Validation Study of Two-microphone Acoustic Reflectometry for Determination of Breathing Tube Placement in 200 Adult Patients

2002 ◽  
Vol 97 (6) ◽  
pp. 1371-1377 ◽  
Author(s):  
David T. Raphael ◽  
Maxim Benbassat ◽  
Dimiter Arnaudov ◽  
Alex Bohorquez ◽  
Bita Nasseri
Keyword(s):  
Tracheal Intubation ◽  
False Negative ◽  
Adult Patients ◽  
Tube Placement ◽  
Segment Length ◽  
Esophageal Intubation ◽  
Cross Sectional ◽  
Identification Rate ◽  
Breathing Tube

Background Acoustic reflectometry allows the construction of a one-dimensional image of a cavity, such as the airway or the esophagus. The reflectometric area-distance profile consists of a constant cross-sectional area segment (length of endotracheal tube), followed either by a rapid increase in the area beyond the carina (tracheal intubation) or by an immediate decrease in the area (esophageal intubation). Methods Two hundred adult patients were induced and intubated, without restrictions on anesthetic agents or airway adjunct devices. A two-microphone acoustic reflectometer was used to determine whether the breathing tube was placed in the trachea or esophagus. A blinded reflectometer operator, seated a distance away from the patient, interpreted the acoustic area-distance profile alone to decide where the tube was placed. Capnography was used as the gold standard. Results Of 200 tracheal intubations confirmed by capnography, the reflectometer operator correctly identified 198 (99% correct tracheal intubation identification rate). In two patients there were false-negative results, patients with a tracheal intubation were interpreted as having an esophageal intubation. A total of 14 esophageal intubations resulted, all correctly identified by reflectometry, for a 100% esophageal intubation identification rate. Conclusions Acoustic reflectometry is a rapid, noninvasive method by which to determine whether breathing tube placement is correct (tracheal) or incorrect (esophageal). Reflectometry determination of tube placement may be useful in airway emergencies, particularly in cases where visualization of the glottic area is not possible and capnography may fail, as in patients with cardiac arrest.

Acoustic Reflectometry Profiles of Endotracheal and Esophageal Intubation

2000 ◽  
Vol 92 (5) ◽  
pp. 1293-1299 ◽  
Author(s):  
David T. Raphael
Keyword(s):  
Pilot Study ◽  
Endotracheal Tube ◽  
Cardiopulmonary Arrest ◽  
Cross Sectional Area ◽  
Tube Placement ◽  
Esophageal Intubation ◽  
Sectional Area ◽  
Cross Sectional ◽  
Emergency Imaging ◽  
Sudden Decrease

Background Acoustic reflectometry can be used to create a "one-dimensional image" of a cavity, such as the airway and lung, with the image displayed as an area-length curve. This pilot study was undertaken to determine whether acoustic reflectometry could be used to distinguish between an endotracheal and an esophageal intubation. Methods Ten adult patients underwent general endotracheal anesthesia and neuromuscular blockade. The reflectometer wavetube was attached to an endotracheal tube, and a reflectometric profile was obtained of the endotracheal tube and the airway and lung cavity. After confirmation of tracheal intubation, a second endotracheal tube was placed in the esophagus. After four breaths were administered, a reflectometric profile of the endotracheal tube-esophagus cavity was obtained. Results The acoustic reflectometric profiles for tracheal and esophageal intubation profiles were distinctive and characteristic. For an endotracheal tube-airway cavity, the profile shows a constant cross-sectional area throughout the length of the endotracheal tube, followed by a rapid rise in the area past the carina. For an esophageal intubation, the profile shows constant cross-sectional area throughout the length of the endotracheal tube, followed by a sudden decrease in the cross-sectional area to zero. Conclusions In this pilot study, acoustic reflectometry within seconds, and without resort to capnography, was able to generate characteristic and distinctive area-length profiles for both endotracheal and esophageal intubation. Acoustic reflectometry may have a role in the emergency imaging of the airway, and in the immediate detection of esophageal intubations, particularly in cases of cardiopulmonary arrest in which the usual techniques for confirmation of breathing tube placement fail.

