U.S. patent application number 15/649908 was filed with the patent office on 2017-11-02 for non-invasively monitoring blood parameters.
The applicant listed for this patent is Covidien LP. Invention is credited to Theodore M. Bailey, Leslie G. Henderson.
Application Number | 20170311824 15/649908 |
Document ID | / |
Family ID | 36126449 |
Filed Date | 2017-11-02 |
United States Patent
Application |
20170311824 |
Kind Code |
A1 |
Henderson; Leslie G. ; et
al. |
November 2, 2017 |
NON-INVASIVELY MONITORING BLOOD PARAMETERS
Abstract
An apparatus for monitoring vital sign parameters in a
biological entity is disclosed. In an embodiment, the apparatus
includes at least one light source for transmitting light through
the biological entity and at least one photodetector for receiving
light transmitted through the biological entity. At least one light
source and at least one photodetector are configured to be
positioned proximate the biological entity in a manner that does
not significantly impede blood flow through the biological entity.
A signal is generated in response to the transmittance or
reflectance of light through the biological entity. The signal
corresponds to at least one characteristic of the generally
unimpeded blood flow through the biological entity. The apparatus
also includes a control system configured to analyze the signal to
determine vital sign parameters in the biological entity. A method
for monitoring vital sign parameters in a biological entity is also
provided.
Inventors: |
Henderson; Leslie G.;
(Cicero, IN) ; Bailey; Theodore M.; (Indianapolis,
IN) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Covidien LP |
Mansfield |
MA |
US |
|
|
Family ID: |
36126449 |
Appl. No.: |
15/649908 |
Filed: |
July 14, 2017 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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12248683 |
Oct 9, 2008 |
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15649908 |
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12025564 |
Feb 4, 2008 |
9380951 |
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12248683 |
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10958458 |
Oct 5, 2004 |
7341560 |
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12025564 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B 5/02416 20130101;
A61B 5/6824 20130101; A61B 5/02125 20130101; A61B 5/6826 20130101;
A61B 5/021 20130101; A61B 5/6814 20130101; A61B 5/14551 20130101;
A61B 5/6838 20130101; A61B 5/0059 20130101; A61B 2560/0412
20130101; A61B 5/14552 20130101 |
International
Class: |
A61B 5/024 20060101
A61B005/024; A61B 5/021 20060101 A61B005/021; A61B 5/00 20060101
A61B005/00; A61B 5/00 20060101 A61B005/00; A61B 5/1455 20060101
A61B005/1455; A61B 5/1455 20060101 A61B005/1455; A61B 5/021
20060101 A61B005/021; A61B 5/00 20060101 A61B005/00; A61B 5/00
20060101 A61B005/00 |
Claims
1-5. (canceled)
6. An oximetry monitoring system for monitoring a subject's tissue,
comprising: an adhesive forehead sensor comprising a light source
and a photodetector in a side-by-side position, the light source
emitting light at first and second wavelengths, and the
photodetector providing an electrical signal in response to
exposure to the light after reflectance by the monitored tissue; a
control system in communication with the photodetector, and
equipped to sample the electrical signal and calculate an area
under the curve metric responsive to a blood oxygen status of the
monitored tissue; and a display operated by the control system to
provide an indication of the blood oxygen status.
7. The system of claim 6, wherein the light source and the
photodetector are carried by a flexible support.
8. The system of claim 7, wherein the flexible support comprises an
adhesive patch.
9. The system of claim 6, further comprising an alarm triggered by
the control system based on the blood oxygen status.
10. The system of claim 9, wherein the blood oxygen status
comprises a measure of oxygen saturation in the monitored
tissue.
11. The system of claim 6, wherein the blood oxygen status
comprises a measure of tissue perfusion in the monitored
tissue.
12. The system of claim 6, wherein the control system comprises an
analog to digital converter for sampling the electrical signal, and
a processor programmed to calculate the area under the curve
metric.
13. The system of claim 12, wherein the processor is further
programmed to calculate a tissue perfusion index based on the blood
oxygen status over time.
14. The system of claim 6, further comprising a database of
reference characteristics, and wherein the control system is
further programmed to compare the pulse waveform signal to the
reference characteristics.
15. An oximetry system, comprising: a sensor input receiving first
and second electrical signals representative of light emitted by
first and second emitters, reflected by a subject's tissue, and
detected at first and second detectors; a control system programmed
to: receive the first and second electrical signals and develop a
pulse waveform signal representative of a blood parameter;
determine a value of the blood parameter based on the pulse
waveform signal; produce an area under the curve metric based on a
pulse of the pulse waveform signal; and determine a tissue
perfusion index based on the area under the curve metric; a display
in communication with the control system; and an alarm triggered by
the control system based on a status of the pulse waveform
signal.
16. The system of claim 15, further comprising a database of
reference characteristics, and wherein the control system is
further programmed to compare the pulse waveform signal to the
reference characteristics.
17. The system of claim 15, further comprising an adhesive forehead
sensor in communication with the sensor input, the adhesive
forehead sensor comprising a light source and a photodetector in a
side-by-side position, the light source emitting light at first and
second wavelengths, and the photodetector providing the first and
second electrical signals to the sensor input.
18. A method for monitoring vital sign parameters of a subject,
comprising: emitting light from first and second light emitters
into a subject's forehead; detecting the emitted light after
reflectance by the subject's forehead, at first and second
photodetectors; generating first and second electrical signals
representative of the detected light; developing a pulse waveform
signal based on the electrical signals; analyzing the pulse
waveform signal to produce an area under the curve metric;
monitoring the pulse waveform signal over time; and displaying the
pulse waveform signal.
19. The method of claim 18, further comprising determining an
oxygen saturation of the subject's tissue based on the first and
second electrical signals.
20. The method of claim 18, further comprising triggering an alarm
based on a status of the pulse waveform signal.
Description
FIELD OF THE INVENTION
[0001] The present invention relates to medical devices and, more
particularly, to apparatuses and methods for non-invasively
monitoring vital sign parameters of a biological entity, such as a
neonate.
BACKGROUND OF THE INVENTION
[0002] A basic requirement in determining the health of a human
adult or neonate is to measure certain vital sign parameters, such
as blood pressure, pulse rate, blood oxygen saturation, and
respiratory rate. For example, measuring blood pressure in a human
adult is typically accomplished using either an oscillometric-based
method or an auscultatory method, both of which traditionally
involve the application of an inflatable blood pressure cuff around
the arm of the subject. While oscillometric-based and auscultatory
methods are easily implemented with a human adult, these methods
are not well suited for subjects such as neonates due to their
diminutive size and inability to comprehend and cooperate with the
procedure.
[0003] Beyond the inability to accurately monitor vital sign
parameters in a small subject, traditional methods of measuring
vital sign parameters are generally carried out on a periodic
basis, as opposed to providing near-continuous monitoring. This is
because traditional methods of monitoring generally required that
the subject be disturbed in some manner. For example, in monitoring
blood pressure, blood flow through the subject's body member was
occluded, through inflation of the blood pressure cuff, in order to
measure blood pressure. Inflation of the blood pressure cuff may be
disturbing to a neonate, particularly during their rest if
performed on a periodic basis.
