Landquart, Switzerland
Landquart, Switzerland

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Grant
Agency: European Commission | Branch: H2020 | Program: RIA | Phase: PHC-18-2015 | Award Amount: 5.54M | Year: 2016

Each year 15 million babies are born prematurely and many suffer from respiratory failure due to immaturity of the lung and lack of control of breathing. Although respiratory support, especially mechanical ventilation, can improve their survival, it also causes severe injury to the vulnerable lung resulting in severe and chronic pulmonary morbidity lasting in to adulthood. Heterogeneity of lung aeration, resulting in areas of lung over inflation and lung collapse, plays a crucial part in the risk of mortality and morbidity due to respiratory failure. This distribution of lung aeration cannot be detected by currently available bedside monitoring tools and imaging methods. Thus, an imaging technique for continuous non-invasive bedside monitoring of infants lung function is urgently needed. In order to address this, CRADL will use EIT technology to establish a monitoring tool for interventions in the paediatric population. Electrical impedance tomography (EIT) is a non-radiative, inexpensive technique that can facilitate real time dynamic monitoring of lung aeration, and recent studies have shown that it is effective in monitoring aeration in preterm babies. CRADL will show how EIT can provide new cost effective, easy to use, respiratory management tools and clinical protocols that can be universally adopted to reduce deaths and disability in preterm babies by delivering a tool that provides continuous, non-invasive, radiation free, bedside information on regional lung aeration and ventilation during daily clinical care of (preterm) infants and children with respiratory failure. CRADL will also assess the effectiveness, efficacy and safety of such a system in guiding respiratory management and supportive care of the most common causes of paediatric respiratory failure (respiratory distress syndrome, bronchiolitis and acute respiratory distress syndrome), with the final goal of reducing short and long term adverse effects of disease and its treatment in this populat


Tusman G.,Hospital Privado Of Comunidad | Bohm S.H.,Swisstom AG | Warner D.O.,Rochester College | Sprung J.,Rochester College
Current Opinion in Anaesthesiology | Year: 2012

PURPOSE OF REVIEW: This review evaluates the link between perioperative lung atelectasis and postoperative pulmonary complications (PPCs) and how appropriate ventilatory strategies could mitigate this problem. RECENT FINDINGS: Atelectasis may contribute to serious PPCs including respiratory failure and pneumonia. Ventilator settings during anesthesia, especially with higher tidal volumes (V T) (>10 ml/kg), high plateau pressures (>30 cmH 2O) and without positive end expiratory pressure (PEEP), are associated with lung injury even in healthy, but partially collapsed, lungs. These injurious settings may cause inflammation which is related to repetitive tidal recruitment and alveolar overdistension. Such ventilator-induced lung injury can be attenuated by using low V T and plateau pressures at sufficient PEEP, ideally after actively recruiting the lungs. The use of continuous positive airway pressure and 'lower' FiO 2 during anesthetic induction, intraoperative use of lower FiO 2, low V T, lung recruitment and PEEP ('protective ventilatory strategy') in conjunction with postoperative early mobilization, breathing exercises and continuous positive airway pressure may help in maintaining lung aeration, thereby decreasing hypoxemia and risk of postoperative pneumonia. Evidence is accumulating suggesting that the incidence of postoperative pulmonary complication could be markedly reduced if an 'open lung' philosophy was adopted for the perioperative care. SUMMARY: A goal-directed ventilatory approach keeping an 'open lung' condition during the perioperative period may reduce the incidence of PPCs. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Tusman G.,Hospital Privado Of Comunidad | Sipmann F.S.,Uppsala University | Sipmann F.S.,Institute Investigacion Sanitaria | Bohm S.H.,Swisstom AG
Anesthesia and Analgesia | Year: 2012

Dead space is the portion of a tidal volume that does not participate in gas exchange because it does not get in contact with blood flowing through the pulmonary capillaries. It is commonly calculated using volumetric capnography, the plot of expired carbon dioxide (CO2) versus tidal volume, which is an easy bedside assessment of the inefficiency of a particular ventilatory setting. Today, Bohr's original dead space can be calculated in an entirely noninvasive and breath-by-breath manner as the mean alveolar partial pressure of CO2 (PACO2) which can now be determined directly from the capnogram. The value derived from Enghoff's modification of Bohr's formula (using PaCO2 instead of PACO2) is a global index of the inefficiency of gas exchange rather than a true "dead space" because it is influenced by all causes of ventilation/perfusion mismatching, from real dead space to shunt. Therefore, the results obtained by Bohr's and Enghoff's formulas have different physiological meanings and clinicians must be conscious of such differences when interpreting patient data. In this article, we describe the rationale of dead space measurements by volumetric capnography and discuss its main clinical implications and the misconceptions surrounding it. Copyright © 2012 International Anesthesia Research Society.


