This disclosure relates generally to invasive blood pressure (IBP) monitoring and, more particularly, to techniques for converting IBP readings into auditory feedback to assist in catheter placement.
When catheters, such as pulmonary artery catheters, are placed into patients, imaging is typically not available to allow a clinician to visualize the catheter location at the time of insertion. Clinicians are forced to rely upon their knowledge of typical pressure waveform characteristics and pressure magnitudes in blood vessels and chambers of the heart in order to identify the anatomic location of the catheter. However, when inserting an indwelling catheter, the clinician's focus of attention is the catheter insertion site and the insertion procedure. Conventionally, determining the pressure waveform requires the clinician to look away from the insertion site (and the patient) to observe the invasive blood pressure (IBP) parameter of the monitoring system, thus dividing the clinician's attention and increasing the likelihood of error.
The present disclosure relates to systems and methods for providing auditory feedback to eliminate the need for the clinician to watch an IBP monitor during catheter placement. One aspect of the disclosure includes a method for providing auditory feedback about the anatomic location of a pressure transducer coupled to a catheter during insertion thereof into a heart chamber or blood vessel of a patient. The method may include acquiring pressure waveform data from the pressure transducer indicative of blood pressure readings over time. The method may further include generating an audible signal from the pressure waveform data that conveys information about the anatomic location of the pressure transducer within the heart chamber or blood vessel.
In one embodiment, the audible signal is a tone, and the process of generating the audible signal may include modulating the pitch of the tone according to the pressure waveform data. Higher pitched tones may represent higher blood pressure readings in the pressure waveform data, and lower pitched tones may represent lower blood pressure readings in the pressure waveform data.
In another embodiment, the process of generating the audible signal may include matching the acquired pressure waveform data with a pressure waveform signature for particular location within the heart chamber or blood vessel. The process may further include locating a stored audio signal associated with the matching pressure waveform signature and outputting the stored audio signal to the clinician. In one embodiment, the stored audio signal may be a prerecorded voice prompt describing the anatomic location of the pressure transducer.
The pressure waveform signature may include a representation of typical pressure waveform data for the particular location. Alternatively, the pressure waveform signature may include a stored representation of pressure waveform data previously acquired at the particular location.
In certain embodiments, the process of matching the pressure waveform data may include determining one or more pressure waveform characteristics of the pressure waveform data and locating a pressure waveform signature having the one or more pressure waveform characteristics. Various waveform characteristics that may be identified include, but are not limited to:
An aspect of the present disclosure includes a method for adding pressure waveform signatures to a signature library. The method may include storing a pressure waveform signature corresponding to pressure waveform data acquired at a new location of the pressure transducer. The method may also include recording an audio signal comprising a voice prompt describing the anatomic location of the pressure transducer. The method may further include associating the recorded audio signal with the stored pressure waveform signature, such that a subsequent acquisition of similar pressure waveform data by the pressure transducer will trigger annunciation of the voice prompt.
Another aspect of the present disclosure includes a system for providing auditory feedback about the anatomic location of a pressure transducer coupled to a catheter during insertion thereof into a heart chamber or blood vessel of a patient. The system may include a blood pressure monitor interface for acquiring pressure waveform data from a pressure transducer indicative of blood pressure readings over time. The system may further include an anatomic location annunciator for generating an audible signal from the pressure waveform data that conveys information about the anatomic location of the pressure transducer within the heart chamber or blood vessel.
In one embodiment, the anatomic location annunciator may include a tone generator for modulating the pitch of a tone according to the pressure waveform data. Alternatively, or in addition, the anatomic location annunciator may include a pattern matcher for matching the pressure waveform data with a pressure waveform signature for a particular location within the heart chamber or blood vessel and locating a stored audio signal associated with the matching pressure waveform signature. The anatomic location annunciator may further include an audio player to output the stored audio signal to a clinician.
In one embodiment, the anatomic location annunciator may include or have access to a signature library comprising a plurality of pressure waveform signatures corresponding to different locations within the heart chamber or blood vessel. The pressure waveform signatures within the signature library may comprise typical pressure waveform data for the particular location or may have been previously acquired at the particular location.
In one embodiment, the system may include a signature generator for generating and storing a pressure waveform signature corresponding to the pressure waveform data acquired at the anatomic location of the pressure transducer. The system may further include a voice digitizer for recording an audio signal comprising a voice prompt describing the anatomic location of the pressure transducer within the heart chamber or blood vessel. The voice digitizer may store the recorded voice prompt within the signature library, such that a subsequent acquisition of similar pressure waveform data by the pressure transducer will trigger annunciation of the voice prompt.
The embodiments of the disclosure will be best understood by reference to the drawings, wherein like elements are designated by like numerals throughout. In the following description, numerous specific details are provided for a thorough understanding of the embodiments described herein. However, a skilled artisan will recognize that one or more of the specific details may be omitted, or other methods, components, or materials may be used. In some cases, operations are not shown or described in detail.