[0004] Accordingly, a need exists for apparatuses and methods for
monitoring vital sign parameters, such as blood pressure, oxygen
saturation, pulse rate, and respiration, regardless of whether the
subject is a human adult, a neonate or some other biological
entity. The apparatuses and methods should be easily implemented
and obtain accurate results, as well as be carried out in a
near-continuous manner so as to allow for monitoring without
disturbing the subject. Also, the apparatuses and methods should be
employed such that any biological entity, regardless of size, may
be monitored.
SUMMARY OF THE INVENTION
[0005] The present invention provides apparatuses for monitoring
vital sign parameters of a biological entity. In one embodiment of
the invention, the apparatuses include at least one light source
for transmitting light through the biological entity and at least
one photodetector for receiving light transmitted through the
biological member. At least one light source and at least one
photodetector are configured to be positioned proximate the
biological entity in a manner that does not significantly impede
blood flow through the biological entity. A signal is generated in
response to the transmittance or reflectance of light through the
biological entity. The signal corresponds to at least one
characteristic of the generally unimpeded blood flow through the
biological member. The apparatuses also include a control system
configured to analyze the signal to determine blood pressure,
oxygen saturation, pulse rate, perfusion index, cardiac index,
vascular elasticity, and respiration, among other blood parameters,
of the biological entity.
[0006] The present invention also provides methods for monitoring
vital sign parameters in a biological entity. In one embodiment,
the method includes positioning at least one sensor assembly
proximate the biological entity. A signal is generated by at least
one sensor assembly that corresponds to at least one characteristic
of the blood flow through the biological entity. The signal is
analyzed to determine blood pressure, oxygen saturation, pulse
rate, perfusion index, cardiac index, vascular elasticity, and
respiration, among other blood parameters, of the biological
entity.
DESCRIPTION OF THE DRAWINGS
[0007] Embodiments of the invention will now be described, by way
of example, with reference to the accompanying drawings,
wherein:
[0008] FIG. 1A depicts, from a first perspective, a
trans-illuminating cuff according to an embodiment of the
invention;
[0009] FIG. 1B is a cross-sectional view of the trans-illuminating
cuff of FIG. 1A;
[0010] FIG. 2 is a view of the trans-illuminating cuff of FIG. 1A
from a second perspective;
[0011] FIG. 3 is a depiction of the trans-illuminating cuff of FIG.
1A from a third perspective;
[0012] FIG. 4 is a perspective view of a trans-illuminating cuff
according to another embodiment of the invention;
[0013] FIGS. 5A and 5B depict two possible optical paths that may
be established through a biological member;
[0014] FIG. 6A is a perspective view of the trans-illuminating cuff
of FIG. 1A applied to the arm of a neonate;
[0015] FIG. 6B, is a perspective view of the trans-illuminating
cuff of FIG. 1A applied to the finger of an adult;
[0016] FIG. 7 depicts, from a first perspective, a
trans-illuminating patch according to another embodiment of the
invention;
[0017] FIG. 8 is a view of the trans-illuminating patch of FIG. 7
from a second perspective;
[0018] FIG. 9 is a front elevational view of the trans-illuminating
patch of FIG. 7 applied to the head and neck of an adult;
[0019] FIG. 10 is a perspective view of a trans-illuminating clip
according to another embodiment of the invention;
[0020] FIG. 11 is a block diagram of a vital sign parameter control
system incorporating the trans-illuminating cuff of FIG. 1A and the
trans-illuminating patch of FIG. 7;
[0021] FIG. 12A are exemplary pulse waveform signals obtained from
the use of the trans-illuminating cuff of FIG. 1A and
the-trans-illuminating patch of FIG. 7 with a biological member,
such as the arm or head of a neonate;
[0022] FIGS. 12B-12D are exemplary pulse waveform signals of FIG.
12A that have been positioned within an analysis envelope;
[0023] FIGS. 13A and 13B are further exemplary pulse waveform
signals illustrating optical oscillometric blood pressure
measurements with a vital sign monitor;
[0024] FIG. 14 is a graph that illustrates the spectral
characteristics of hemoglobin (Hb) and oxygenated hemoglobin
(HbO2);
[0025] FIG. 15 illustrates the presence of respiratory variations
in the graphs of transmittance of light of first and second
wavelengths;
[0026] FIGS. 16A and 16B is an exemplary pulse waveform signal that
has been labeled to define areas of interest that are related to
the pumping action of a heart;
[0027] FIG. 17 is an enlarged exemplary pulse waveform signal of
FIG. 12A to illustrate transition points of the signal; and
[0028] FIGS. 18A and 18B are exemplary electrocardiogram signals
and an exemplary pulse waveform signals shown for comparison
purposes.
DETAILED DESCRIPTION OF THE INVENTION
[0029] One embodiment of the present invention will now be
described with reference to FIGS. 1-3. Illustrated in FIG. 1A is
one side of a member trans-illuminating cuff 100 for monitoring
certain vital sign parameters of a biological entity. A particular
biological entity that is discussed in the several embodiments is a
newborn, neonate, or infant (collectively referred to as "neonate"
for the remainder of the application and understood to represent
not only a person in their early stages of life, but any person of
relatively diminutive size, such as an infant, regardless of age).
Although the following describes these several embodiments in use
with a neonate, it must be understood that these embodiments may
also be used to monitor the vital signs of other biological
entities such as an adult person or animals (e.g., canines and
primates).
[0030] In the illustrated embodiment, cuff 100 includes a flexible
support member 122 that can be readily wrapped or applied around an
arm, leg, finger or other appendage (collectively referred to as a
"limb" for the remainder of the application) of a biological
entity. Incorporated within or mounted upon one side of cuff 100 is
at least one light source 132 and at least one photodetector 134
positioned to diametrically oppose light source 132 when cuff 100
is applied over a limb of a neonate. One suitable type of light
source for use in cuff 100 is a light emitting diode (LED), such as
the type L660/805/975-40D00, available from Epitex, Kyoto, Japan,
and a suitable photodetector is a photoresistor or photodiode, such
as the QSD723 photoresistor available from QT Optoelectronics.
However, other light sources and photodetectors for generating and
receiving one of more frequencies of light may also be used in cuff
100 without departing from the spirit and scope of the
invention.
[0031] In the embodiment illustrated in FIGS. 1-3, cuff 100
includes two light sources 132a and 132b that are spaced along the
interior side of cuff 100 so as to oppose photodetector 134 when
cuff 100 is applied over a limb 200 (see, e.g., FIG. 5A). This dual
light source configuration provides for increased transmission of
light through the tissue bed and around a bone 210 of limb 200.
Alternatively, light source 132 and photodetector 134 may be
positioned side-by-side to allow for the monitoring of blood
parameters based not on light transmitted directly from the light
source 132 to the photodetector 134, but instead on light
transmitted into the tissue of the limb 200 by light source 132 and
subsequently reflected back to photodetector 134 (see, e.g., FIG.
5B).
