{"id":168932,"date":"2024-05-02T11:13:59","date_gmt":"2024-05-02T15:13:59","guid":{"rendered":"https:\/\/www.hajim.rochester.edu\/senior-design-day\/?p=168932"},"modified":"2025-05-02T14:44:34","modified_gmt":"2025-05-02T18:44:34","slug":"bioimpedance-placement-probe-for-neonatal-intubation-a-novel-method-for-endotracheal-tube-validation","status":"publish","type":"post","link":"https:\/\/www.hajim.rochester.edu\/senior-design-day\/bioimpedance-placement-probe-for-neonatal-intubation-a-novel-method-for-endotracheal-tube-validation\/","title":{"rendered":"Bioimpedance Placement Probe for Neonatal Intubation: A Novel Method for Endotracheal Tube Validation"},"content":{"rendered":"\n<p>We have developed a neonatal intubation probe that utilizes bioimpedance technology to accurately verify the placement of the endotracheal tube. This device aims to reduce the risk of misplacement during intubation, enhancing patient safety and outcomes. By providing feedback to healthcare providers, our device facilitates efficient and precise intubation in neonates, ultimately improving clinical care and reducing complications.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Problem Statement<\/h2>\n\n\n\n<p>ETTs can become dislodged and repositioned in the esophagus, leading to complications such as hypoxia, respiratory failure, cardiac arrest, brain damage, or mortality [2]. Currently, the only way to validate ETT placement in neonates is direct visualization with a laryngoscope, necessitating a less invasive approach [1].<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Background<\/h2>\n\n\n\n<p>Neonatal tracheal intubation is a life saving procedure that is performed during respiratory failure, apnea, surgical procedures, or upsizing of an existing endotracheal tube. Given the small size of neonates, this procedure can potentially be dangerous if proper visualization of the patients\u2019 trachea cannot be obtained by the provider [1]. Failure to intubate a patients\u2019 airway in a timely manner may lead to complications such as hypoxia, respiratory failure, cardiac arrest, brain damage, or mortality [2]. Research has shown that as the number of intubation attempts increases, the neonate\u2019s risk of intraventricular hemorrhage (IVH) increases. IVH, or bleeding into the ventricles surrounding the brain, may have a variety of impact on newborns, ranging from similar outcomes as premature babies to severe developmental delays and movement problems [2]. To reduce the time needed to intubate neonates and prevent the need for multiple intubation attempts, we plan to design an endotracheal intubation device that validates proper placement within the patient\u2019s trachea without needing to hyperextend the patient\u2019s neck to gain visualization of the airway.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Design Metrics<\/h2>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td class=\"has-text-align-center\" data-align=\"center\"><strong>Metric<\/strong><\/td><td class=\"has-text-align-center\" data-align=\"center\"><strong>Goal<\/strong><\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\">Time of intubation<\/td><td class=\"has-text-align-center\" data-align=\"center\">&lt; 30 seconds<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\">Degree of neck rotation<\/td><td class=\"has-text-align-center\" data-align=\"center\">0 degrees<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\">Sterility assurance level<\/td><td class=\"has-text-align-center\" data-align=\"center\">&lt; 10e-6<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\">Current<\/td><td class=\"has-text-align-center\" data-align=\"center\">&lt; 10 \u00b5A<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\">Tube diameter<\/td><td class=\"has-text-align-center\" data-align=\"center\">2-12mm in .5mm increments<\/td><\/tr><\/tbody><\/table><figcaption class=\"wp-element-caption\">Table I: Design Specification Metrics<\/figcaption><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">Description of Procedure <\/h2>\n\n\n\n<p>This procedure aims to verify the placement of an endotracheal tube that has already been inserted into a neonate via intubation. The provider will simply insert the stylet down the endotracheal tube, and squeeze the handle to activate the bioimpedance reader. The sensor at the tip of the stylet will read the impedance of the tissue wall, and notify the provider if it is respiratory tissue or esophageal tissue.<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"715\" height=\"554\" src=\"https:\/\/www.hajim.rochester.edu\/senior-design-day\/wp-content\/uploads\/2024\/05\/procedure.png\" alt=\"\" class=\"wp-image-169222\" srcset=\"https:\/\/www.hajim.rochester.edu\/senior-design-day\/wp-content\/uploads\/2024\/05\/procedure.png 715w, https:\/\/www.hajim.rochester.edu\/senior-design-day\/wp-content\/uploads\/2024\/05\/procedure-300x232.png 300w\" sizes=\"auto, (max-width: 715px) 100vw, 715px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">Articulating Stylet Prototype<\/h2>\n\n\n\n<p>The articulating stylet provides a mechanism for the sensor electrodes to make contact with the tracheal and esophageal tissues.