- Amitava Sur
- Department of Neonatology, Lancashire Women and Newborn Centre, East Lancashire Hospital NHS Trust, Casterton Avenue, Burnley, BB10 2PQ, United Kingdom.
| | - Anshuman Paria
- Department of Neonatology, Lancashire Women and Newborn Centre, East Lancashire Hospital NHS Trust, Casterton Avenue, Burnley, BB10 2PQ United Kingdom
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Koenig A, Petitdidier N, Grateau H, Characoun S, Ghaith A, Verges S, Doutreleau S, Gharbi S, Gerbelot R, Gioux S, Dinten JM. Contact, high-resolution spatial diffuse reflectance imaging system for skin condition diagnosis: a first-in-human clinical trial. JOURNAL OF BIOMEDICAL OPTICS 2021; 26:JBO-200286R. [PMID: 33515218 PMCID: PMC7846121 DOI: 10.1117/1.jbo.26.1.012706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/15/2020] [Indexed: 06/12/2023]
Abstract
SIGNIFICANCE Oxygenation is one of the skin tissue physiological properties to follow for patient care management. Furthermore, long-term monitoring of such parameters is needed at the patient bed as well as outside the hospital. Diffuse reflectance spectroscopy has been widely used for this purpose. AIM The aim of the study is to propose a low-cost system for the long-term measurement of skin physiological parameters in contact. APPROACH We have developed a low-cost, wearable, CMOS-based device. We propose an original method for processing diffuse reflectance data to calculate the tissue oxygen saturation (StO2). RESULTS We tested the device for the assessment of tissue oxygenation during a first-in-human clinical trial that took place at the Grenoble University Hospital France. CONCLUSIONS The results of this clinical trial show a good accordance between our sensor and commercial devices used a reference.
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Affiliation(s)
- Anne Koenig
- Université Grenoble Alpes, France—CEA, LETI, MINATEC Campus, Grenoble, France
| | - Nils Petitdidier
- Université Grenoble Alpes, France—CEA, LETI, MINATEC Campus, Grenoble, France
- Université de Strasbourg, Strasbourg, France
| | - Henri Grateau
- Université Grenoble Alpes, France—CEA, LETI, MINATEC Campus, Grenoble, France
| | - Samarmar Characoun
- Université Grenoble Alpes, CHU Grenoble Alpes, INSERM, Hôpital Sud, Laboratoire HP2 (U 1042), Avenue Kimberley, Echirolles, France
| | - Abdallah Ghaith
- Université Grenoble Alpes, CHU Grenoble Alpes, INSERM, Hôpital Sud, Laboratoire HP2 (U 1042), Avenue Kimberley, Echirolles, France
| | - Samuel Verges
- Université Grenoble Alpes, CHU Grenoble Alpes, INSERM, Hôpital Sud, Laboratoire HP2 (U 1042), Avenue Kimberley, Echirolles, France
| | - Stéphane Doutreleau
- Université Grenoble Alpes, CHU Grenoble Alpes, INSERM, Hôpital Sud, Laboratoire HP2 (U 1042), Avenue Kimberley, Echirolles, France
| | - Sadok Gharbi
- Université Grenoble Alpes, France—CEA, LETI, MINATEC Campus, Grenoble, France
| | - Rémi Gerbelot
- Université Grenoble Alpes, France—CEA, LETI, MINATEC Campus, Grenoble, France
| | - Sylvain Gioux
- Université de Strasbourg, Strasbourg, France
- Télécom Physique Strasbourg, Laboratoire ICube, Illkirch, France
| | - Jean-Marc Dinten
- Université Grenoble Alpes, France—CEA, LETI, MINATEC Campus, Grenoble, France
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Cascales JP, Roussakis E, Witthauer L, Goss A, Li X, Chen Y, Marks HL, Evans CL. Wearable device for remote monitoring of transcutaneous tissue oxygenation. BIOMEDICAL OPTICS EXPRESS 2020; 11:6989-7002. [PMID: 33408975 PMCID: PMC7747925 DOI: 10.1364/boe.408850] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 06/12/2023]
Abstract
Wearable devices have found widespread applications in recent years as both medical devices as well as consumer electronics for sports and health tracking. A metric of health that is often overlooked in currently available technology is the direct measurement of molecular oxygen in living tissue, a key component in cellular energy production. Here, we report on the development of a wireless wearable prototype for transcutaneous oxygenation monitoring based on quantifying the oxygen-dependent phosphorescence of a metalloporphyrin embedded within a highly breathable oxygen sensing film. The device is completely self-contained, weighs under 30 grams, performs on-board signal analysis, and can communicate with computers or smartphones. The wearable measures tissue oxygenation at the skin surface by detecting the lifetime and intensity of phosphorescence, which undergoes quenching in the presence of oxygen. As well as being insensitive to motion artifacts, it offers robust and reliable measurements even in variable atmospheric conditions related to temperature and humidity. Preliminary in vivo testing in a porcine ischemia model shows that the wearable is highly sensitive to changes in tissue oxygenation in the physiological range upon inducing a decrease in limb perfusion.