[0032] As illustrated in FIG. 2, cuff 100 also includes an
attachment device 138 for securing cuff 100 to limb 200 of a
neonate. According to the present embodiment, attachment device 138
includes a cinch-loop 140 attached to a first end 142 of the
flexible support member 122 through which a second end 144 extends
when cuff 100 is applied to the limb of a neonate. In the
illustrated configuration, hook-and-loop style fastener components
146a and 146b, such as Velcro, are applied to the second, or
exterior, side of flexible support member 122. Once cuff 100 is
applied to limb 200 of a neonate, fastener components 146a and 146b
may be used to secure the cuff 100 in its wrapped position without
significantly impeding the flow of blood through the limb (see,
e.g., FIGS. 6A and 6B). In an alternative embodiment, cuff 100 may
lack a cinch-loop 140, relying entirely on hook-and-loop style
fastener components 146a and 146b to secure cuff 100. In addition,
further embodiments may forgo the hook-and-loop style fastener
components 146a and 146b in favor of other attachment means, such
as, for instance, adhesives, reusable or otherwise, and other types
of variable tension fastening systems.
[0033] In addition to light source 132 and photodetector 134, cuff
100 may optionally include one or more inflatable bladders 124 that
are either incorporated into cuff 100 or mounted to an interior
side of cuff 100. Upon placing cuff 100 around limb 200 of a
neonate, bladder 124 may be inflated to a relatively low pressure
level that would aid in securing cuff 100 in position while not
significantly impeding the flow of blood through limb 200.
Alternatively, as will be discussed later, it may be desirable to
include a bladder 124 that may be inflated to a sufficiently high
enough pressure level to temporarily obstruct the flow of blood
through limb 200.
[0034] Regardless of either of the above intended functions, the
addition of a bladder 124 to cuff 100 may be done in such a manner
as to ensure that light source 132 and photodetector 134 optically
communicate with limb 200. For illustrative purposes, consider the
following two embodiments. In a first embodiment, bladder 124
mounts to an interior side of cuff 100 over light source 132 and
photodetector 134. To ensure that neither light source 132 nor
photodetector 134 are obstructed, bladder 124 may be fashioned from
a material, such as polyurethane, which is optically transparent to
the wavelength of light emitted by light source 132 and to which
photodetector 134 is sensitive. Alternatively, according to another
embodiment, cuff 100 may incorporate a bladder 124 in such a manner
that when bladder 124 is inflated, light source 132 and
photodetector 134 remain in contact with or proximal to limb 200.
This can be accomplished, for example, by configuring cuff 100 so
that light source 132 and photodetector 134 are mounted not upon
flexible support member 122, but upon bladder 124.
[0035] According to another embodiment of the invention, flexible
support member 122 may include a generally cylindrical sleeve (not
illustrated) that may be slipped around the limb 200 of a neonate.
To accommodate limbs 200 of different sizes, the generally
cylindrical sleeve may possess elastic characteristics that allow
it to stretch and contract as a limb 200 is inserted into the
sleeve. The contractile forces generated by the sleeve as it is
slipped around a limb 200 also serve to secure the placement of the
sleeve without significantly impeding blood flow through the
limb.
[0036] In still another embodiment of the invention, flexible
support member 122 may include a generally cylindrical sleeve that
does not have elastic characteristics. Instead, at least one
bladder 124 may be incorporated into the sleeve or mounted upon the
interior surface of the sleeve. Once sleeve is slipped around the
limb 200 of a neonate, bladder 124 may be inflated with sufficient
pressure to secure the sleeve around the limb without significantly
impeding blood flow. If desired, the bladder may also be inflated
to a pressure exceeding the systolic blood pressure of the subject,
thereby substantially obstructing the flow of blood through limb
200.
[0037] According to yet another embodiment of the invention, an
example of which is illustrated in FIG. 4, a trans-illuminating
cuff 300 is provided that includes a rigid or semi-rigid housing
310, such as a plastic tube, into which limb 200 of the neonate can
be inserted. Similar to the previous embodiments, at least one
light source 332 and at least one photodetector 334 are
incorporated into or mounted upon housing 310 in such a manner
that, upon insertion of limb 200, light source 332 may transmit
light through the tissue of limb 200, with the transmitted light
subsequently being received by photodetector 334.
[0038] To ensure an adequate fit with different limb sizes, a
resilient sleeve or layer of material 320 may be incorporated with,
or mounted onto, the interior surface of housing 310. Resilient
layer 320 may include, for example, foam rubber and other materials
that readily compress upon being pressed against limb 200. In this
manner, a fixed diameter housing 310 may accommodate various limb
sizes, the resilient layer 320 compressing and expanding as needed
to generally conform to the shape of limb 200. As will be
appreciated, resilient layer 320 may be configured so that it does
not obstruct the transmission of light from light source 332 into
the tissue of limb 200, nor interfere with the reception of light
by photodetector 334. This can be accomplished through selective
placement of resilient layer 320 or, alternatively, by making
resilient layer 320 out of a material that is optically transparent
to the wavelengths) of light transmitted by light source 332 and
received by photodetector 334. In another configuration, light
source 332 and photodetector 334 may be positioned on resilient
layer 320 instead of housing 310. In this manner, resilient layer
320 aids in positioning the light source 332 and photodetector 334
in close proximity to limb 200 as layer 320 expands and contracts
in response to the presence of limb 200.
[0039] In another configuration, housing 310 of cuff 300 may be
configured so that resilient layer 320 is supplemented or replaced
by at least one bladder (see, e.g., bladder 124) that are
selectively inflatable to a pressure level sufficient to hold
housing 310 in place on limb 200 without significantly impeding the
flow of blood through limb 200. For reasons that will be described
below, the bladder(s) may also be selectively inflated to a
pressure exceeding the systolic blood pressure of the neonate,
thereby substantially obstructing the flow of blood through limb
200.
[0040] According to another embodiment of the invention, an example
of which is illustrated in FIGS. 7 and 8, a trans-illuminating
patch 400 is provided. Similar to previous embodiments, at least
one light source 432 and at least one photodetector 434 are
incorporated into or mounted upon patch 400. Unlike the previous
embodiments, patch 400 may be placed on any location or position of
the neonate's body and used to monitor the vital sign parameters.
Limb 200 may be used for placement, but is not required. Patch 400
may be positioned on the neonate's head, chest, neck, thigh, or
other suitable location to monitor vital sign parameters (see e.g.,
FIG. 9, patch 400 is positioned on the head and neck of an adult
person). Patch 400 may be attached to the particular area of the
body with adhesives, reusable or otherwise, or some other
attachment device such as a bandage, headband, or the like.
[0041] Patch 400 may be positioned on the neonate in relatively
flat locations rather than encircling limb 200 like cuffs 100, 300.
Therefore, light source 432 and photodetector 434 may be positioned
side-by-side to allow for monitoring of vital sign parameters based
not on light transmitted directly from the light source 432 to
photodetector 434, but instead on light transmitted into the tissue
of the neonate's body by light source 432 and subsequently
reflected back to photodetector 434 (see, e.g., FIG. 5B).
[0042] In addition to light sources 432 and photodetector 434,
patch 400 may also include one or more inflatable bladders (see,
e.g., bladder 124) that are incorporated into patch 400. The
bladders may be mounted to patch 400 such that the bladders may be
between the neonate and the patch 400. In this case, the bladders
may be fashioned from a material, such as polyurethane, which is
optically transparent to the wavelength of light emitted by light
sources 432 and to which photodetector 434 is sensitive. As will be
discussed later, the bladders may be selectively inflated to a
pressure exceeding the systolic blood pressure of the neonate,
thereby substantially obstructing the flow of blood through that
particular area of the neonate's body.