Electrode sensor comprising an array of spaced apart individual contact elements (27, 41), and an interface structure (30, 35) for forming contact between said contact elements and the skin; said interface structure comprising an interface layer of an essentially electrically insulating or poorly electrically conducting material (20, 29, 37) defining a skin (31) contact surface on one side and an array contact surface on the other side of the interface layer, a first pattern of an electrically conducting material on the array contact surface, a second pattern of an electrically conducting material on the skin contact surface, and electrical pathways (21, 39) connecting the first pattern with the second pattern; whereas, the first pattern comprises pattern elements, each individual contact element (27, 41) comprises a contacting surface area large enough to cover several pattern elements of said first pattern when contacting the array contact surface of the interface structure, and by contacting distinct sections of the first pattern with said individual contact elements, groups of electrical pathways establish contact further with distinct sections of the second pattern, so that an individual contact element (27, 41) defines an individual effective electrode on the skin contact surface. Method of manufacturing said electrode sensor, comprising the steps of: providing said interface structure, creating a first pattern of an electrically conducting material on its array contact surface, a second pattern of an electrically conducting material on its skin contact surface, electrically conducting pathways connecting the first pattern with the second pattern, and contacting sections of the electrically conducting first pattern with an array of spaced apart contact elements.


Patent
Swisstom Ag | Date: 2014-10-03

An electrical impedance tomography system for determining electric properties of an internal body part of a patient comprises an electrode array in electrical contact with the patient, a device for applying current or voltage between electrodes of the array and for measuring voltages or currents between other combinations of the array. A computing unit comprises a processor and a storage unit. The storage unit comprises a reconstruction algorithm used by the data processor for reconstructing the measured voltages of the body part into electrical properties or changes thereof. The data processor outputs a representation of the reconstructed electrical properties and generates or processes anatomical models descriptive of the body part. The data processor uses biometric data of the patient and, according to the biometric data of the patient, selects an anatomical model for reconstructing the measured electrical voltages of the body part into electrical properties or changes thereof.


An electrode assembly for an EIT scanning device (11) including an electrode (15), a current supply unit (17), a voltage buffer unit (19), a switch logic unit (21), and lines for connecting the different elements, whereby the switch logic unit (21) comprises at least one element of a first shift register (27) and at least one element of a second shift register (29). A belt-like device comprising a plurality of said electrode assemblies. A method of measuring an EIT-image using such electrode assemblies preferably arranged in such a belt-like device.


An electro impedance measuring belt for placing electrodes around the thorax of a patient comprises an array of a plurality of spaced apart electrodes, and a support structure, on which the electrodes are arranged. The support structure with the electrode array comprises two angulated legs on which the electrodes are lined up, the two legs spread out from an apex at an angle, such that, when the belt is put around the thorax of a patient, the array of electrodes extends from the back of the patient, where the apex of fee angulated legs is to be located, essentially parallel to the ribs to the lower part of the breastbone of the patient.


A sensor device for EIT imaging comprises an electrode array for measuring an impedance distribution, with at least one sensor for determining spatial orientation of the electrode array coupled to the electrode array. An EIT imaging instrument is connectable to a sensor for determining spatial orientation of a test person, and optionally in addition connectable to a sensor for gathering information on electrical and/or acoustic activity and/or a sensor for gathering information on dilation. A computing device is connected or integrated for adjusting impedance data based on spatial data, which spatial data describe the spatial orientation of a test subject. An EIT imaging method for measuring an impedance distribution and adjusting said measured impedance distribution comprises measuring impedance distribution by using an impedance distribution measuring device comprising an electrode array, and transforming the measured impedance distribution into EIT images.


An electrode sensor kit for establishing electrical contact with skin comprises at least one contact element and a preparation comprising a mixture of water and at least one lipid for enhancing electrical contact properties between said contact element and the skin, wherein said mixture forms an emulsion, in particular a water-in-oil or an oil-in-water emulsion, having a conductivity of less than 3 mS/cm. An electrode assembly for electrical impedance tomography which comprises said kit is characterized in that (a) said at least one contact element forms an electrode or sensor plate, and (b) said at least one contact element comprises a layer of said preparation.


A pressure measuring System (11, 111, 211) is described comprising a sensor assembly (13, 113, 213) and a vessel adapter (17, 217), with the sensor assembly defining a compartment (19, 119, 219, 220), comprising a measurement port (29, 129, 229, 230), an actuator (21, 121, 221, 222) for enabling and disabling pressure transmission across the measurement port, and at least one pressure sensor (23, 123, 223, 224, 225) for measuring a pressure in the compartment relative to a reference pressure, and the vessel adapter defining a fluid chamber (47, 247, 248), said chamber being in pressure connection with the compartment by means of said measurement port, and characterized in that in-between the compartment and the fluid chamber at least one membrane (15, 215) is located which separates the medium in the compartment from the medium in the fluid chamber. The pressure measuring System is used to measure the pressure of a medium in a vessel adapter relative to a reference pressure. In a further embodiment the pressure measuring System is adapted to measure the differential pressure of a medium flowing through a vessel adapter with a flow restrictor.

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