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Development of an Automatic Detection of Pressure
Distortion and Alarm System of Endotracheal Tube
Md. Nasfikur R. Khan, M M Tanzirul Iqbal, Sarmila Yesmin, A K Ehsanul Haque Mashuk, Faisal Bin Shahin, M Abdur Razzak
Department of Electrical and Electronic Engineering, Independent University, Bangladesh
Plot-16, Block-B, Bashundhara, Dhaka-1212, Bangladesh
E-mail: mnrkhan@iub.edu.bd
Abstract – Endotracheal tube (ETT) is a widely used lifesaving
tool in case of moderate to severe medical predicaments. It
enables an alternative means of mechanical ventilation for
tranced or comatose patients. The gadget also helps in ventilation
in case of giving general anaesthesia during major surgical
procedures. Along the symbiotic use of the system comes the
delicate maintenance and adequate monitoring of the instrument.
One of the important features of the system is the air-filled cuffs
or simply the air balloons that are availed to sustain the optimal
intrinsic conditions of the pharmacological actions desired for the
patient. The mechanism is to prevent aspiration of secretion of
nasal mucosa. Because these secretions can cause aspiration
pneumonia which is a life-threatening complication of these
morbid patients. However, this requires periodic monitoring of
pressure levels and facile adjustments to avoid aspiration, which
might be even fatal. The subtlety of the course of action is often
overlooked and negligence gives rise to unsought fatality in some
patients. To reverse the course of this mishap, we came about our
vocational modification to the conventional endotracheal tubes
and air cuffs. The embodiment of automation ensures the
inviolability as well as omission of professional lapse. The
automatic apparatus facilitates the automatic detection of the
pressure distortion and alarms the designated healthcare expert
as a forewarning and hence the patient is bypassed any
associated threat.
Keywords: Endotracheal tube, air cuffs, pressure sensor, alarm
system, PVC tube, microcontroller, Bluetooth module, Arduino
.
I.
I
NTRODUCTION
During 1893, the use of a cuffed Endotracheal Tube (ETT)
was first explained by Esienmenger, and the intracuff pressure
monitoring system using pilot balloon was also introduced
during that time [1]. Franz Kuhn, a well-known
anaesthesiologist, showed the use of metal tubes, and
preferred the oral route over tracheostomy which made
orotracheal anaesthesia popular in the early 1900s [2]. He was
the first to discover the importance of the ETT as a path to
remove pulmonary secretions. In 1913, Jackson and Janeway
published their experiences using laryngoscopy, paving the
way for development and claiming of flexible rubber tubes
[3]. They used Insufflation anaesthesia technique, where gas
was blown into lungs through a small tube and exhaled gas
flowed around outside of the tube. In 1920, an improved
laryngoscope was introduced, making the endotracheal
technique more accepted [4]. Row Botham and Magill (1926)
designed larger rubber tubes that allowed gas to follow
bidirectional manner through the tube [5].
The early tubes were made from commercial rubber hose,
whose diameters are varying from 3/8 to 3/16th of an inch.
Now, the simplest Endotracheal Tube is considered to be
made from the transparent polyvinyl chloride (PVC) with a
tubing length of about 30cm long. This ETT is an
improvement comparing to the early day’s rubber and metal
ETTs. These PVC EET tubes are in flammable and easy to
make curvature shape comparing to those metal and rubber
ETTs. Due to curvature shape, these ETTs are easy to insert.
The Anatomical curvature of the endotracheal tube guides
the path of the airway and the head should be held in the
neutral position. According to ISO5356-1 standard [2], a
curvature of approximately 140mm radius (+/- 20mm) is
needed to be designed with some exceptions, where the size of
connectors for airway equipment are determined by the size of
the body. According to this standard, the connectors’ internal
diameters should be 15mm and 22mm, respectively. In order
to avoid ventilation, all airway equipment should be
connectable to each other.
For adults, air-filled cuff is the key feature of the ETT.
Once filled with air, the cuff seals the lungs against the liquid
secretions sloshing around in the upper airway. This problem
has been solved using pilot balloon which can be pressurized
below the cuff and ventilated with a carefully controlled gas
mixture. This method seals the trachea thereby preventing to
escape the positive pressure from the lower airway. This will
also seal the upper airway by blocking material above the
glottis to enter into the trachea. However, pilot balloon is a
small sack of air to guide to the integrity of anyone’s cuff. It is
connected to the cuff with a narrow lumen, which is not very
strong, and can be overtaken easily. There is also a spring-
powered one-way valve used in the pilot balloon which can
break in the process of frequent use. The size of the pilot
balloon is another concern of fixing this problem.