[0043] According to another embodiment of the invention, an example
of which is illustrated in FIG. 10, a trans-illuminating clip 500
is provided. Similar to previous embodiments, at least one light
source 532 and at least one photodetector 534 are incorporated into
or mounted upon clip 500. Clip 500 may be secured to smaller
portions of the body such as earlobes, fingers, toes, and the like,
and used to monitor the vital sign parameters. (see e.g., FIG. 9,
clip 500 is positioned on the earlobe of an adult person). Clip 500
includes an attachment device 538 that includes a biasing member
540 such as a spring, resilient rubber, or the like, to ensure that
light source 532 and photodetector 534 remain proximate the tissue
of the neonate.
[0044] With reference now to FIG. 11, a control system 600 of the
present invention is shown. In an embodiment, control system 600
includes a processor 605 that controls, among other things,
operation of light sources (e.g., 132, 432) and photodetectors
(e.g., 134, 434) in a sensor assembly (e.g. cuff 100, patch 400).
Although the sensor assembly employing light sources and
photodetectors is the preferred means of generating a signal
relating to vital sign parameters, it must be understood that
equivalent means for generating signals relating to vital sign
parameters may be employed such as ultrasound or the like. Although
control system 600 is discussed controlling two sensor assemblies,
it should be understood that control system 600 may control
multiple channels so that multiple sensor assemblies, that are
positioned on a neonate, may be used in monitoring vital sign
parameters.
[0045] During vital sign parameter measurements, for example, in
the measuring of blood pressure, the microprocessor energizes the
light sources continually. When activated, photodetectors convert
the light transmitted through the tissue in limb 200 or reflected
in head 450 (or other part of the body such as the neck, chest, or
thigh) into a corresponding electronic signal. This electronic
signal is subsequently supplied to processor 605 for analysis after
being optionally passed through amplifiers 610a and 610b. The
amplified photodetector output signal is converted to digital form
in the microprocessor itself if the microprocessor has an internal
A/D converter, or in a separate A/D converter provided between the
amplifier and the microprocessor. Results of the analysis may then
be directed to a variety of output devices, such as, for example, a
display screen 620. In the embodiment illustrated in FIG. 11,
processor 605 is depicted as being separate from the sensor
assemblies. However, in an alternative embodiment, control system
600 may be more integrated into the sensor assemblies, with one or
more of the components, including processor 605, being incorporated
into the sensor assemblies.
[0046] The sensor assemblies may also communicate with pumps 630a,
630b if one or more inflatable bladders are included in the sensor
assemblies. Inflation and deflation of the bladders may be readily
controlled by pumps 630a, 630b. For example, according to one
embodiment, pumps 630a, 630b are controlled by processor 605 and
convey air into the inflatable bladders through inflation tubes
635a and 635b. Pressure transducers 640a and 640b may also be
incorporated into control system 600 for monitoring the pressure in
inflation tubes 635a and 635b and the bladders, and conveying
signals indicative of such pressure back to the processor 605.
Suitable transducers are available from Cobe Labs, Littleton,
Colo.
[0047] Operation of the sensor assemblies in conjunction with
control system 600 to monitor certain vital sign parameters of a
neonate, will now be discussed with reference to FIG. 12A. Before
any vital signs may be monitored, a first sensor assembly (e.g.,
cuff 100) is secured around limb 200 of a neonate (see, e.g., FIG.
6A) and a second sensor assembly (e.g., patch 400) is secured to
the head of a neonate (see, e.g., FIG. 9). Once appropriately
positioned, control system 600 activates the sensor assemblies by
operating or energizing light sources (e.g., 132, 432) and
photodetectors (e.g., 134, 434). Once energized, the light sources
begin to transmit light of a first wavelength or frequency. This
transmitted light, representing an optical signal, passes through
the skin and into the tissue of limb 200 (see, e.g., FIG. 5A) and
passes through the skin and is reflected off the skull in head 450
(see, e.g., FIG. 5B). The optical signal continues to travel
through the tissue making up limb 200 and head 450, including, for
example, various types of skin tissue, muscle, and blood vessels.
As the optical signal travels through these various constituent
tissues comprising limb 200 and head 450, portions of the signal
are deflected or absorbed. The remainder of the optical signal that
makes it through the tissue of limb 200 is received by the
photodetector. The remainder of the optical signal that is
reflected through the tissue of head 450 is received by the
photodetector. The photodetectors subsequently convert the optical
signals into electric signals to be sent to control system 600.
[0048] At any specific point in time, this electric signal produced
by the photodetectors represents the transmittance (T) of the
optical signal through the tissue of limb 200 and the reflectance
(R) through the tissue of head 450 at that moment in time. This
transmittance (T) or reflectance (R) of the optical signal is not
constant, but continuously fluctuates due to ongoing changes
occurring in the tissue of limb 200 and head 450, including without
limitation, changes in blood flow. Specifically, blood is
distributed throughout limb 200 and head 450 by a variety of blood
vessels, including, for example, arteries and arterioles. The rate
and volume of blood flow through these vessels is largely dependent
on blood pressure levels, which in turn are dependent on the
pumping action of the heart as well as the blood vessels
themselves, some of which constrict or dilate depending on the
current biological state of the subject. Accordingly, the
transmittance (T) of the optical signals through the tissue of limb
200 and reflectance (R) of the optical signals through the tissue
of the head 450 are dependent on volumetric changes in blood flow,
which, in turn, are dependent on blood pressure levels.
Consequently, analysis of the electric signals, which represent
variations in transmittance (T) or reflectance (R) of the optical
signals due to volumetric changes in blood flow, permits the
determination of several vital sign parameters, including without
limitation, blood pressure oxygen saturation, pulse rate, perfusion
index, cardiac index, vascular elasticity, and respiration.
[0049] Illustrated in FIG. 12A is a graphical representation of
exemplary signals 700a, 700b (referred to for the remainder of the
discussion as a pulse waveform signals) generated by the
photodetectors. Pulse waveform signal 700a is obtained after
securing the first sensor assembly around limb 200 and energizing
the light source and the photodetector. A similar pulse waveform
700b is obtained after securing the second sensor assembly to head
450 and energizing the light source and the photodetector. The
rhythmic pattern of fluctuations or oscillations within pulse
waveform signals 700a, 700b represent changes in the volumetric
flow of blood through limb 200 or head 450 primarily due to the
pumping or "beating" action of the human heart.
[0050] Subsequent analysis of pulse waveform signals 700a, 700b
permit the determination of certain blood parameters that influence
the flow of blood, such as, for example, mean arterial blood
pressure, diastolic blood pressure and systolic blood pressure.
This determination is possible due to the relationships, as
discussed above, between transmittance (T) of the optical signal
and between reflectance (R) of the optical signal, volumetric
changes in blood flow, and blood pressure levels. In an embodiment
of the present invention, analysis of pulse waveform signals 700a,
700b includes the application of one or more algorithms that
manipulate the data of pulse waveform signals 700a, 700b in
accordance with one or more predefined relationships that exist
between transmittance (T) and reflectance (R) of the optical
signal, blood flow and blood pressure levels. This is further
discussed below.
