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Method, system and software for assessing extubation failure

A technology of esophageal pressure and objects, applied in the direction of application, medical science, diagnosis, etc., can solve problems such as complex treatment strategies or preventive strategies

Inactive Publication Date: 2017-05-10
CHILDRENS HOSPITAL OF LOS ANGELES
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  • Summary
  • Abstract
  • Description
  • Claims
  • Application Information

AI Technical Summary

Problems solved by technology

This complicates treatment or prevention strategies when there is no clear gold standard for diagnostic outcome

Method used

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  • Method, system and software for assessing extubation failure
  • Method, system and software for assessing extubation failure
  • Method, system and software for assessing extubation failure

Examples

Experimental program
Comparison scheme
Effect test

Embodiment 1

[0148] Embodiment 1: experimental method

[0149] Intervention trials in intubated and ventilated children admitted to pediatric or cardiothoracic intensive care units. If the child was between 37 weeks corrected gestational age and 18 years of age, was intubated continuously for at least 12 hours, and was scheduled to be extubated Monday through Friday from 7 a.m. to 5 p.m. and when the investigator was available, then including said child. Children were excluded if they had contraindications to receive esophageal catheters (high bleeding risk, esophageal abnormalities) or breath electroplethysmography bands (abdominal or chest wall defects).

[0150] research proposal

[0151] After consent was obtained, an age-appropriate esophageal balloon catheter (Carefusion, Avea SmartCath6, 7, or 8Fr) was placed through the nose into the lower third of the esophagus with pressure monitored by chest radiograph or during brief endotracheal tube occlusion Deflection determines catheter...

Embodiment 2

[0154] Example 2: Determination of results: upper airway blockage

[0155] Post-extubation UAO was assessed by examining calibrated respiratory electroplethysmography as a measure of flow combined with esophageal pressure versus the presence of inspiratory flow limitation. Inspiratory flow limitation is characterized by disproportionately high inspiratory effort relative to flow increase (negative esophageal pressure). RIP flow was calibrated under two conditions: spontaneously breathing on CPAP of 5 before extubation using an algorithm called quantitative diagnostic calibration, and as an isovolumetric maneuver during the NIF procedure prior to extubation (Sackner, 1989 #319). We previously showed that NIF calibration (equal volume conditions) is superior to QDC on CPAP, especially when UAO deteriorates. Therefore, NIF calibration of RIP using a combination of RIP and esophageal manometry was used for the primary outcome of inspiratory flow limitation. Flow limitation was g...

Embodiment 3

[0156] Example 3: Analysis

[0157] To assess whether an objective characterization of UAO severity correlates with clinical outcome, the area under the curve (AUC) of the subject operating characteristic (ROC) plot, measured 5 minutes after extubation, was assessed for outcomes of reintubation within 48 hours The UAO severity parameter.

[0158] To assess whether subject parameters differ from the clinical assessment of wheeze, we folded the Westley wheeze score for physicians, nurses, and respiratory therapists into very mild (wheeze without ), mild, moderate and severe categories. We report the predictive power of these scores for the outcome of reintubation at 5 minutes post-extubation, and describe interobserver variability between providers at the time of UAO at 5 minutes post-extubation versus 60 minutes post-extubation, and extubation Variability between clinical providers and objective assessment of UAO after 5 and 60 minutes (using flow-limited algorithm).

[0159...

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PUM

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Abstract

A method, system and software for monitoring a signal from a living subject to measure a function of the living subject. Specifically, a computer method, computer system and software for accurately calibrating respiratory inductance plethysmography and esophageal manometry signals to measure effort of breathing before and after extubation of a patient to provide an automated real-time interpretation for a clinician of whether or not the patient has upper airway obstruction, and severity of the same. The method, system and software can be adapted specifically for a child or infant.

Description

[0001] government rights [0002] This invention was made with Government support under Contract No. 1K23HL103785 awarded by the National Institutes of Health. The government has certain rights in this invention. technical field [0003] The present invention generally relates to methods, systems and software for monitoring signals from a living body in order to measure the functioning of the living body. In particular, the present invention relates, for example, to a computer method, computer system and software for accurately calibrating a respiratory induction plethysmography (RIP) signal in relation to an esophageal manometry signal Combined to identify inspiratory flow limitation and measure respiratory effort before and after patient extubation, to provide clinicians with an automated real-time interpretation of whether a child / infant has an upper airway obstruction and its severity. Background technique [0004] All publications herein are herein incorporated by ref...

Claims

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Application Information

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Patent Type & Authority Applications(China)
IPC IPC(8): A61B5/0402A61B5/091A61B5/1455
CPCA61B5/0205A61B5/0806A61B5/091G16H40/63Y02A90/10A61B5/037A61B5/0816A61B5/085A61B5/4233
Inventor 罗宾德·科赫曼尼鲁特格尔·弗林克克里斯托弗·JL·纽思
Owner CHILDRENS HOSPITAL OF LOS ANGELES
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