Suction port enables the aspiration of secretions which is
collected above the tube cuff. Those secretions which consist
of an infected mixture of saliva and nasal mucus, stewing in
the steamy environment of the plugged larynx. The
disadvantage of suctioning above the cuff is mucosal damage
because the sucker applies about 100mmHg pressure to the
tracheal wall. This sort of pressure known as "low wall
suction" can still strip mucosa off the walls of the trachea. So,
there is a risk associated with continuous rather than
intermittent subglottic suction [6].
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The endotracheal tube performs in a symmetrical sliding
way through the nasal cavity. The inferior turbinate divides
the upper and the lower pathway of the tube. The passage of
the upper tube prompts the presentation to the tracheal
pathway. The lower portion of the tube meets the esophageal
stream. Bougies are an essential part of the entire apparatus
that are placed for the facilitation of the passage through the
airways. These Bougies acts as a catheter of the air exchange.
The air caught inside these bougies stay under pressure and
makes an impermeable environment. Under these conditions,
the assurance of the pressure fluctuations must be observed
periodically [7-10].
The objective of this research paper is to design a new type
of Endotracheal Tube (ETT) with automatic pressure
monitoring system, which will help to solve issues of
manually monitoring the condition of ETT by checking the
pressure on the pilot Balloon. It is also reusable, and will
reduce human labour [11].
II. P
ROPOSED
S
YSTEM
To have a superior experience and a programmed
framework a better system has been proposed. Here, the
difficult route and fizzled intubation envelop a range including
difficult cover ventilation, difficult laryngoscopy, difficult
intubation and failed intubation. The most feared circumstance
is that we can't ventilate- respiratory events [12-14]. The
acclimated specifications of the equipment manage a level of
weight that probably won't be all around endured, and causes
consequent slash and hampers the desired result. The way that
the system is completed fairly physically enables the
conceivable outcomes of human mistake to remain. Thus, a
digitalization of the procedure control would give access to a
systemically effective device [15-16].
To encourage this phenomenon, we have conjectured the
expansion of a sensitive baroceptor or pressure recognizing
device inside the bougies to detect the distinctions in the
encompassing pressure. The device has a precision of 0.01
atm. The pressure sensor identifies pressure changes and sends
signals to micro-controller which gathers and processes the
information received. Progressively, utilizing a Bluetooth
device the collected information is sent to the handsets or
tabloids of the personnel observing and attending the patients.
By the use of an easy application, the information is
introduced to the personnel. At a point the pressure near the
subjective condition oscillate above or beneath the assigned
pressure of the indicator, a signaling alarm will notify the
responsible individual. On that record, the occurring variance
of pressure is informed to the healthcare professional,
instantly. A definitive target of this adjustment is to improve
the observing episodes and guarantee better proficiency [17-
19].
Our primary target was to develop this device with least
minimum cost and maximum effectiveness. The system
components and their role are listed below where all the
transmitter and receiver work in low power supply.
(i) ATmega 328p: The elite Microchip Pico Power 8-bit
AVR RISC-based microcontroller combines 32KB ISP flash
memory with read-while-write capacities, 1024B EEPROM,
2KB SRAM, 23 broadly useful I/O lines, 32 general purpose
working registers, three adaptable clock/counters with
compare modes, internal and external interrupts on, serial
programmable it works inside 1.8-5.5 Volts.
(ii) HC-05 Bluetooth module: It is used for wireless
communication fully supported via the Bluetooth having the
speed of 2.4GHz radio transceiver with a sensitivity of 80
dBm along with a supply voltage of 3.3-5 volts.
(iii) Arduino: A 8 bits AVR microcontroller with
comprisable amounts of flash memory, pins, and features. It
runs at 8 MHz and dispense with the on-board voltage
regulator due to specific form-factor restrictions. It can operate
within the voltage range of 3.3-5 volts.
(iv) BMP 280 pressure sensor: A barometric pressure
sensor especially designed for mobile applications. It has a
small dimension and its low power consumption allows the
implementation in battery driven devices such as mobile
phones, GPS modules etc. The operating voltage range is
between 1.71-1.80 volts.
(v) Battery: It consists of chemical cells which drive the
current into a conductive component to a device to activate the
respective circuit. It controls up the entire system when the
system begins.
III. P
RACTICAL
I
MPLEMENTATION
The practical implementation could be clarified in two sub
sections. Initially, the system assembling isdescribed, and after
that the system implementation is presented.