[0051] Now referring to FIGS. 12B-12D, the microprocessor may be
suitably programmed to generate an envelope 702 from the pulse
waveform signal. Envelope 702 is comprised of a lower band 704 and
upper band 706 that may be positioned around subsequent pulse
waveform signals. Envelope 702 may be used to further aid health
care professionals in the near continuous monitoring of a neonate's
vital sign parameters and for diagnostic analysis.
[0052] Microprocessor 605 may generate envelope 702 from pulse
waveform signal 700a by using a signal sampling technique that is
known in the art of signal processing. As the microprocessor
generates a pulse waveform signal based on the electrical signal
received from the sensor assembly (e.g., cuff, patch, clip, or
other like device) used to monitor the neonates vital sign
parameters, the microprocessor may be programmed to "sample" the
pulse waveform signal periodically. Sampling the pulse waveform
signal produces a second signal that may be similar to the original
pulse waveform signal. The number of samples taken and the time
period between samples will determine how closely the sampled
signal resembles the original pulse waveform signal taken from the
cuff, patch or other like device. Once the sample signal has been
generated, the microprocessor may be programmed such that lower
band 704 and upper band 706 may be developed from the sampled
signal, as determined by a healthcare professional, by adjusting
the signal gain to produce envelope 702.
[0053] For example, FIG. 120 illustrates envelope 702 that is a set
of simple limit bars (lower band 704 and upper band 706) that are
based on a sampled electrical signal from the sensor assembly. In
this instance, microprocessor samples the pulse waveform signal at
only a few points to identify the peak value of the pulse waveform
signal. The microprocessor then sets the lower and upper bands of
the envelope based upon the peak value or as directed by a
healthcare professional. In FIG. 12C, envelope 702 more closely
resembles the pulse waveform signal that was generated by the
microprocessor from the electrical signal received from the sensor
assembly. The envelope in FIG. 12C is based on more frequent
sampling of the pulse waveform signal than the envelope in FIG.
12B. The envelope in FIG. 12D is based on an even greater frequency
of sampling of the pulse waveform signal then the envelope in FIG.
12C so that the lower and upper bands more closely resemble the
actual pulse waveform signal.
[0054] The sampling period of the microprocessor may be adjusted to
be used in the manner determined by the health care professional.
The greater the frequency of the sampling period, the greater the
number of sampling points generated, and the more the envelope will
resemble the actual electrical signal from the sensor assembly. In
this manner the health care professional will have greater
precision when employing the use of an envelope in a diagnostic
analysis or a near continuous monitor mode.
[0055] Once lower band 704 and upper band 706 of envelope 702 have
been determined, the health care professional my employ envelope
702 for a number of continuous monitoring and diagnostic analysis
techniques. For example, an audible alert may be incorporated into
control system 600 such that during continuous monitoring of a
neonate with sensor assemblies, an alarm may be sounded if the
incoming electrical signal crosses either lower band 704 or upper
band 706 indicating a unwanted change in vital sign parameters.
[0056] Also, after the signal envelopes have been established,
pulse waveform signal 700a may be analyzed through a process of
comparing signal 700a to a number of previously established pulse
waveform signals that have already been associated with one or more
known vital sign measurements. Specifically, the present analysis
method involves the creation of a database of reference envelopes
based on previous pulse waveform signals and corresponding blood
flow characteristics associated with the reference signals. Each
individual envelope characteristic in the database or,
alternatively, a combination of two or more envelope
characteristics, is then associated with one or more vital sign
measurements, such as, for example, blood pressure respiration, and
heart rate. A pulse waveform signal 700a undergoing analysis is
evaluated for one or more identifiable and defining
characteristics. These defining characteristics in the evaluated
pulse waveform signal 700a are compared to the established envelope
characteristics maintained in the database. If this comparison
meets certain predetermined criteria between the characteristics of
the pulse waveform signal 700a being analyzed and the specific
reference characteristics stored in the database, it can be assumed
that the blood parameters associated with pulse waveform signal
700a are the same as the known blood parameters associated with the
selected reference envelopes stored in the database. The known
blood parameters corresponding to the monitored waveform signal
700a may then be presented to the healthcare provider, such as on
display 620.
[0057] Additionally, the envelopes developed from the pulse
waveform signals may be generated and stored in databases for an
entire population. A generic database of envelopes may be developed
that may be based on age, gender, size, or any number of
attributes. By employing the use of these databases, health care
professionals may be able to establish a base line reading for
those people who have not had a medical physical in quite some
time. Rather than taking several months or years to establish a
baseline, a generic pulse waveform envelope baseline can be drawn
from the database based on parameters such as size, age, and
gender, and the person's pulse waveform signal monitored against
established envelopes. While, every person will still require an
individual assessment, irregularities may be identified in advance
with the use of the generic database of envelopes that closely
correspond to a particular person's size, age, gender, etc.
[0058] For those people that do visit their healthcare professional
regularly, an individual database of envelopes may be developed for
future diagnostic analysis. One example may involve a person who
visits his health care professional for regular physicals. Each
time the person returns his yearly physical, the healthcare
professional can access his previous envelopes to be used in
comparison purposes with the new pulse waveform signal that is
presently being generated. The healthcare professional may be
alerted to potential physiological problems if the new signal
passes outside the envelope indicating a change in the person's
vital sign parameters. In another example, a person may find
himself in an accident where he is unconscious and cannot
communicate with onsite health care professionals. Identification
information about the victim can be entered into a computer and the
onsite professionals can access the victim's database of pulse
waveform signal envelopes to identify any of the victim's vital
sign parameter abnormalities that may require attention prior to
treating the victim. In this manner, people may receive a
relatively quick and accurate diagnosis, which in turn leads to
quick and more importantly the correct form of treatment.
[0059] Physiological markers that may be monitored and measured by
these embodiments may include, but are not limited to, glucose
levels, lactate, C-reactive protein, cytokines, white blood cell
counts, and gene or protein expression in-vivo. These biological
markers not only provide insight into the health status, but also
address pre-symptomatic activity due to infection, chemical or
biological agent exposure.
[0060] Microprocessor 605 may also compare pulse waveform signal
700a produced from the first sensor assembly positioned around limb
200 (see e.g., FIGS. 6A and 6B), with pulse waveform signal 700b
produced from the second sensor assembly positioned on head 450
(see e.g., FIG. 9). As discussed above, a database of envelope
signals may be created for comparison purposes. The health care
provider may monitor these waveforms-taken from different areas of
the subject to diagnosis possible internal biological problems that
may be found between the monitoring devices. Also, the two separate
sensor assemblies may be used in conjunction with one another for
vital sign comparison purposes and analysis of the neonate.
