Respiration Rate Apnea Monitor Apnea Monitor From the

Respiration Rate Apnea Monitor “Apnea Monitor. ” From the publication: Core Medical Equipment. Geneva, Switzerland, 2011

Quiz 1. What are the 3 common technologies used for Apnea monitoring? 1. Which is the best technique to detect OBSTRUCTIVE apnea? 2. What are the causes for false alarms?

Apnea • Central or diaphragmatic apnea Sleep Apnea (20%) – No respiratory effort, no nasal airflow, lack of neural input from central nervous system – Common in children – Sudden Infant Death Syndrome (SIDS)

Apnea Drcamachoent (Own work) [CC BY-SA 4. 0 (http: //creativecommons. org/licenses/by-sa/4. 0)], via Wikimedia Commons

Apnea • OBSTRUCTIVE Sleep Apnea – The most common form of Apnea – Caused by upper airway obstruction – Respiratory movements persist

Apnea Monitor • Respiration rhythm • Cardiac activity (Optional) • Oxygen saturation (Optional)

Apnea Monitoring Technologies • Transthoracic Electric Impedance • Pneumatic Abdominal • Mouth and Nose Air Pressure/Temperature

Transthoracic BIA • Heart rate and respiration • 2 electrodes limitation

Transthoracic BIA 55 k. Hz – 250 k. Hz 2 to 3 m. V Placed in the 5 th intercostal space on each side of the neonate Applied Cardiopulmonary Pathophysiology 7: 57 -62, 1998. @ 1998 Kluwer Academic Publishers. Retrieved from http: //www. mikropolis. pl/_pdf/lu ng-diuresis. pdf

Transthoracic BIA • 2 Eletrodes limitation Tissue Impedance Respiration impedance change Cardiac Impedance Change Lead Wire Impedance Electrode Impedance Lead Wire Impedance To Monitor Virginia Reid (2016), Transthoraic BIA [image]. Created from previous diagram (source unknown)

Transthoracic BIA • Limitations: • Muscle movement artifacts • Electrical noise

Pneumatic Abdominal Sensor • Measures the motion of the abdomen • Impedance of the abdomen does not change (no air) • Linear variable displacement transducer (LVDT) or strain gauge

Thermistors and Pressure Sensors • Proximal airway pressure sensing pressure at the mouth and nose • Distinguishes between central and obstructive apnea (BIA and Abdominal sensors can not) • Thermistors monitor change in airway temperature-cooler room air for inspiration and warmer lung air for expiration.

Apnea Monitor Controls By Appendinisapprentice (Own work) [CC 0], via Wikimedia Commons. Retrieved from https: //commons. wikimedia. org/wiki/File: Flux. Med_Respiratory_Mechanics_Monitor. jpg

National Heart Lung and Blood Institute (NIH) (National Heart Lung and Blood Institute (NIH)) [Public domain], via Wikimedia Commons. Retrieved from https: //commons. wikimedia. org/wiki/File: Sleep_studies. jpg

Multiparameter Apnea Monitors Nascar. Ed (Own work) [CC BY-SA 3. 0 (http: //creativecommons. org/licenses/by-sa/3. 0)], via Wikimedia Commons

Examples Robert Lawton (Own work) [CC BY-SA 2. 5 (http: //creativecommons. org/licenses/by-sa/2. 5)], via Wikimedia Commons

Patient’s Safety • Electrodes extensive use may irritate baby's skin

Preventive Maintenance • Check batteries • Check lead wires • Confirm accuracy of each parameter monitored • Check switches and display • Check connectors

Common Problems • Old Batteries • Electrodes and cables contact • The gel build up on the paddles and have to be cleaned with alcohol

Apnea Monitor False Alarms • False negative alarms – Equipment vibration – ECG – Patient movement • False positive alarms – loose electrodes or sensor – Weak breath

Common Problems • User error – Change a limit without consulting with the physician – Poorly attached leads and sensors

Test Procedures • Test alarms on yourself • Check your heart rate (max error 5 beats per minute) • Check and compare respiration rate. Max 2 breaths/min error

Questions ?