<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"774\" height=\"530\" src=\"https:\/\/www.hajim.rochester.edu\/senior-design-day\/wp-content\/uploads\/2024\/05\/stylet.png\" alt=\"\" class=\"wp-image-169252\" srcset=\"https:\/\/www.hajim.rochester.edu\/senior-design-day\/wp-content\/uploads\/2024\/05\/stylet.png 774w, https:\/\/www.hajim.rochester.edu\/senior-design-day\/wp-content\/uploads\/2024\/05\/stylet-300x205.png 300w, https:\/\/www.hajim.rochester.edu\/senior-design-day\/wp-content\/uploads\/2024\/05\/stylet-768x526.png 768w\" sizes=\"auto, (max-width: 774px) 100vw, 774px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">Bioimpedance Testing<\/h2>\n\n\n\n<p>Tissues measured for bioimpedance:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Porcine tracheal lining<\/li>\n\n\n\n<li>Porcine esophageal lining<\/li>\n\n\n\n<li>Porcine posterior lingual surface<\/li>\n\n\n\n<li>Physiological buffer (control)<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"624\" height=\"363\" src=\"https:\/\/www.hajim.rochester.edu\/senior-design-day\/wp-content\/uploads\/2024\/05\/testing.png\" alt=\"\" class=\"wp-image-169412\" srcset=\"https:\/\/www.hajim.rochester.edu\/senior-design-day\/wp-content\/uploads\/2024\/05\/testing.png 624w, https:\/\/www.hajim.rochester.edu\/senior-design-day\/wp-content\/uploads\/2024\/05\/testing-300x175.png 300w\" sizes=\"auto, (max-width: 624px) 100vw, 624px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">Bioimpedance Sensor Data<\/h2>\n\n\n\n<p>The following can be concluded based on the results:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>The pig esophagus impedance profile has a higher magnitude than the pig trachea impedance profile.<\/li>\n\n\n\n<li>The pig esophagus impedance profile is frequency dependent in the 40-60 kHz range, whereas the pig trachea impedance profile is not.<\/li>\n\n\n\n<li>The pig tongue impedance profile is similar to the pig esophagus impedance profile (both are muscular structures).<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"514\" src=\"https:\/\/www.hajim.rochester.edu\/senior-design-day\/wp-content\/uploads\/2024\/05\/graph-1024x514.png\" alt=\"\" class=\"wp-image-169612\" srcset=\"https:\/\/www.hajim.rochester.edu\/senior-design-day\/wp-content\/uploads\/2024\/05\/graph-1024x514.png 1024w, https:\/\/www.hajim.rochester.edu\/senior-design-day\/wp-content\/uploads\/2024\/05\/graph-300x150.png 300w, https:\/\/www.hajim.rochester.edu\/senior-design-day\/wp-content\/uploads\/2024\/05\/graph-768x385.png 768w, https:\/\/www.hajim.rochester.edu\/senior-design-day\/wp-content\/uploads\/2024\/05\/graph-1250x629.png 1250w, https:\/\/www.hajim.rochester.edu\/senior-design-day\/wp-content\/uploads\/2024\/05\/graph.png 1254w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">Conclusions &amp; Future Directions<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Bioimpedance measurements can be used to reliably distinguish between tracheal and endotracheal tissue<\/li>\n\n\n\n<li>Next step #1: Miniaturization of stylet and refinement of articulating mechanism to enable compatibility with neonatal ETTs<\/li>\n\n\n\n<li>Next step #2: Development of small-scale custom electronics with an intuitive feedback system to make the device fully portable and user-friendly<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Acknowledgements <\/h2>\n\n\n\n<p>Thanks to Dr. Brown for the logistical guidance he has provided since the start of this project, Dr. Seidman for helping with the acquisition of our bioimpedance sensing circuit and pig tissue for testing , and Dr. Barbut (our customer) for supplying endotracheal tubes and facilitating a comprehensive NICU tour.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Team Members<\/h2>\n\n\n\n<p>Hannah Bushey, Elizabeth McGinn, Laura Nafis, Benedikt Winzer, Thomas Xue<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Customer<\/h2>\n\n\n\n<p>Dr. Gal Barbut, M.D., Department of Pediatrics, Neonatology, UR Medical Center<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Supervisor<\/h2>\n\n\n\n<p>Dr. Edward Brown, Ph. D, Biomedical Engineering, Neuroscience, James Wilmot Cancer Center, University of Rochester<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">References<\/h2>\n\n\n\n[1] G. Barbut. \u201cGal Barbut BME Pitch\u201d. Panopto. https:\/\/rochester.hosted.panopto.com\/Panopto\/Pages\/Viewer.aspx?id=f20848cf-511f-4f6b-8aa4-b081016aca4c (accessed 11\/3\/2023).&nbsp;<\/p>\n\n\n\n[2] \u201cIntraventricular hemorrhage,\u201d Johns Hopkins Medicine, https:\/\/www.hopkinsmedicine.org\/health\/conditions-and-diseases\/intraventricular-hemorrhage (accessed Dec. 15, 2023<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The Endotrach team has successfully developed an articulating probe utilizing bioimpedance spectroscopy to verify endotracheal tube placement after intubation.<\/p>\n","protected":false},"author":6242,"featured_media":168992,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_coblocks_attr":"","_coblocks_dimensions":"","_coblocks_responsive_height":"","_coblocks_accordion_ie_support":"","_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[4442,56],"tags":[],"coauthors":[8612],"class_list":["post-168932","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-archive","category-bme-archive"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Bioimpedance Placement Probe for Neonatal Intubation: A Novel Method for Endotracheal Tube Validation - Senior Design Day<\/title>\n<meta name=\"description\" content=\"We have developed a neonatal intubation probe that utilizes bioimpedance technology to accurately verify the placement of the endotracheal tube. 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