[0061] In addition to the embodiments discussed above, the sensor
assembly may also be configured to actively measure blood pressure
of a subject through an oscillometric-based method. According to
this embodiment, the sensor assembly may include at least one
inflatable bladder selectively operable to occlude blood flow in
limb 200 or head 450 upon inflation to a sufficiently high enough
pressure. An illustrative example of this embodiment will now be
discussed with reference to FIGS. 13A and 13B, which depicts a
pulse waveform signal 710 along with a graph 720 of corresponding
sensor assembly pressure. As in the previous embodiments, a pulse
waveform signal 710 is obtained by applying the sensor assembly
around limb 200 or to head 450 of the subject and then subsequently
energizing the light source to transmit an optical signal through
the tissue of the limb or the head to the photodetector. When the
bladders are in a deflated state, and thus not significantly
impeding the flow of blood through limb 200 or head 450, the sensor
assembly will generate a first pulse waveform signal 710a that is
similar in nature to the pulse waveform signals 700a, 700b obtained
in the previously discussed embodiment of the invention.
[0062] At time B, pump 630a, 630b (illustrated in FIG. 11)
activates, thereby increasing the pressure in the bladders, as
illustrated in FIGS. 13A and 13B by graph segment 722. As the
bladder pressure increases, sensor assembly begins to constrict
limb 200 or head 450. This constriction causes at least a partial
pinching of the blood vessels running through the limb or the head,
which, in turn, impedes blood flow through the blood vessels.
During this stage of increasing bladder pressure, the pulses or
oscillations in the pulse waveform signal 710b first increase in
amplitude, reach a maximum, and then decrease in amplitude. Once
the pressure in the bladder exceeds the systolic blood pressure;
substantially all blood flow through the limb or head is
terminated. The essential lack of blood flow through limb 200 or
head 450 during this time period results in a near constant level
of transmittance (T) of the optical signal traveling through the
tissue of limb 200 or reflectance (R) of the optical signal
traveling through the tissue of head 450. As a result of this near
constant transmittance (T) or reflectance (R), the pulse waveform
signal becomes nearly constant (see, e.g., segment 710c),
exhibiting substantially no variances or oscillations in form. At
time D, the bladder is allowed to deflate or depressurize at a
predetermined rate, as indicated by graph segment 726. The
transition period DE in bladder pressure results in amplified
oscillations or spikes in the pulse waveform signal (see, e.g.,
segment 710d). As the sensor assembly returns to an un-pressurized
state, the oscillations in the pulse waveform signal (see, e.g.,
segment 710e) return to a substantially uniform level.
[0063] During both transient pressure stages, indicated in FIG. 13B
as stages 722 and 726, respectively, the pulse waveform signal
exhibits transient increases in the amplitude of the oscillations
occurring in the signal (see, e.g., segments 710b and 710d). While
the pressure is being increased and decreased by the
microprocessor, the microprocessor is also sampling the incoming
signal so that an envelope 715 may be generated based upon the
transient signal. The positive peak of the envelope is at a point
where the pulse amplitude reaches a maximum, identified as mean
arterial blood pressure (A.sub.m) in FIGS. 13A and 13B. The maximum
amplitude of the pulse is also a point where the bladder pressure
is substantially equal to mean arterial blood pressure. Similarly,
there exist points in waveform signal segments 710b and 710d that
correspond to diastolic blood pressure and systolic blood pressure.
The determination of the oscillation amplitudes at these points
allows for the determination of diastolic and systolic blood
pressure. Empirical studies indicate that these oscillation
amplitudes, identified as A.sub.d for diastolic pressure and
A.sub.s for systolic pressure, are related to the oscillation
amplitude A.sub.m, which corresponds to mean arterial blood
pressure. As such, diastolic blood pressure can be identified by
first determining the relationship between A.sub.d and A.sub.m,
which is a fixed constant, and then determining oscillation
amplitude A.sub.m, which is readily identifiable since, by
definition, it is the oscillation of maximum amplitude. Systolic
blood pressure can be identified in a similar manner.
[0064] To illustrate the process described above, consider an
example where it is assumed that the relationships between the
oscillation amplitudes A.sub.m, A.sub.d, and A.sub.s may be
mathematically represented by the equations:
A.sub.d/A.sub.m=X, and
A.sub.s/A.sub.m=Y,
where X and Y are constants that are empirically determined based
on certain characteristics of the subject, such as shape. Upon
determination of oscillation amplitude A.sub.m through analysis of
the pulse waveform signal, one can readily obtain oscillation
amplitudes A.sub.d and A.sub.s. The points on the pulse waveform
signal that correspond to oscillation amplitudes A.sub.d and
A.sub.s are then identified, by interpolation if necessary. The
relationship of A.sub.d/A.sub.m is a fixed constant value while the
relationship of A.sub.s/A.sub.m may determined by a linear
algorithm. Once these points in time are identified, the
corresponding cuff pressures that exist at these two times and
which correspond, respectively, to diastolic and systolic blood
pressures, are readily determined.
[0065] After a blood pressure has been determined through the use
of the above algorithm, the steady state signal occurring after the
deflation of the bladder will have the characteristics of the
calculated blood pressure. The steady state signal (e.g. graph
segment 710e) generated by the sensor assembly after the
measurement of mean arterial pressure and deflation of the bladder,
may be monitored in a near-continuous manner. The steady state
signal generated after the deflation of the bladder is a signature
of the measured mean arterial pressure and the calculated blood
pressure. Rather than continuously monitoring blood pressure by
inflating and deflating the bladder and disturbing the neonate, an
envelope may be positioned around waveform signal 710e and then
monitored for one or more predetermined signal characteristics,
such as any substantial deviations or fluctuations occurring in the
electrical signal that may cross either the lower or upper limit
bands of the envelope and indicated an abnormal condition in the
neonate. Provided pulse waveform signal 710e remains in a steady
state or near steady state condition, it may be assumed that the
previously measured blood pressures levels correlating to the
waveform signals 710e have not substantially changed. If at any
time the generated signal from the sensor assembly passes outside
of the envelope, control system 600 may be programmed to trigger an
alarm to notify health care professionals of the irregularity
and/or perform a new blood pressure measurement and calculation as
described above.
[0066] In this manner, an actual blood pressure measurement
involving inflation of the bladder and subsequent analysis of the
pulse waveform signal 710 occurs only when changes in the waveform
signal 710e indicate probable changes in blood pressure. In this
way, continuous monitoring of blood pressure can be maintained
without having the intrusive inflating and deflating of the bladder
that may disturb the subject.
[0067] In addition to monitoring blood pressure, the sensor
assembly may also provide near-continuous monitoring of the pulse
or heart rate of the subject. This is accomplished in a manner
similar to that previously discussed for providing near-continuous
monitoring of blood pressures. Specifically, the sensor assembly is
applied to a limb of the subject. If the sensor assembly includes
one or more bladders, they should be deflated so as to not
constrict the limb, and, consequently, impede blood flow. The light
source and the photodetector are energized, generating a pulse
waveform signal such as that illustrated in FIG. 12. A similar
waveform signal may be generated by a sensor assembly located
elsewhere on the subject such as the head. As previously discussed,
the pulse waveform signals 700a, 700b are indicative of the
volumetric changes occurring in the flow of blood through the limb
or head. A typical pulse waveform signal 700 will be characterized
by a rhythmic pattern of fluctuations or oscillations in the
signal. These oscillations represent near-continuous changes in the
volumetric blood flow due to the pumping or "beating" action of the
heart or cardiac muscle. Consequently, heart rate can be monitored
by analyzing the waveform signal and determining the number of
oscillations that occur within a predetermined period of time.
