Respiratory Inductance Plethysmography Monitoring

Respiratory Inductance
Plethysmography

© 2009 CareFusion Corporation or one of its subsidiaries. All rights reserved.

RIP Applications
• Research
Over 1000 Research papers published.
Chimes Study

• ICU
Non Invasive Monitoring of FRC changes in Ventilated patients
Apnea monitoring

• SLEEP!!!


Adobe
Acrobat Document

ASSM Scoring Rules


History
MOVEMENTS OF THE THORACIC CAGE AND
DIAPHRAGM IN RESPIRATION
by 0. L. WADE J. Physiol. (I954)
Fig. 1. Diagram showing
the method of tracking
diaphragmatic movement
and of recording
vertical movements of the
chest and changes of chest
circumference. Inset
diagram
illustrates the geometric
distortion for which
corrections were made.


History
Measurement of the separate volume changes of rib
cage and abdomen during breathing
KIMIO KONNO AND JERE MEAD J. Appl.Physiol. 22(3) : 407-422. I967


History
NIMS Respitrace Corp

Introduction of Respitrace Basic 1979

(still available from Ambulatory Care Inc)


History
Herman Watson 1/5/1982
Respitrace Corp

Respiratory Inductive Plethysmography


History

Herman Watson 2/15/1983
Respitrace Corp

Calibration of RIP


History

QDC
Qualitative Diagnostic Calibration
MARVIN A SACKNER, HERMAN WATSON,
ANNE S. BELSITO, DREW FEINERMAN,
MANUEL SUAREZ, GERARDO GONZALEZ,
FRANKLIN BIZOUSKY, AND BRUCE KRIEGER.

September 8 1988
Calibration of respiratory inductive
plethysmography during natural
breathing

QDC Calibration
5 Minutes of Normal Resting Breathing….
To calibrate RIP to volume change (ΔV) the qualitative diagnostic calibration (QDC)
procedure uses the equation ΔV = M * (K * ΔRIPrc + ΔRIPab), in which ΔRIPrc and
ΔRIPab are the rib cage and abdominal RIP changes relative to the values at FRC,
respectively. K is a calibration factor, indicating the relative contribution of both
compartments to volume, and M scales the sum to volume and is expressed in ml. ( M is
determined in a second stage Calibration to a pneumotach)
In the QDC method, a number of undisturbed breaths are collected during 5 minutes
uninterrupted mechanical ventilation. Breaths with similar tidal volume are selected, based
on the uncalibrated sum signal (RIPrc+RIPab), including only breaths within one standard
deviation of the mean. Then, the standard deviations of RIPrc and RIPab are determined
over the selected breaths. Calibration factor K is estimated by SD(RIPab) / SD(RIPrc). M is
determined by injection of a known volume, e.g. tidal volume. With M and K known,
every pair of RIPab and RIPrc are converted to a calibrated volume.

History
• NIMS
• September 1991 introduces Respitrace Plus
Respitrace Plus monitors breathing pattern and the
electrocardiogram. It incorporates NIMS' patented Respitrace
technology for assessment of respiratory frequency, changes
of tidal volume, labored breathing and detection of central
and obstructive apneas. Respitrace is the only commercially
available technology that by itself is capable of monitoring
these parameters


History
• NIMS – SensorMedics Agreement
• August 2 1994
• Respitrace PT2
• Respitrace Plus
• Respitrace Cardio
• Respibands


History
• SensorMedics / VIASYS
– April 1999
– Qualitative Diagnostic Calibration
• 5 minutes Normal Resting Breathing

– Calibrated SUM channel
– FVL with RespiEvents Software
– dVt Channel (Derived Flow) in 2002
– FVL integrated into Somnostar in 2002