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Costanzo I, Sen D, Rhein L, Guler U. Respiratory Monitoring: Current State of the Art and Future Roads. IEEE Rev Biomed Eng 2020; 15:103-121. [PMID: 33156794 DOI: 10.1109/rbme.2020.3036330] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In this article, we present current methodologies, available technologies, and demands for monitoring various respiratory parameters. We discuss the importance of noninvasive techniques for remote and continuous monitoring and challenges involved in the current "smart and connected health" era. We conducted an extensive literature review on the medical significance of monitoring respiratory vital parameters, along with the current methods and solutions with their respective advantages and disadvantages. We discuss the challenges of developing a noninvasive, wearable, wireless system that continuously monitors respiration parameters and opportunities in the field and then determines the requirements of a state-of-the-art system. Noninvasive techniques provide a significant amount of medical information for a continuous patient monitoring system. Contact methods offer more advantages than non-contact methods; however, reducing the size and power of contact methods is critical for enabling a wearable, wireless medical monitoring system. Continuous and accurate remote monitoring, along with other physiological data, can help caregivers improve the quality of care and allow patients greater freedom outside the hospital. Such monitoring systems could lead to highly tailored treatment plans, shorten patient stays at medical facilities, and reduce the cost of treatment.
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Abstract
PURPOSE OF REVIEW The last decades, anesthesia has become safer, partly due to developments in monitoring. Advanced monitoring of children under anesthesia is challenging, due to lack of evidence, validity and size constraints. Most measured parameters are proxies for end organ function, in which an anesthesiologist is actually interested. Ideally, monitoring should be continuous, noninvasive and accurate. This present review summarizes the current literature on noninvasive monitoring in noncardiac pediatric anesthesia. RECENT FINDINGS For cardiac output (CO) monitoring, bolus thermodilution is still considered the gold standard. New noninvasive techniques based on bioimpedance and pulse contour analysis are promising, but require more refining in accuracy of CO values in children. Near-infrared spectroscopy is most commonly used in cardiac surgery despite there being no consensus on safety margins. Its place in noncardiac anesthesia has yet to be determined. Transcutaneous measurements of blood gases are used mainly in the neonatal intensive care unit, and is finding its way to the pediatric operation theatre. Especially CO2 measurements are accurate and useful. SUMMARY New techniques are available to assess a child's hemodynamic and respiratory status while under anesthesia. These new monitors can be used as complementary tools together with standard monitoring in children, to further improve perioperative safety.