[0068] One primary function of blood is to transport oxygen to all
tissues that make up the human body. The ability of blood to
"carry" oxygen is due to the presence of hemoglobin (Hb) in the red
blood cells. Oxygen brought in by the lungs temporarily binds to
the hemoglobin (Hb). The oxygenated hemoglobin (HbO2) is then
transported through the circulatory system, where it releases the
oxygen to the cells that need it. Through use of a device known as
a pulse oximeter, the oxygen saturation level, defined as the ratio
of oxygenated hemoglobin (HbO2) to the total amount of hemoglobin
(Hb+HbO2), can be measured and used to help assess the health of an
individual.
[0069] In an embodiment of the invention, control system 600 may be
configured to function as a pulse oximeter. In an embodiment, the
sensor assembly, may be configured to generate light of two
different wavelengths, such as, for example, 650 nanometers (nm)
and 805 nm. As illustrated in FIG. 14, hemoglobin (Hb) offers
negligible transmission of light having a wavelength of 650 nm,
while oxygenated hemoglobin (HbO2) readily allows for the
transmission of light of 650 nm. In contrast, light having a
wavelength of 805 nm transmits equally well though both hemoglobin
(Hb) and oxygenated hemoglobin (HbO2). Accordingly, the
transmission of light at 650 nm indicates a density of oxygenated
hemoglobin (HbO2), while the transmission of light at 805 nm
indicates a density of total hemoglobin (Hb+HbO2).
[0070] To measure blood oxygen saturation levels, control unit 600
may be configured to alternately energize the two light sources of
the sensor assembly in rapid succession, e.g., energizing the light
sources at 200 pulses per second. In this manner, high-intensity,
short duration pulses of first and second wavelengths of light are
alternately transmitted through the tissue of limb 200 or head 450.
After passing through the tissue of limb 200 or reflecting through
the tissue of head 450, the alternating streams of light are
received by the photodetectors, which, according to this
embodiment, is a broadband photodetector capable of detecting both
wavelengths. Alternatively, two separate narrow band photodetectors
can be used with the sensor assembly, each photodetector capable of
detecting light of one wavelength but not light of the other
wavelength. The photodetectors convert the two alternating optical
signals of different wavelengths into an electric signal
representing the transmittance of two wavelengths. Processor 605
then analyzes the signal and determines the optical density for
each of the two wavelengths. The ratio of first wavelength to
second wavelength optical density is subsequently calculated and
scaled to provide an output value corresponding to the percentage
of oxygen saturation. As part of this process, the output value
generated from the ratio of optical densities can be compared to an
appropriate calibration curve programmed into processor 605, such
as, for example, in the form of a lookup table. The calibration
curve relates optical density to a suspension, such as blood, and
is derived from a variation of Beer's law that relates optical
density to the concentration of a dissolved substance.
[0071] It may be advantageous to establish a baseline measurement
of the transmittance of the two wavelengths of light before using
the sensor assembly to measure blood oxygen saturation levels. In
an embodiment of the invention, such a baseline measurement may be
readily established if the sensor assembly includes at least one
inflatable bladder. Specifically, the bladder may be inflated to a
sufficiently high enough pressure so that it constricts the limb or
head and drives or squeezes substantially all the blood out of the
vessels that run within the portion of the limb or head located in
the cuff or beneath the patch. The constriction of the limb or head
ensures a lack of blood within the optical path established between
the light source and the photodetector. An optical signal passed
through these bloodless regions of the limb and head can then be
assigned a 100% transmission value.
[0072] To decrease the sensitivity of the sensor assembly systems
to stray ambient light, the photodetectors can be synchronously
energized with the light sources. This feature ensures that the
photodetectors are turned on only when a light source is energized,
and minimizes the amount of power drawn by the system, as well as
the amount of heat generated by the light sources and
photodetectors.
[0073] The present invention may also be configured to monitor the
respiration rate of a neonate. Specifically, blood oxygen
saturation levels vary subtly with the breathing process, which
includes the inspiration of oxygen and expiration of waste gases
such as carbon dioxide. Unlike current commercially available pulse
oximeters, the sensor assembly possesses short enough response
times in its measuring capabilities to detect the subtle rhythmic
changes that occur in blood oxygen saturation levels due to the
breathing process. An example of this is illustrated in FIG. 15,
which depicts an analog recording of the transmittance of the first
and second wavelengths of light, such as 650 nm and 805 nm, used to
measure blood oxygen saturation levels. Beyond the relatively
high-frequency oscillations 800 that occur in the signals due to
the pumping of the cardiac or heart muscle, the more subtle
rhythmic variations caused by respiration are readily identified
within the signals by the addition of a signal envelope 820.
[0074] In another embodiment of the present invention, the pulse
waveform signal generated by sensor assembly (e.g., cuff 100 or
patch 400) may be analyzed to interpret the performance of the
cardio-vascular and pulmonary systems in a human being. FIGS. 16A
and 16B illustrate a pulse volume waveform signal similar to pulse
waveform signal 700a of FIG. 12A. The pulse volume waveform signal
of FIG. 16A has been labeled as follows to define areas of interest
that are related to the pumping action of the heart: [0075] A.
Ventricular Contraction [0076] B. Ventricular Pressure Rises and
Ventricular Volume Increases otherwise known as the QRS Complex
[0077] C. When ventricular pressure exceeds aortic pressure, the
aortic valve opens and blood is ejected into the aorta [0078] D.
Isovolumetric Relaxation, muscle relaxes, but maintains volume, and
pressure reduces [0079] E. The rate of volumetric change is shown
by the slope of the curve [0080] F. Dicrotic Notch is observed and
is caused by the closure of the aortic valve [0081] G. T-Wave (EKG)
ends, ventricular pressure decreases, and volume increases [0082]
H., I., J. Are the result of Ventricular Systole [0083] K., L.
Relaxation of the Atrial Chamber provides this signal Changes in
A., B., and C. are understood to be related to the capacity of the
heart to contract or "pump performance" while changes in E., F.,
G., and H. are understood to be related to vascular elasticity. The
sampling and envelope technique described above in a previous
embodiment may be employed to identify changes in the
cardio-vascular and pulmonary systems of a particular human being
as illustrated in FIG. 16B. The changes in the pulse volume
waveform with respect to the envelope may be analyzed and
interpreted by a health care professional to predict in advance
heart disease and other cardio-vascular events that may be related
to a heart attack.
[0084] In yet another embodiment of the present invention, the
pulse waveform signal generated by the sensor assembly, may be used
to produce a Myocardial Contractility Index or "Cardiac Index" and
a Tissue Perfusion Index. Myocardial Contractility is the ability
of the cardiac muscle to contract. The greater the ability of the
cardiac muscle to contract, the greater the cardiac output. Tissue
perfusion is related to the volume and flow of blood through the
blood vessels. Tissue perfusion is related to ability of body
tissues to efficiently exchange waste and nutrients with the blood
and is related to the oxygen saturation levels. A cardiac index and
a perfusion index may be developed from the pulse waveform signals
generated by the sensor assembly.