History
• Compumedics
• David Burton
• Jiang Hong Tan
• Patent # 6142953 November 2000
A device for reliably and non-invasively measuring respiration rates and effort by encircling the patient's chest with a device
having a large section of inelastic belt attached to a small section of elastic material. The elastic material having two magnetic
tapes with wire windings thereon proximate each other with an insulation material therebetween. The wire windings are
electrically connected to each other. The magnetic tapes have opposite ends attached to the elastic material such that when the
elastic material expands and contracts the wire windings move relative to each. A toroidal transformer is connected to the wire
windings. When a carrier signal is introduced to the transformer and the magnetic tapes move relative to each other on the
elastic material when the patient breathes a mutual inductance in the wire windings modulates the carrier signal and thus
measures the expansion and contraction of the patient's chest which is directly related to the patient's respiration rate. The
electronics connected to the device for monitoring respiration also measures belt shifting for diameter changes during
monitoring by measuring the central amplitude during a breath cycle and comparing the initial belt diameter conditions to later
conditions. The electronics can then compensate for amplitude variations in the signal caused by belt shifting which may be
confused with shallower breathing in uncompensated devices.


History
• Compumedics 2000
•
•
•
•
•
•
•
•

•
•
•
•
•
•
•
•

Inductive plethysmography technology
Linear response to changes in effort
Balanced SUM channel output
Continuous, automatic channel balancing
Operates with any PSG amplifier system
800 hours of operation from a small low-cost battery
Long lasting, reusable sensor bands
Cost effective and easy to use


History
• Embla 2005
•
•
•
•
•
•
•
•
•
•
•
•
•
•

• XFlow™ is a semi-quantitative measure of inspiratory and
expiratory flow, providing a complementary flow signal
for studies without airflow sensors. X-flow is a reliable
backup and great tool for titrations.
• XSum™ is the summation of the abdominal and thoracic
signals providing a semi-quantitative measurement of
lung volume.
• RMI™ (Respiratory Mechanics Instability) is a proprietary
algorithm that assesses the severity of Sleep Disordered
Breathing by analyzing the phase relationship between
the abdomen and thorax.
• Phase Analysis displays (in degrees) the phase relationship
between the abdomen and the thorax for evaluation and
analysis of paradoxical breathing.


History
• Pro Tech June 2005
• zRIP
– Compatible with all PSG systems
– Washable belts
– Non-calibrating SUM channel


History
• Braebon

2006

• Q-RIP


History
• Sleepmate 2007
• RIPmate

The RIPmate system is designed with a washable one-size-fits-all belt
and buckle that is comfortable and stays in place. The RIPmate
Inductance Processor module plugs directly into the AC input of any
headbox with no additional software needed. The system provides a
reliable effort signal that eliminates the problems of effort signal loss
and false paradoxical signals.


Comparison Piezo Belts

– Poor QUALITATIVE grading of waveform
• NOT Quantitative

– False Paradox due to low signal
– Must be readjusted throughout night
– Loss of signal due to position shift


Comparison Non Calibrated RIP
•False paradox eliminated
(if reference and signal inputs must be connected with the same polarity).

•Excellent signal quality
•Small interface device (usually battery operated)
•Sum channel not equal to true RC + ABD volume change


Comparison Calibrated RIP
• False paradox eliminated
•Excellent signal quality
•Larger driver/interface device (usually AC operated)
•Sum channel equal to true RC + ABD volume change
•dVt
•FVL
•Konno Mead Loops
• QUANTITATIVE


Device Comparison


Obstructive Apnea
No Flow

Paradoxical
Effort


Central Apnea

No Flow!

No Volume!


No Patient Effort

Hypopneas - Non Calibrated RIP


Hypopneas – Calibrated RIP with
FVL


Hypopnea
• Take the guesswork out of
Hypopneas!
• Quantify the
difference of
percentage of
breaths against
the Baseline
Breath


Inspiratory Flow Limitation - UARS
• Flattening on the Inspiratory Side
of the Flow Volume Loop
vs.
• Chest and Abdomen out of
Phase


Inspiratory Flow Limitation UARS
Flattening of dVt Channel

Flattening of Chest Signal

Increased I:E Ratio


Flattening of Inspiratory Curve

CPAP TITRATION
The first step to compliance is proper Titration
Eliminate all obstructive and events
• Gross titration by stepwise increases in PAP until no events
are observed via Thermocouple/Nasal Pressure and effort
belts.
Elimination of UARS
• Fine titration of stepwise increases in PAP until Airway is
splinted open observed via Flow Volume Loops or Esophageal
Pressure.
Elimination of Central Events caused by over titration