A. Assembling the System
The overall assemble procedure has been described in two
different stages. In Stage 1, the transmitter unit has been
discussed while stage 2, which is the master slave section,
explains the receiver.
(1) Stage 1: Slave Section/ Transmitter Unit
Figure 1 shows the block diagram of stage 1. This section
contains ATmega 328p, Bluetooth HC 05, and BMP 280.The
BMP 280 calculates the pressure at a particular area, placed on
a plastic balloon, which is considered here the as a lung of a
human. The pressure sensor detects the pressure inside the air
tight balloon with respect to VCC and ground the SCL and
SDA pin sends the pressure value to AT mega 328p. Here
ATmega works as the processing unit for the transmitting
section.It receives the signal from the pressure sensor with
respect to VCC and ground; the processing unit send the
signal to the Bluetooth HC 05 through pins RX and TX
(receiver and transmitter). The RX of ATmega 328p is
connected to the TX of Bluetooth HC 05 and the TX of
ATmega is connected to the RX of Bluetooth HC. The
Bluetooth HC 05 receives the message from the processing
unit and transmits the signal in the air to let the other receiver
receives the message with respect to time. Figure 1
demonstrates the transmitter unit of the implemented system.
2018 IEEE-EMBS Conference on Biomedical Engineering and Sciences (IECBES)
978-1-5386-2471-5 ©2018 IEEE
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Fig. 1. Shows the block diagram of stage 1
(2) Stage 2: Master Slave Section / Receiver Unit
This section consists of Bluetooth HC 05, Arduino and
personal computer (PC). The IP address for both the Bluetooth
HC 05 of transmitter unit and receiver unit is matched so that
when the slave section transmits the signal the master slave
receives the transmitted signal sent by the slave section. The
master slave Bluetooth HC 05 the TX is connected to the TX
of Arduino and the RX is connected to the RX of Arduino.
Here both the pins are matched to receive the same signal data
send by the slave section. The Arduino receives the data signal
from the Bluetooth and sends the data to the PC to analyse a
graphical view programmed at the PC. In Arduino, the
programming is done to detect the pressure value inside the
balloon. If the pressure value of the balloon increases more
than its reference value the buzzer is turned on making alert to
the surroundings. The buzzer will also buzz, if the pressure is
below the reference level. Fig. 2 shows the block diagram of
receiver unit of the implemented system.
Fig. 2. Demonstrates the block diagram of stage 2
B. Implementation
In the implementation section, we tested that whether the
Bluetooth HC 05 receives or transmits signal with a confirmed
IP address. The transmitter and receiver setup are shown in
Fig. 3 and 4, respectively.
Fig. 3. Shows the primary setup of the transmitter
While testing we confirmed that the processing unit sends
the signal from the pressure sensor. ETT cuff pressure was
weighed in 10 adult patients who went through critical care
where endotracheal intubation was needed. The overall
procedure of ETT cuff pressures within the recommended
range (25–30 cm of water) was 40% and it was above the
recommended range in 60% [20]. We checked the graphical
values of the stored data in the Arduino from the master slave
section. Fig. 5 demonstrates the graphical display of the data
stored from patient’s response.
Fig. 4. Demonstrates the primary setup of the receiver
Fig. 5. Shows the graphical display of the stored data
The ulterior motive of the indicated alterations and
technical enhancement of the apparatus was sheer
augmentation of the conventionally used application of
endotracheal intubation throughout the medical industry and
healthcare institutions. To receive a preceding admonition
based on the authentic pathophysiological condition of the
patient not only evade chances of casualty but also saves the
valuable time of the skillful professionals who are designated
to multiple patients simultaneously. An up to date rendition is
sought for in every aspects of vitality and specially health care
[21].
2018 IEEE-EMBS Conference on Biomedical Engineering and Sciences (IECBES)
978-1-5386-2471-5 ©2018 IEEE
478
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IV. C
ONCLUSION
An automatic detection of pressure distortion and alarm
system of endotracheal tube is developed and tested which
confirms that the processing unit sends the signal from the
pressure sensor successfully. The proposed system is a
modification of the conventional endotracheal tube, where the
pressure distortion of endotracheal tube is monitored via a
pressure sensor thereby sending the alarm to the respective
personnel automatically. The proposed system intends to meet
the demands of the patients and professionals as well as
mitigate the scopes of flaws and delicacy.
A
CKNOWLEDGMENT
We would like to thank Eng. Mohammad Masud Uddin
Khan and Ahsanul Kabir Shawon for their continuous support
in research and development of the project.
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