[0085] FIG. 17 illustrates a pulse volume waveform signal similar
to pulse waveform signal 700a of FIG. 12A. The microprocessor may
be suitably programmed to determine the slope of the curve as well
as the area under the curve associated with a single contraction or
beat of the heart. This single contraction is represented by a time
period from t.sub.0 to t .sub.total. The maximum acceleration,
determined by the upward slope of the curve represents the maximum
contractility of the myocardium at a particular heart rate; The
change in the slope can be used to develop the Myocardial
Contractility Index. Also identified during the single contraction
is a point on the curve where the slope of the curve is equal to
zero, or t.sub.slope=0. The Tissue Perfusion Index may be
represented by the following ratio in determining the area under
the curve to the left of t.sub.slope=0:
t 0 - t slope = 0 t 0 - t total . ##EQU00001##
As the heart rate increases or decreases, each of the above ratios
may change and the rate of change may correlate to underlying heart
disease. A small change in heart rate may cause a drastic change in
the amount of oxygen being carried in the blood, which changes the
efficiency of body tissues to exchange waste and nutrients with the
blood.
[0086] A Vascular Elasticity Index may also be developed from the
same curve used to define the Myocardial Contractility Index and
the Tissue Perfusion Index. The Vascular Elasticity Index may be
represented by the following ratio in determining the area under
the curve to the right of t.sub.slope=0:
t slope = 0 - t total t 0 - t total . ##EQU00002##
Vascular elasticity is a measure of the flexibility of blood
vessels. As the flexibility of the blood vessels increase or
decrease, each of the above ratios may change and the rate of
change may correlate to an underling constriction of the blood
vessels leading to heart disease.
[0087] In another embodiment of the present invention, the pulse
waveform signal generated from the sensor assembly may be compared
to a signal generated from an electrocardiogram (EKG). A
traditional EKG is a measurement of the electrical activity of the
heart. There may be cases where an EKG may be reflect the normal
electrical activity of the heart, yet there is no actual pumping of
blood from the heart. This is known in the art as electromechanical
disassociation. In this particular embodiment, a sensor assembly,
such as patch 400 or cuff 100, may be attached to the skin or
implanted within the body near or around a major artery such as the
aorta. A signal will be generated by the sensor assembly from the
flow of blood through the artery as described in previous
embodiments. The signal generated by the sensor assembly measures
the actual mechanical pumping of the heart as discussed previously.
FIG. 18A illustrates the electrical activity of the heart, an EKG
900, and a signal generated by the pumping action of the heart, the
pulse waveform signal similar to 700a. The two signals may be
monitored concurrently to identify instances when the electrical
activity of the heart, as evidenced by the EKG waveform, is
present, yet there is no measurement of tissue perfusion by the
sensor assembly, i.e., the heart is not pumping (see FIG. 18B).
This would be evidence of electromechanical disassociation.
Electromechanical disassociation, if not recognized, may result in
death. Also, both signals may be monitored on a particular person
that requires the aid of a pacemaker to ensure that the heart is
responding to the signals from the pacemaker.
[0088] In yet another embodiment of the present invention, a health
care professional may rely on the actual measurements of mean
arterial pressure (see FIGS. 13A and 13B), myocardial contractility
(see FIG. 17), tissue perfusion (see FIG. 17), and vascular
elasticity (see FIG. 17) as defined and discussed above to perform
a diagnostic analysis or diagnosis of a person without having to
rely on a calculation of the traditional diastolic and systolic
blood pressure numbers. The measurements described above are all
available signals generated from the sensor assemblies that detect
the volume and flow of blood through the vessels. A health care
professional may rely on the actual measurements rather than the
calculated systolic and diastolic blood pressure numbers to provide
a more precise and accurate diagnosis of the pulmonary system of
any particular person.
[0089] Databases of envelopes may also be created as described in
previous embodiments based on the above measurements to develop a
number diagnostic indexes such as the cardio index, tissue
perfusion index, and vascular elasticity index. These databases may
be developed either generically across a population of people based
on age, gender, size, etc., or specific to one person based on
previous physicals and signal monitoring. The above indexes along
with a measurement of mean arterial pressure may be used to
quickly, precisely, and accurately diagnose a potentially fatal
pulmonary issue if left untreated and more importantly
undiscovered.
[0090] In another embodiment of the present invention, a sensor
assembly, such as patch 400 or similar device may be adapted for
use in an effort monitor the physical health of a person on the
battlefield or in flight during a war or fighting situation. The
embodiments described above to generate pulse waveform signals to
monitor vital sign parameters may be employed to continuously or
periodically monitor a person's physical health in battle. Rather
than being connected directly to control system 600 as described in
previous embodiments, radio frequency, ultrasonic, or optical based
signals may be employed to transmit signals between an individual
soldier and a central command center monitoring all soldiers. Low
power devices such as patch 400 may be directly interfaced onto the
soldier's outer skin or incorporated into their uniforms or
gear.
[0091] It will be appreciated from the above description the sensor
assemblies of the present invention provides significant advantages
over prior art systems and methods by providing the ability to
monitor blood parameters, such as blood pressure, heart rate,
oxygen saturation and respiration rate, in a near-continuous manner
through analysis of a single optical signal. Furthermore; the
non-invasive features of the present invention make it an ideal
blood parameter monitor for use with neonates. Traditional
monitoring devices, such as, for example, ausculatory and prior
oscillometric-based methods for monitoring blood pressure, are
frequently ineffective with subjects such as neonates due to their
relatively small size. In contrast, the sensor assemblies of the
present invention are capable of accurately monitoring blood
parameters in a relatively small biological entity by transmitting
an optical signal through the limb or head of the biological
entity. Indeed, the smaller the biological entity, the less tissue
the optical signal has to traverse, resulting in a stronger signal
that is received by the photodetector and subsequently analyzed to
determine vital sign parameters such as, for example, blood
pressure.
[0092] In the foregoing discussion, the present invention has been
drawn to a system and method for monitoring certain vital sign
parameters of a neonate by directing an optical signal through the
tissue of the neonate's limb or forehead. According to the
embodiments discussed up until now, this is accomplished through
the use of a cuff-based or patch-based structure that wraps around
a limb or is position on a head, or, alternatively, into which a
limb is inserted, the cuff and patch structure thereby retaining a
light source and photodetector in proximity to the limb and head.
However, it is envisioned that the present invention can be
implemented in numerous other configurations that would be as
equally effective in providing near-continuous monitoring of
certain blood parameters of a neonate. For example, according to
one additional embodiment of the invention, no such type of cuff
structure is utilized. Instead, the light source and photodetector
are selectively retained in proximity to the limb through the use
of some form of clip or clamping structure that does not encircle
the entire limb or, alternatively, through the use of a removable
adhesive.
[0093] The present invention has been particularly shown and
described with reference to the foregoing embodiments, which are
merely illustrative of the best modes for carrying out the
invention. It should be understood by those skilled in the art that
various alternatives to the embodiments of the invention described
herein may be employed in practicing the invention without
departing from the spirit and scope of the invention as defined in
the following claims. It is intended that the following claims
define the scope of the invention and that the method and apparatus
within the scope of these claims and their equivalents be covered
thereby. This description of the invention should be understood to
include all novel and non-obvious combinations of elements
described herein, and claims may be presented in this or a later
application to any novel and non-obvious combination of these
elements. Moreover, the foregoing embodiments are illustrative, and
no single feature or element is essential to all possible
combinations that may be claimed in this or a later
application.
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