Efficacy of the Self-inflating Bulb in Confirming Tracheal Intubation in the Morbidly Obese

1996 ◽  
Vol 85 (2) ◽  
pp. 246-253 ◽  
Author(s):  
David J. Lang ◽  
Yaser Wafai ◽  
Ramez M. Salem ◽  
Edward A. Czinn ◽  
Ayman A. Halim ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
False Negative ◽  
The Self ◽  
Morbidly Obese ◽  
Esophageal Intubation ◽  
Obese Patients ◽  
True Positive ◽  
Negative Results ◽  
False Negative Results ◽  
Positive Results

Background This study was designed to determine the incidence of false-negative and false-positive results when the self-inflating bulb (SIB) is used to differentiate tracheal from esophageal intubation in morbidly obese patients using two techniques. In technique 1, the SIB is compressed before it is connected to the tube; in technique 2, the SIB is compressed after connection to the tube. Methods With institutional review board approval, 54 consenting adult morbidly obese patients (body mass index > 35) undergoing elective surgical procedures were included in the study. After anesthetic induction and muscle relaxation, both the trachea and esophagus were intubated under direct vision with identical cuffed tubes. The efficacy of the SIB in verifying the position of both tubes was tested by a second anesthesiologist. The speed of reinflation was graded as rapid ( < 4 s) or none ( > 4 s), using both techniques. In the case of tracheal intubation, the absence of reinflation was recorded as a false-negative, whereas in cases of esophageal intubation, rapid reinflation was recorded as a false-positive. Identification of tube location by the second anesthesiologist was based on SIB reinflation results from techniques 1 and 2, as well as the presence of a flatuslike sound elicited by technique 2 in esophageally placed tubes. All patients were retested by the SIB after receiving three breaths of 400-500 ml each. In all patients exhibiting false-negative results, six obese patients exhibiting true-positive results, and four nonobese patients exhibiting true-positive results, tracheal responses to the SIB maneuvers were observed directly by a flexible fiberoptic bronchoscope incorporating an airtight system, 15-20 min after mechanical ventilation was instituted. Results The incidence of false-negative results was initially 30% with technique 1 and 11% with technique 2, but decreased to 4% when technique 2 was used after the delivery of three breaths. The second anesthesiologist initially identified tube location in 92.5% of patients correctly. After the delivery of three breaths, tube location was correctly identified in 96.3% of patients. Fiberoptic bronchoscopic examination of the patients exhibiting false-negative results revealed exaggerated inward bulging of the posterior tracheal membrane during reinflation of the SIB when technique 1 was used. Conclusions Contrary to previous investigations in healthy patients, the current study demonstrates a high incidence of false-negative results when the SIB is used to confirm tracheal intubation in morbidly obese patients. If the SIB is used, the technique should include compression of the SIB after connection to the tube and should be used in conjunction with other clinical signs and technical aids. The mechanism of false-negative results in these patients seems to be related to reduction of caliber of airways secondary to a marked decrease in functional residual capacity, and collapse of large airways due to invagination of the posterior tracheal wall when sub-atmospheric pressure is generated by the SIB.

Gender determination of caucasoid hair using image analysis

1993 ◽  
Vol 51 ◽  
pp. 216-217
Author(s):  
T.B. Ball ◽  
W.M. Hess
Keyword(s):  
Image Analysis ◽  
Cross Sections ◽  
Scalp Hair ◽  
The Body ◽  
Equivalent Diameter ◽  
Cross Sectional ◽  
Hair Samples ◽  
Length Width ◽  
Morphological Differences

It has been demonstrated that cross sections of bundles of hair can be effectively studied using image analysis. These studies can help to elucidate morphological differences of hair from one region of the body to another. The purpose of the present investigation was to use image analysis to determine whether morphological differences could be demonstrated between male and female human Caucasian terminal scalp hair.Hair samples were taken from the back of the head from 18 caucasoid males and 13 caucasoid females (Figs. 1-2). Bundles of 50 hairs were processed for cross-sectional examination and then analyzed using Prism Image Analysis software on a Macintosh llci computer. Twenty morphological parameters of size and shape were evaluated for each hair cross-section. The size parameters evaluated were area, convex area, perimeter, convex perimeter, length, breadth, fiber length, width, equivalent diameter, and inscribed radius. The shape parameters considered were formfactor, roundness, convexity, solidity, compactness, aspect ratio, elongation, curl, and fractal dimension.

