This paper is concerned with the mathematical modeling and detection of endotracheal (ET) intubation in children under general anesthesia during surgery. In major pediatric surgeries, the airway is often secured with an endotracheal tube (ETT) followed by initiation of mechanical ventilation. Clinicians utilize auscultation of breath sounds and capnography to verify correct ETT placement. However, anesthesia providers often delay timely charting of ET intubation. This latency in event documentation results in decreased efficacy of clinical decision support systems. In order to target this problem, we collected real inpatient data and designed an algorithm to accurately detect the intubation time within the clinically valid range; the results show that we are able to achieve high accuracy in more than 96% of the cases. Automatic detection of ET intubation time would thus enhance better real-time data capture to support future improvement in clinical decision support systems.
Issue Section:
Research Papers
References
1.
Das
, S. K.
, Choupoo
, N. S.
, Haldar
, R.
, and Lahkar
, A.
, 2015
, “Transtracheal Ultrasound for Verification of Endotracheal Tube Placement: A Systematic Review and Meta-Analysis
,” Can. J. Anesth.
, 62
(4
), pp. 413
–423
.2.
Schmolzer
, G. M.
, O'Reilly
, M.
, Davis
, P. G.
, Cheung
, P.-Y.
, and Roehr
, C. C.
, 2013
, “Confirmation of Correct Tracheal Tube Placement in Newborn Infants
,” Resuscitation
, 84
(6
), pp. 731
–737
.3.
Tehrani
, F.
, Rogers
, M.
, Lo
, T.
, Malinowski
, T.
, Afuwape
, S.
, Lum
, M.
, Grundl
, B.
, and Terry
, M.
, 2004
, “A Dual Closed-Loop Control System for Mechanical Ventilation
,” J. Clin. Monit. Comput.
, 18
(2
), pp. 111
–129
.4.
Corno
, C.
, Fiore
, G. B.
, and Costantino
, M. L.
, 2004
, “A Mathematical Model of Neonatal Tidal Liquid Ventilation Integrating Airway Mechanics and Gas Transfer Phenomena
,” IEEE Trans. Biomed. Eng.
, 51
(4
), pp. 604
–611
.5.
Robert
, R.
, Micheau
, P.
, Avoine
, O.
, Beaudry
, B.
, Beaulieu
, A.
, and Walti
, H.
, 2010
, “A Regulator for Pressure-Controlled Total-Liquid Ventilation
,” IEEE Trans. Biomed. Eng.
, 57
(9
), pp. 2267
–2276
.6.
Ionescu
, C. M.
, Segers
, P.
, and De Keyser
, R.
, 2009
, “Mechanical Properties of the Respiratory System Derived From Morphologic Insight
,” IEEE Trans. Biomed. Eng.
, 56
(4
), pp. 949
–959
.7.
Lange
, M.
, Jonat
, S.
, and Nikischin
, W.
, 2002
, “Detection and Correction of Endotracheal-Tube Position in Premature Neonates
,” Pediatr. Pulmonol.
, 34
(6
), pp. 455
–461
.8.
Falck
, A. J.
, Escobedo
, M. B.
, Baillargeon
, J. G.
, Villard
, L. G.
, and Gunkel
, J. H.
, 2003
, “Proficiency of Pediatric Residents in Performing Neonatal Endotracheal Intubation
,” Pediatrics
, 112
(6 Pt. 1
), pp. 1242
–1247
.9.
Bismilla
, Z.
, Finan
, E.
, McNamara
, P. J.
, LeBlanc
, V.
, Jefferies
, A.
, and Whyte
, H.
, 2010
, “Failure of Pediatric and Neonatal Trainees to Meet Canadian Neonatal Resuscitation Program Standards for Neonatal Intubation
,” J. Perinatol.
, 30
(3
), pp. 182
–187
.10.
Roberts
, W. A.
, Maniscalco
, W. M.
, Cohen
, A. R.
, Litman
, R. S.
, and Chhibber
, A.
, 1995
, “The Use of Capnography for Recognition of Esophageal Intubation in the Neonatal Intensive Care Unit
,” Pediatr. Pulmonol.
, 19
(5
), pp. 262
–268
.11.
Sanders
, R. C.
, Jr., Giuliano
, J. S.
, Jr., Sullivan
, J. E.
, Brown
, C. A.
, III, Walls
, R. M.
, Nadkarni
, V.
, and Nishisaki
, A.
, and National Emergency Airway Registry for Children Investigators and Pediatric Acute Lung Injury and Sepsis Investigators Network
, 2013
, “Level of Trainee and Tracheal Intubation Outcomes
,” Pediatrics
, 131
(3
), pp. e821
–e828
.12.
Weiss
, M.
