Optical confirmation and monitoring of endotracheal tube position in pediatric patients

气管内插管(ETT)是一种重要的呼吸道管理程序，以使适当的 危重病人或大手术后康复病人的肺通气量和气体交换 干预。鉴于患者无法自主呼吸和呼吸，最令人恐惧和 对于接受ETT的患者来说，危及生命的情况是将管子移位或移位，以便足够 通风不再可能。ETT错位的发生率在新生儿和青年中尤其高 儿童由于气管较短。目前，还没有临床系统可以用来提供准确的 并向关怀团队提供有关ETT的适当位置的实时信息，并且以前没有发布过 指一种易于以高效和廉价的方式使用的系统。目前的建议将使 开发一种新的、易于扩展的新设备的下一个合乎逻辑的步骤将使护理团队能够 持续监测ETT的位置，减少ETT移动或移位的并发症，并实质性地 通过允许在不中断的情况下进行ETT，提高对任何ETT患者的整体护理质量 工作流程、高成本和/或需要更多专业知识或现场人员。具体地说，我们建议开发 一种近红外光学传感器(OPT-ETT)，用于对ETT位置进行非侵入性和连续评估。OPT-ETT 使用嵌入ETT中的侧烧光纤用于气管照明和带有五个光电探测器的贴纸 贴在皮肤上以检测光线。一旦管子准确地放入气管，它的位置就会显示在 OPT-ETT的屏幕实时显示，如果管子移动超出了APRESET，护理团队会立即得到通知 限制。将构建一个概念验证的OPT-ETT系统，并在体外猪气管上对其进行表征 组织，结果将与目标1中的蒙特卡罗模拟结果进行比较和校准。在目标2中， 将对小猪进行活体研究，以验证我们的中心假设，即OPT-ETT将检测到位移 最大可达±20 mm，精度为±0.5 mm，该系统能够准确地产生报警 不同胸壁厚度和气管深度。OPT-ETT是可批量生产的，成本效益高，因此可以 广泛应用于新生儿重症监护病房和产房，特别是胸部X光或 无法进行超声波检查。

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.