Profil Penyakit Malaria Di Rumah Sakit Islam Siti Rahmah Padang Tahun 2018

2020 ◽  
Vol 2 (2) ◽  
pp. 08-15
Author(s):  
Rahma Triyana ◽  
Salmi Salmi
Keyword(s):  
Observational Study ◽  
Frequency Distribution ◽  
Cross Section ◽  
Laboratory Tests ◽  
Age Group ◽  
Normal Range ◽  
Cross Sectional ◽  
West Sumatra ◽  
Severity Of The Disease

Malaria is one of the health problems in Indonesia, especially West Sumatra. Determination of the description of Malaria disease in an area is needed to determine the spread and severity of the disease. This study aims to determine the frequency distribution according to age, sex and place of residence, description of the types of Plasmodium causes of Malaria and hematological features in Malaria patients at Siti Rahmah Padang Hospital in 2018. This type of research is a descriptive observational study with an approach or design cross section (cross sectional). The frequency distribution of Malaria sufferers in Siti Rahmah Padang Hospital in 2018 according to the highest age was in the age group 21-30 years as many as 28 cases (36.8%), the highest sex among men was 46 (60.5%) and the highest number of residences was found in Koto Tangah sub-district there were 31 cases (40.8%). The type of Plasmodium found in Malaria cases in Siti Rahmah Padang Hospital in 2018 was P. vivax (73 cases (96.05%)) and P. falciparum (3 cases (3.95%)). The results of laboratory tests on Hb, hematocrit, platelet and leukocyte levels in Malaria positive patients in Siti Rahmah Padang Hospital in 2018 were in the normal range.

Profil Penyakit Malaria di Rumah Sakit Islam Siti Rahmah Padang Tahun 2018

2020 ◽  
Vol 2 (2) ◽  
pp. 08-15
Author(s):  
Rahma Triyana Y ◽  
Salmi Salmi
Keyword(s):  
Observational Study ◽  
Frequency Distribution ◽  
Cross Section ◽  
Laboratory Tests ◽  
Age Group ◽  
Normal Range ◽  
Cross Sectional ◽  
West Sumatra ◽  
Severity Of The Disease

Malaria is one of the health problems in Indonesia, especially West Sumatra. Determination of the description of Malaria disease in an area is needed to determine the spread and severity of the disease. This study aims to determine the frequency distribution according to age, sex and place of residence, description of the types of Plasmodium causes of Malaria and hematological features in Malaria patients at Siti Rahmah Padang Hospital in 2018. This type of research is a descriptive observational study with an approach or design cross section (cross sectional). The frequency distribution of Malaria sufferers in Siti Rahmah Padang Hospital in 2018 according to the highest age was in the age group 21-30 years as many as 28 cases (36.8%), the highest sex among men was 46 (60.5%) and the highest number of residences was found in Koto Tangah sub-district there were 31 cases (40.8%). The type of Plasmodium found in Malaria cases in Siti Rahmah Padang Hospital in 2018 was P. vivax (73 cases (96.05%)) and P. falciparum (3 cases (3.95%)). The results of laboratory tests on Hb, hematocrit, platelet and leukocyte levels in Malaria positive patients in Siti Rahmah Padang Hospital in 2018 were in the normal range.

DETERMINATION OF THE FUNCTION OF THE ROD’S CROSS-SECTIONAL AREA USING VIBRATION EIGENFREQUENCIES

2020 ◽  
Vol 0 (4) ◽  
pp. 19-24
Author(s):  
I.M. UTYASHEV ◽  
◽  
A.A. AITBAEVA ◽  
A.A. YULMUKHAMETOV ◽  
◽  
...  
Keyword(s):  
Cross Sectional Area ◽  
Variable Cross ◽  
Sectional Area ◽  
Longitudinal Vibrations ◽  
Cross Sectional ◽  
Method Error ◽  
Various Boundary Conditions ◽  
Elastic Fixation ◽  
Crosssectional Area

The paper presents solutions to the direct and inverse problems on longitudinal vibrations of a rod with a variable cross-sectional area. The law of variation of the cross-sectional area is modeled as an exponential function of a polynomial of degree n . The method for reconstructing this function is based on representing the fundamental system of solutions of the direct problem in the form of a Maclaurin series in the variables x and λ. Examples of solutions for various section functions and various boundary conditions are given. It is shown that to recover n unknown coefficients of a polynomial, n eigenvalues are required, and the solution is dual. An unambiguous solution was obtained only for the case of elastic fixation at one of the rod’s ends. The numerical estimation of the method error was made using input data noise. It is shown that the error in finding the variable crosssectional area is less than 1% with the error in the eigenvalues of longitudinal vibrations not exceeding 0.0001.

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