, Knirsch
, W.
, Kretschmar
, O.
, Dullenkopf
, A.
, Tomaske
, M.
, Balmer
, C.
, Stutz
, K.
, Gerber
, A. C.
, and Berger
, F.
, 2006
, “Tracheal Tube-Tip Displacement in Children During Head-Neck Movement: A Radiological Assessment
,” Br. J. Anesth.
, 96
(4
), pp. 486
–491
.13.
Schmolzer
, G. M.
, and Roehr
, C. C.
, 2014
, “Techniques to Ascertain Correct Endotracheal Tube Placement in Neonates
,” Cochrane Database Syst. Rev.
, 9
, p. CD010221
.14.
Birmingham
, P. K.
, Cheney
, F. W.
, and Ward
, R. J.
, 1986
, “Esophageal Intubation: A Review of Detection Techniques
,” Anesth. Analg.
, 65
(8
), pp. 886
–891
.15.
Kattwinkel
, J.
, Perlman
, J. M.
, Aziz
, K.
, Colby
, C.
, Fairchild
, K.
, Gallagher
, J.
, Hazinski
, M. F.
, Halamek
, L. P.
, Kumar
, P.
, Little
, G.
, McGowan
, J. E.
, Nightengale
, B.
, Ramirez
, M. M.
, Ringer
, S.
, Simon
, W. M.
, Weiner
, G. M.
, Wyckoff
, M.
, and Zaichkin
, J.
, 2010
, “Part 15: Neonatal Resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
,” Circulation
, 122
(18 Suppl. 3
), pp. S909
–S919
.16.
Kattwinkel
, J.
, Perlman
, J. M.
, Aziz
, K.
, Colby
, C.
, Fairchild
, K.
, Gallagher
, J.
, Hazinski
, M. F.
, Halamek
, L. P.
, Kumar
, P.
, Little
, G.
, McGowan
, J. E.
, Nightengale
, B.
, Ramirez
, M. M.
, Ringer
, S.
, Simon
, W. M.
, Weiner
, G. M.
, Wyckoff
, M.
, and Zaichkin
, J.
, and American Heart Association
, 2010
, “Neonatal Resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
,” Pediatrics
, 126
(5
), pp. e1400
–e1413
.17.
Kempley
, S. T.
, Moreiras
, J. W.
, and Petrone
, F. L.
, 2008
, “Endotracheal Tube Length for Neonatal Intubation
,” Resuscitation
, 77
(3
), pp. 369
–373
.18.
Rudraraju
, P.
, and Eisen
, L. A.
, 2009
, “Confirmation of Endotracheal Tube Position: A Narrative Review
,” J. Intensive Care Med.
, 24
(5
), pp. 283
–292
.19.
Verghese
, S. T.
, Hannallah
, R. S.
, Slack
, M. C.
, Cross
, R. R.
, and Patel
, K. M.
, 2004
, “Auscultation of Bilateral Breath Sounds Does Not Rule Out Endobronchial Intubation in Children
,” Anesth. Analg.
, 99
(1
), pp. 56
–58
.20.
O'Connor
, C. J.
, Mansy
, H.
, Balk
, R. A.
, Tuman
, K. J.
, and Sandler
, R. H.
, 2005
, “Identification of Endotracheal Tube Malpositions Using Computerized Analysis of Breath Sounds Via Electronic Stethoscopes
,” Anesth. Analg.
, 101
(3
), pp. 735
–739
.21.
Amarilyo
, G.
, Mimouni
, F. B.
, Oren
, A.
, Tsyrkin
, S.
, and Mandel
, D.
, 2009
, “Orotracheal Tube Insertion in Extremely Low Birth Weight Infants
,” J. Pediatr.
, 154
(5
), pp. 764
–765
.22.
Suarez
, M.
, Chediak
, A.
, Ershowsky
, P.
, and Krieger
, B.
, 1987
, “Evaluation of a Flexible Fiberoptic Catheter in Confirming Endotracheal Tube Placement in the Intensive Care Unit
,” Respir. Care
, 32
(2
), pp. 81
–84
.23.
Sagarin
, M. J.
, Barton
, E. D.
, Chng
, Y.-M.
, and Walls
, R. M.
, 2005
, “Airway Management by U.S. and Canadian Emergency Medicine Residents: A Multicenter Analysis of More Than 6,000 Endotracheal Intubation Attempts
,” Ann Emerg. Med.
, 46
(4
), pp. 328
–336
.24.
Cook
, T.
, Woodall
, N.
, and Frerk
, C.
, 2011
, “Major Complications of Airway Management in the UK: Results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: Anesthesia
,” Br. J. Anesth.
, 106
(5
), pp. 617
–631
.25.
Chen
, W.-H.