The described features, operations, or characteristics may be combined in any suitable manner in one or more embodiments. It will also be readily understood that the order of the steps or actions of the methods described in connection with the disclosed embodiments may be changed as would be apparent to a skilled artisan. Thus, any order in the drawings or Detailed Description is for illustrative purposes only and is not meant to imply a required order, unless specified to require an order.
Various IBP monitors 102 are known in the art, such as the Mindray PM9000 Express patient monitor, available from Shenzhen Mindray Bio-Medical Electronics, Co., Ltd., of Shenzhen, China, which monitors a variety of physiological parameters, including IBP. The IBP monitor 102, as well as the other components of the system 100 described hereafter, may be embodied as any suitable combination of hardware, software, and/or firmware and may operate within the context of a general purpose computer including a processor, memory, and other standard components known to a skilled artisan.
The IBP monitor 102 is coupled to or otherwise in communication with an anatomic location annunciator 108. The anatomic location annunciator 108 may be a component of the IBP monitor 102 or a separate software program or device that communicates with the IBP monitor 102 via wireless or wired communication protocols. The anatomic location annunciator 108 converts the pressure waveform data into auditory feedback 110 about the anatomic location of the pressure transducer 104 within the vessel or chamber, which may be output to the clinician by a speaker 112. As described in greater detail with reference to
By virtue of the auditory feedback 110 provided by the methods and systems disclosed herein, a clinician need not look away from the insertion site during catheter placement. This greatly reduces the risk of error because the clinician can devote his undivided attention to the insertion procedure.
In one embodiment, the anatomic location annunciator 108 includes an IPB monitor interface 201 for communicating with the IPB monitor 102. The IPB monitor interface 201 may implement all of the necessary protocols for receiving the pressure waveform data 200 from the IPB monitor 102 and may vary depending on the particular IBP monitor 102 in use. The IPB monitor interface 201 may be implemented in software or using any suitable combination of hardware, software, and/or firmware, and may be provided by (or conform to specifications on the manufacturer of the IPB monitor 102.
The anatomic location annunciator 108 may further include a tone generator 202 for modulating the pitch (frequency) of a tone 204 according to the pressure waveform data 200. For example, the tone generator 202 may generate a higher pitched tone to represent a higher blood pressure reading in the pressure waveform data 200 and a lower pitched tone to represent a lower blood pressure reading in the pressure waveform data 200. Software-based tone generators 202 include the NCH Tone Generator, available from NCH Software. However, a skilled artisan will recognize that hardware-based tone generators 202 may also be used.
A clinician with knowledge of typical pressure waveforms for various blood vessels and chambers of the heart will be able to interpret the modulated pitch as an indication of the anatomic location of the pressure transducer 104. For example, the clinician may recognize that a constant tone pitch will be annunciated when monophasic pressure waveforms are present, indicating that the pressure transducer 104 might be in the right atrium of the heart. Likewise, the clinician may recognize that a changing tone pitch will be annunciated when biphasic pressure waveforms are present, indicating that the pressure transducer 104 might be in the right ventricle or pulmonary artery. While such an approach relies on the skill of the clinician in recognizing pressure waveforms, it is superior to conventional techniques that require the clinician to look away from the insertion site.
In one embodiment, the frequency of the tone 204 may be derived from the pressure waveform data 200 using the following equation:
f=s(p+t) Eq. 1
where:
The anatomic location annunciator 108 may include a pattern matcher 302 that receives the pressure waveform data 200 from the IPB monitor interface 201. As described in greater detail below, the pattern matcher 302 compares acquired pressure waveform data 200 (or characteristics thereof) with a plurality of stored pressure waveform signatures 304 (four shown as 304a-d) to determine if a match is found. The pressure waveform signatures 304a-d may be stored within a signature library 306 that associates pressure waveform signatures 304a-d with stored voice prompts 300a-d. The voice prompt 304a associated with the matching pressure waveform signature 304a (e.g., “right ventricle”) is sent to an audio player 308 to be output via the speaker 112.
Pattern matching is known in the art of speech recognition, which correlates speech waveforms with stored signatures for various words or phrases. Hence, one embodiment of the pattern matcher 302 may be implemented using speech recognition algorithms, such as algorithms based on Hidden Markov Models (HMMs). Commercially available speech recognition programs that may be adapted to recognize pressure waveform data 200 include the Dragon Naturally Speaking SDK 9 available from Nuance Communications, Inc.
The pressure waveform signatures 304a-d may comprise actual pressure waveform data 200 previously monitored within particular heart chambers or blood vessels of one or more patients (including the patient being currently monitored). Alternatively, or in addition, the pressure waveform signatures 304a-d may reflect typical pressure waveforms known to be associated with particular heart chambers or blood vessels. In other words, the pressure waveform signatures 304a-d need not contain data that has actually been obtained from a patient, but may be based on previous studies of pressure waveforms within normal and abnormal human circulatory systems.
