Heimann Konrad, Steffen Matthias, Bernstein Nina, Heerich Nora, Stanzel Sven, Cordes Axel, Leonhardt Steffen, Wenzl Tobias G, Orlikowsky Thorsten
Klinik für Kinder- und Jugendmedizin, Sektion Neonatologie, Universitätsklinikum der RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Deutschland.
Biomed Tech (Berl). 2009 Dec;54(6):337-45. doi: 10.1515/BMT.2009.044.
Magnetic induction measurement (MIM) allows the identification of resistance in biologic tissues by alternating magnetic fields. These occur when well-conducting (blood) and poor-conducting matter (air) is moved through the thorax during heart and lung activity. As a result, allocation of the resistance changes and the total resistance of the thorax is shifted. By using coils, these changes can be registered in a non-contact manner and recorded. To date, this measuring principle was employed only in adult volunteers or in full-grown pigs. A neonatal animal model has not yet been described. The aim of this study was to test the hypothesis that non-contact monitoring of heart and lung activity using MIM in a porcine newborn piglet model can be applied in order to evaluate neonatal disorders of heart and lung activity in the future.
By using five coils (three measurement and two excitation coils), placed at the bottom of an experimental incubator, magnetic induction changes, depending on the heart and lung activity in 16 analgosedated piglets, were simultaneously measured and compared with pulse oximetry and airflow detection (flow resistance and pressure differential sensor) as reference signals. In addition, spontaneous breathing, including apnea, CPAP (continuous positive airway pressure to prevent end-expiratory alveolar collapse, flow 8 l/min; pressure 5 cm H(2)O), mechanical ventilation (inspiratory pressure 14 cm H(2)O; frequency 40/min) and high frequency oxygenation ventilation (HFOV, ventilation method in lung failure) (frequency 10 Hz, mean pressure 10 cm H(2)O, amplitude 1.5) were performed. Lung activity with MIM compared with the reference signal was estimated with a detection rate (%) of "correct registered lung activity". To quantify the analogy between MIM and reference signal for heart activity, the concordance correlation coefficient after Lin (95% confidence interval) and the Bland-Altman plot were calculated.
The detection rate for breathing [%] of MIM compared with the reference signal under CPAP was 88% [95% CI: (87.1%; 88.5%)], mechanical ventilation 91% [95% CI: (90.3%; 91.2%)] and under HFOV 95% [95% CI: (94.7%; 94.9%)]. For heart activity, during apnea the difference between MIM and reference signal was 1.1 bpm (+/-11.3 SD) in apnea and during HFOV 5.3 bpm (+/-26.4 SD). Under spontaneous breathing it was not possible to achieve a correlation. Owing to interference problems, registration of heart activity with MIM during simultaneous breathing activity (CPAP, conventional mechanical ventilation, HFOV) was insufficient.
Non-contact monitoring of lung activity using MIM in a neonatal piglet model is possible under specific conditions. These results might be a basis for the development of non-invasive parameters in neonatology. It also provides the possibility of obtaining more information about the characteristics of lung activity of the newborn.
磁感应测量(MIM)可通过交变磁场识别生物组织中的电阻。当在心肺活动期间,良导体(血液)和不良导体物质(空气)在胸腔中移动时,就会出现这种情况。结果,电阻变化的分布发生改变,胸腔的总电阻也会偏移。通过使用线圈,可以以非接触方式记录并记录这些变化。迄今为止,这种测量原理仅应用于成年志愿者或成年猪。尚未描述新生动物模型。本研究的目的是检验以下假设:在新生仔猪模型中使用MIM对心肺活动进行非接触监测,以便将来评估新生儿心肺活动障碍。
通过将五个线圈(三个测量线圈和两个激励线圈)放置在实验培养箱底部,同时测量16只经镇痛镇静的仔猪中取决于心肺活动的磁感应变化,并将其与脉搏血氧饱和度测定和气流检测(流阻和压差传感器)作为参考信号进行比较。此外,还进行了自主呼吸,包括呼吸暂停、持续气道正压通气(CPAP,用于防止呼气末肺泡塌陷,流量8升/分钟;压力5厘米水柱)、机械通气(吸气压力14厘米水柱;频率40次/分钟)和高频氧合通气(HFOV,肺衰竭时的通气方法)(频率10赫兹,平均压力10厘米水柱,振幅1.5)。将MIM测得的肺活动与参考信号进行比较,以“正确记录的肺活动”检测率(%)进行评估。为了量化MIM与心脏活动参考信号之间的相似性,计算了Lin一致性相关系数(95%置信区间)和Bland-Altman图。
与参考信号相比,MIM在CPAP下的呼吸检测率为88%[95%CI:(87.1%;88.5%)],机械通气时为91%[95%CI:(90.3%;91.2%)]。在HFOV下为95%[95%CI:(94.7%;94.9%)]。对于心脏活动,在呼吸暂停期间,MIM与参考信号之间的差异在呼吸暂停时为1.1次/分钟(±11.3标准差),在HFOV期间为5.3次/分钟(±26.4标准差)。在自主呼吸时,无法实现相关性。由于干扰问题,在同时进行呼吸活动(CPAP、传统机械通气、HFOV)期间,使用MIM记录心脏活动不足。
在特定条件下,在新生仔猪模型中使用MIM对肺活动进行非接触监测是可行的。这些结果可能是新生儿学中开发无创参数的基础。它还提供了获取有关新生儿肺活动特征更多信息的可能性。