, Su
, H.-P.
, Chiu
, Y.-H.
, Tseng
, C.-C.
, and Chung
, K.-C.
, 2008
, “A Two-Stage Approach to Positioning and Identification of Tracheal Intubation Using LED-Based Lightwand and Acoustic Models
,” Engineering in Medicine and Biology Society, EMBS
30th Annual International Conference of the IEEE
, Vancouver, Canada, Aug. 20–25, pp. 4883
–4886
.26.
Volyanskyy
, K. Y.
, Haddad
, W. M.
, and Bailey
, J. M.
, 2011
, “Pressure-and Work-Limited Neuroadaptive Control for Mechanical Ventilation of Critical Care Patients
,” IEEE Trans. Neural Networks
, 22
(4
), pp. 614
–626
.27.
Hahn
, J.-O.
, Dumont
, G. A.
, and Ansermino
, J. M.
, 2012
, “System Identification and Closed-Loop Control of End-Tidal Co in Mechanically Ventilated Patients
,” IEEE Trans. Inf. Technol. Biomed.
, 16
(6
), pp. 1176
–1184
.28.
Li
, H.
, and Haddad
, W. M.
, 2012
, “Optimal Determination of Respiratory Airflow Patterns Using a Nonlinear Multicompartment Model for a Lung Mechanics System
,” Comput. Math. Methods Med.
, 2012
, p. 165946
.29.
Hou
, S. P.
, Meskin
, N.
, and Haddad
, W. M.
, 2015
, “Optimal Determination of Respiratory Airflow Patterns for a General Multicompartment Lung Mechanics System With Nonlinear Resistance and Compliance Parameters
,” ASME J. Dyn. Syst. Meas. Control
, 137
(12
), p. 121014
.30.
Salem
, M. R.
, 2001
“Verification of Endotracheal Tube Position
,” Anesthesiol. Clin. North Am.
, 19
(4
), pp. 813
–839
.31.
Addison
, P. S.
, 2005
, “Wavelet Transforms and the ECG: A Review
,” Physiol. Meas.
, 26
(5
), pp. R155
–R199
.32.
Zhang
, Z.
, Toda
, H.
, Horihata
, S.
, and Miyake
, T.
, 2006
, “Nonstationary Signal Analysis Using the Ri-Spline Wavelet
,” Integr. Comput. Aided Eng.
, 13
(2
), pp. 149
–161
.33.
Boashash
, B.
, 2015
, Time-Frequency Signal Analysis and Processing, Second Edition: A Comprehensive Reference
, Academic Press
, London.34.
del Pozo
, F.
, Rodríguez
, M.
, Arredondo
, M.
, Gómez
, E.
, and Halberg
, F.
, 1991
, “Minimal Sampling Requirements for a Parametric Representation of Blood Pressure Profiles
,” Annual International Conference of the IEEE
Engineering in Medicine and Biology Society
, Oct. 31–Nov. 3, pp. 470
–471
.35.
Hermida
, R. C.
, Ayala
, D. E.
, Fernández
, J. R.
, Mojón
, A.
, Alonso
, I.
, and Calvo
, C.
, 2002
, “Modeling the Circadian Variability of Ambulatorily Monitored Blood Pressure by Multiple-Component Analysis
,” Chronobiol. Int. J. Biol. Med. Rhythm Res.
, 19
(2
), pp. 461
–481
.36.
Sokoloff
, M. D.
, Bortner
, L.
, and Panos
, R. J.
, 2012
, “Development of a Non-Invasive Dynamic Pulmonary Function Monitor
,” ASME J. Med. Devices
, 6
(2
), p. 021003
.37.
Jalali
, A.
, Ghaffari
, A.
, Ghorbanian
, P.
, and Nataraj
, C.
, 2011
, “Identification of Sympathetic and Parasympathetic Nerves Function in Cardiovascular Regulation Using ANFIS Approximation
,” Artif. Intell. Med.
, 52
(1
), pp. 27
–32
.38.
Aletti
, F.
, Bassani
, T.
, Lucini
, D.
, Pagani
, M.
, and Baselli
, G.
, 2009
, “Multivariate Decomposition of Arterial Blood Pressure Variability for the Assessment of Arterial Control of Circulation
,” IEEE Trans. Biomed. Eng.
, 56
(7
), pp. 1781
–1790
.39.
Jalali
, A.
, Buckley
, E. M.
, Lynch
, J. M.
, Schwab
, P. J.
, Licht
, D. J.
, and Nataraj
, C.
, 2014
, “Prediction of Periventricular Leukomalacia Occurrence in Neonates After Heart Surgery
,” IEEE J. Biomed. Health Inf.
, 18
(4
), pp. 1453
–1460
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