In certain embodiments, the pressure waveform signatures 304 may not include pressure waveform data 200 in the form of pressure readings over time, but, rather, representations of such data in the form of polynomial curves, features, characteristics, heuristics, rules, or the like. Such an embodiment will be described in greater detail in connection with
Voice prompts 304a-d may be stored, for example, as pulse-code modulated (PCM) or MPEG Layer 3 (MP3) audio data. The audio player 308 may be implemented using any suitable software program or device for decoding and outputting audio signals. For instance, the audio player 308 may be implemented by Windows Media Player available from Microsoft Corporation.
The signature library 306 that associates the voice prompts 300a-d with the corresponding pressure waveform signatures 304a-d may be implemented within the context of a relational database management system (RDBMS), such as the Oracle RDBMS, available from Oracle Corporation, or DB2, available from IBM. Although the signature library 306 is depicted as being within the anatomic location annunciator 108, a skilled artisan will recognize that the signature library 306 may be stored remotely and accessed using client software (not shown) over a network.
In some embodiments, the anatomic location annunciator 308 may include both the tone generator 202 of
Referring to
Monophasic pressure, which is characterized by the lack of systolic/diastolic fluctuations, may be indicative of pulmonary artery wedge pressure. If detected, the pattern matcher 302 may annunciate the anatomic location as the pulmonary capillary wedge. By contrast, strong systolic and diastolic fluctuations, as well as the magnitude of the pulse pressure (systolic minus diastolic pressure), may be used by the pattern matcher 302 to recognize the biphasic pressure typically found in the pulmonary artery.
Identification of a dicrotic notch 400 on the end systolic portion of a pressure waveform may be indicative of right ventricle pressure. The dicrotic notch 400 may be identified as a sign change in the second derivative of the pressure waveform shortly after detection of the maximum systolic pressure. By contrast, the lack of a dicrotic notch, with the waveform reflecting a continual increase or decrease in diastolic pressure, may indicate pulmonary artery pressure.
As illustrated in
The clinician may choose (or be prompted) to record a voice prompt 300. The voice prompt 304 may be recorded via a microphone 602 coupled to a voice digitizer 602, such as Microsoft's Sound Recorder. The recorded voice prompt 300 and the pressure waveform data 200 received contemporaneously therewith is provided to a signature generator 604. In one embodiment, the signature generator 604 may store the pressure waveform data 200 as the pressure waveform signature 304. In other embodiments, the signature generator 604 may convert the pressure waveform data 200 into different representations, such as polynomial curves, features, characteristics, heuristics, or rules.
Once stored in the signature library 306, the pressure waveform signature 304 will enable the anatomic location annunciator 108 (and more particularly, the pattern matcher 302) to recognize the pressure waveform data 200 when it is subsequently monitored, allowing the associated voice prompt 300 to be output to the clinician.
If, on the other hand, tone feedback has been selected, the pitch of a tone is modulated according to the pressure waveform data. For example, higher pitched tones may be generated to represent higher blood pressure readings in the pressure waveform data, and lower pitched tones may be generated to represent lower blood pressure readings in the pressure waveform data. The modulated tone is then output 714 to the clinician.
Embodiments of the foregoing disclosure may include various steps, which may be embodied in computer-executable instructions to be executed by a general-purpose or special-purpose computer (or other electronic device). Alternatively, the steps may be performed by hardware components that include specific logic for performing the steps or by any suitable combination of hardware, software, and/or firmware.
Embodiments may also be provided as a computer program product including a computer-readable medium having stored thereon instructions that may be used to program a computer (or other electronic device) to perform processes described herein. The computer-readable medium may include, but is not limited to, hard drives, floppy diskettes, optical disks, CD-ROMs, DVD-ROMs, ROMs, RAMs, EPROMs, EEPROMs, magnetic or optical cards, solid-state memory devices, or other devices for storing electronic instructions.
Several aspects of the embodiments have been illustrated as software modules or components. As used herein, a software module or component may include any type of computer instruction or computer executable code located within a memory device and/or transmitted as electronic signals over a system bus or wired or wireless network. A software component may, for instance, comprise one or more physical or logical blocks of computer instructions, which may be organized as a routine, program, object, component, data structure, etc., that performs one or more tasks or implements particular abstract data types.
In certain embodiments, a particular software component may comprise disparate instructions stored in different locations of a memory device, which together implement the described functionality of the component. Indeed, a component may comprise a single instruction or many instructions, and may be distributed over several different code segments, among different programs, and across several memory devices. Some embodiments may be practiced in a distributed computing environment where tasks are performed by a remote processing device linked through a communications network. In a distributed computing environment, software components may be located in local and/or remote memory storage devices. In addition, data being tied or rendered together in a database record may be resident in the same memory device, or across several memory devices, and may be linked together in fields of a record in a database across a network.
Various modifications, changes, and variations apparent to those of skill in the art may be made in the arrangement, operation, and details of the methods and systems of the disclosure without departing from the spirit and scope of the disclosure. Thus, it is to be understood that the embodiments described above have been presented by way of example, and not limitation, and that the invention is defined by the appended claims.
This application claims the benefit of U.S. Provisional Application No. 61/090,804, filed Aug. 21, 2008, which is incorporated herein by reference.
Number | Date | Country | |
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61090804 | Aug 2008 | US |