Optical confirmation and monitoring of endotracheal tube position in pediatric patients

气管插管（ETT）是一种重要的气道管理程序， 重症患者或从大手术中恢复的患者的肺部通气和气体交换 干预鉴于患者无法自主呼吸和呼吸， 对于使用ETT的患者，危及生命的事件是使该管移位或脱位， 通风不再可能。ETT错位的发生率在新生儿和年轻人中特别高 儿童由于其较短的气管。目前，还没有临床系统可以用来提供准确的 和实时信息，以照顾团队的适当位置的ETT和没有以前的出版物 该系统易于以高效和廉价的方式使用。目前的建议将使 开发一种新颖的、易于扩展的新设备的下一个逻辑步骤，该设备将允许护理团队 持续监测ETT位置，限制ETT移动或脱位引起的并发症， 通过在不中断治疗的情况下进行治疗，提高任何ETT患者的整体护理质量。 工作流程、高成本和/或现场需要额外的专业知识或人员。具体来说，我们建议发展 近红外光学传感器（Opt-ETT），用于无创和连续评估ETT位置。Opt-ETT 使用嵌入气管插管的侧射光纤进行气管照明，并使用带有五个光电探测器的贴纸 贴在皮肤上用于光线探测一旦导管被精确地放置在气管中，其位置将显示在 Opt-ETT的屏幕实时显示，如果试管移动超过预设值，则立即通知护理团队 极限将在离体猪气管上构建概念验证Opt-ETT系统并进行表征 组织，并将结果与目标1中的Monte Carlo模拟结果进行比较和校准。在目标2中， 将对仔猪进行体内研究，以检验我们的中心假设，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报警， 不同的胸壁厚度和气管深度。Opt-ETT可批量生产且具有成本效益，因此可以 广泛用于新生儿重症监护室和产房，特别是在胸部X光或 没有超声波检查。

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.