• Observe FVLs for hyperinflation
Elimination of increased WOB / increased Expiratory Resistance

• Treat Flattening of expiratory curve with Pressure
Release


How can cRIP Help ?
Flow Volume Loops
–

Breath used as the “Signature Breath”
• Select a Baseline Breath at Sleep Onset

–

Compare breaths to the Baseline Breath
• CPAP Titrations
– Titrate sleep patients back to their “Signature Breath

• UARS Visualize Inspiratory Flow Limitation1
• Hypopnea Events
– Show a difference or a percentage as compared to the
Baseline Breath
– Differentiate between Mixed, Obstructive and Central
Hypopneas2
1 Daniel Loube, MD, FCCP, Teotimo Andrada, MS. Pulmonary/Critical Care Medicine Service, Walter Reed Army Medical Center, Washington, DC, USA COMPARISON OF
RESPIRATORY INDUCTANCE PLETHYSMOGRAPHY AND ESOPHAGEAL PRESSURE MONITORING IN THE DETECTION OF UPPERAIRWAY RESISTANCE SYNDROME
2 Classification of a hypopnea as obstructive, central or mixed should not be performed without a quantitative assessment of ventilatory effort (esophageal manometry, calibrated
respiratory inductance plethysmography, or diaphragmatic/intercostal EMG) ASSM Manual for the Scoring of Sleep and Associated Events


How can cRIP Help ?
Konno Mead Loops
–

Work of Breathing
• Visualize accessory muscle use vs. diaphragmatic effort
• Monitor Increased Expiratory Resistance during titrations

–

Chest/Abdominal Asynchrony
• Phase Angle shift

–

Central vs. Obstructive events
• True Paradox


Konno Mead Loop Breakdown
R
i
b
C
a
g
e

Expiration
Inspiration

Abdomen

How can cRIP Help ?
Breath by Breath Tabular View
– Monitor I:E Ratios Inspiratory/Expiratory times
• Inverse I:E ratios indicate increased Inspiratory Resistance

– Pif-Mif Peak Inspiratory Flow/Mean Inspiratory Flow
• Peak flow greater than the mean flow implies a work rate
greater than a constant flow1. <1.5 = inspiratory flow
limitation1

– Selection of multiple breaths for comparison and
printing

1. Lafortuna CL, Minetti AE, Mognoni P. Inspiratory pattern in
humans. J Appl Physiol 1984;57:1111-1119.


PAP Titration with cRIP

Select a reproducible breath

Normal FVL



Titrate to Eliminate Events


Eliminate UARS
Titrate PAP to Open Loop

Inspiratory Resistance

(UARS)

Inverse I:E ratio
Increased WOB



• Titrate Inspiratory and Expiratory curves
separately to Baseline Breath with Bi-Level
• Optimize Expiratory Pressure Release to
decreased expiratory resistance using FVLs
and decrease WOB with Konno Mead Loops


Titrate Bi-Level to Eliminate Hypoventilation

Titrate EPAP to Eliminate Events

Titrate IPAP to increase Vt


Eliminate Expiratory Resistance

Titrate Pressure Release to Open Loop
Expiratory Resistance

Increased WOB


Eliminate Central Apneas Caused by Over Titration

Reduce Pressure to Decrease Vt
Central Apneas


Successful Titration with cRIP
Elimination of Events
Elimination of UARS

Titrated Loops = Baseline Loop

No Hyperinflation

WOB returns to Baseline Level

Successful Titration = Better Compliance = Satisfied Customer

Summary
• Long History of Research and Development
• Validated technique
• Available calibrated and uncalibrated
• Accurate event detection
• A better way to measure Effort
• Enhanced software packages with FVL and
Konno Mead Loops
• A better tool for titration


Respiratory Inductance Plethysmography Monitoring

Recommended

Recommended

More Related Content

Viewers also liked

Viewers also liked (13)

Similar to Respiratory Inductance Plethysmography Monitoring

Similar to Respiratory Inductance Plethysmography Monitoring (20)

More from Randy Clare

More from Randy Clare (19)

Recently uploaded

Recently uploaded (20)

Respiratory Inductance Plethysmography Monitoring