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D'Souza B, Norman M, Sullivan CE, Waters KA. TcCO 2 changes correlate with partial obstruction in children suspected of sleep disordered breathing. Pediatr Pulmonol 2020; 55:2773-2781. [PMID: 32687262 DOI: 10.1002/ppul.24966] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Pediatric sleep disordered breathing (SDB) is characterized by long periods of partial upper airway obstruction (UAO) with low apnea-hypopnea indices (AHI). By measuring snoring and stertor, Sonomat studies allow quantification of these periods of partial UAO. AIM To determine whether transcutaneous CO2 (TcCO2 ) levels correlate with increasing levels of partial UAO and to examine patterns of ΔTcCo2 in the transitions from (a) wakefulness to sleep and (b) non-rapid eye movement (NREM) to rapid eye movement (REM) sleep. METHODS This was a retrospective review of sleep studies in seven asymptomatic controls aged 7 to 12 years and 62 symptomatic children with suspected SDB and no comorbidities, aged 2 to 13 years. Both groups underwent overnight polysomnography, including continuous TcCO2 , at one of two pediatric hospitals in Sydney. Changes in carbon dioxide levels between wake to NREM (sleep onset) and NREM to REM sleep were evaluated using an all-night TcCO2 trace time-linked to a hypnogram. Paired Sonomat recordings were used to quantify periods of UAO in the symptomatic group. RESULTS The ΔTcCO2 at sleep onset was greater in SDB children than controls and ΔTcCO2 with sleep onset correlated with the duration of partial obstruction (r = .60; P < .0001). Children with an increase in TcCO2 from NREM to REM had a higher number of snoring and stertor events compared to those in whom TcCO2 decreased from NREM to REM (91 vs 30 events/h; P = < .0001). CONCLUSIONS In children without comorbidities, the measurement of TcCO2 during sleep correlates with indicators of partial obstruction.
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Affiliation(s)
- Bebe D'Souza
- Professor Discipline of Child and Adolescent Health, The Children's Hospital at Westmead, The University of Sydney, Sydney, New South Wales, Australia
| | - Mark Norman
- Professor Discipline of Child and Adolescent Health, The Children's Hospital at Westmead, The University of Sydney, Sydney, New South Wales, Australia
| | - Colin E Sullivan
- Professor Discipline of Child and Adolescent Health, The Children's Hospital at Westmead, The University of Sydney, Sydney, New South Wales, Australia
| | - Karen A Waters
- Professor Discipline of Child and Adolescent Health, The Children's Hospital at Westmead, The University of Sydney, Sydney, New South Wales, Australia
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van Weteringen W, van Essen T, Gangaram-Panday NH, Goos TG, de Jonge RCJ, Reiss IKM. Validation of a New Transcutaneous tcPO2/tcPCO2 Sensor with an Optical Oxygen Measurement in Preterm Neonates. Neonatology 2020; 117:628-636. [PMID: 32998134 DOI: 10.1159/000510659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/20/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Traditional transcutaneous oxygen (tcPO2) measurements are affected by measurement drift, limiting accuracy and usability. The new potentially drift-free oxygen fluorescence quenching technique has been combined in a single sensor with conventional transcutaneous carbon dioxide (tcPCO2) monitoring. This study aimed to validate optical tcPO2 and conventional tcPCO2 against arterial blood gas samples in preterm neonates and determine measurement drift. METHODS In this prospective observational study, during regular care, transcutaneous measurements were paired to arterial blood gases from preterm neonates aged 24-31 weeks of gestational age (GA) with an arterial catheter. Samples were included based on stability criteria and stratified for sepsis status. Agreement was assessed using the Bland-Altman analysis. Measurement drift per hour was calculated. RESULTS Sixty-eight premature neonates were included {median (interquartile range [IQR]) GA of 26 4/7 [25 3/7-27 5/7] weeks}, resulting in 216 stable paired samples. Agreement of stable samples in neonates without sepsis (n = 38) and with suspected sepsis (n = 112) was acceptable for tcPO2 and good for tcPCO2. However, in stable samples of neonates with sepsis (n = 66), tcPO2 agreement (bias and 95% limits of agreement) was -32.6 (-97.0 to 31.8) mm Hg and tcPCO2 agreement was 4.2 (-10.5 to 18.9) mm Hg. The median (IQR) absolute drift values were 0.058 (0.0231-0.1013) mm Hg/h for tcPO2 and 0.30 (0.11-0.64) mm Hg/h for tcPCO2. CONCLUSION The accuracy of optical tcPO2 in premature neonates was acceptable without sepsis, while electrochemically measured tcPCO2 remained accurate under all circumstances. Measurement drift was negligible for tcPO2 and highly acceptable for tcPCO2.
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Affiliation(s)
- Willem van Weteringen
- Department of Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands, .,Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands,
| | - Tanja van Essen
- Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Norani H Gangaram-Panday
- Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tom G Goos
- Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Biomechanical Engineering, Faculty of Mechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Rogier C J de Jonge
- Pediatric Intensive Care Unit, Departments of Pediatrics and Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Irwin K M Reiss
- Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
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