W1 - C1

14 August 2020 19:58

• Impedance Pneumograph
○ Indirect method for respiration measurement
○ Detects presence of respiration
○ Provides no quantitative data (eg: inspired/expired volume)
○ Commonly used in apnea monitors and neo-natal respiration monitors (as no voluntary exertion by the patient is required)
○ Tells respiration rate
 You count the number of pulses per minute from the output waveform?
○ Principle
 AC Impedance across chest changes during respiration, this is monitored and measured as rate
○ Block Diagram?
○ Working
 Low amplitude (1mA pk-pk, power = 1mW) and high frequency (50-500KHz) signal applied across chest of subject via 250KHz carrier oscillator/ signal
generator
 The range of the signal applied is so that the respiratory muscles are not stimulated (hence low amplitude)
□ Threshold of perception (amplitude of current) = above 1mA - 5mA (safe level)
 High frequency so that this signal does not interfere with other measurements. If other measurements are being taken from the patient simultaneously,
this signal provided should not interfere with the other parameters
□ Amplifiers used for biological signals are limited to ~ 10KHz (max cutoff)
□ So we use a frequency >>10KHz so no interference occurs (from this signal or the others like ECG, EMG etc.)
 This signal is applied via electrodes, which are placed on the subject's chest
□ Electrodes here are similar to ECG electrodes (Ag/AgCl electrodes) of similar size
□ Electrodes positioned on the 8th rib, bilaterally on the mid-axillary line
 Positioned here to obtain maximum change in impedance per unit volume of respiratory air
 Lower positioning of electrode means movement of lungs is more, allowing us to observe a better change in the thoracic impedance
 2 Resistors = R1, R2
□ Have a high value of 100KOhms
□ Both are placed in series with the signal/current source in order to provide a constant AC current source, because if the current fluctuates, so will
the measurement
 Transducer here = Strain Gauge (R, delta R)
□ Strapped across patient's chest
□ R = resistance when there is no breathing
□ Delta R = change in resistance during breathing (can be +ve or -ve)
□ Output of strain gauge = E0 (V) (obtained across R, delta R?)
□ R1,R2, R, delta R form the 4 arms of a bridge network (wheat stone bridge), and through this arrangement, the change in resistance is measured
as E0
 E0 = I*R ± delta R
 I = current through chest in microA
 R = chest impedance without resp. (fixed value in ohms)
 Delta R = change in chest impedance during resp. (3 ohms/litre of resp.volume (v small))
□ E = source voltage
 Since strain gauge is a passive type of transducer, external power supply required (i.e. the 250KHz oscillator - constant current source?)

 E0 given to a differential AC, tuned amplifier

□ It Is tuned to the frequency of the resp. signal
 Basically a band-pass filter
 Tuned amplifier only passes signal of interest, blocking everything else (especially other low freq. biological signals <10KHz)
□ Respiratory signal is of low frequency
□ Superimposition of Resp. signal on carrier signal done, i.e. Amplitude Modulation
 Signal of interest is carried in the amplitude of the carrier signal (amplitude of carrier signal is varied according to the resp. signal)
 Envelope of carrier is carrying the message within it
 Fixed amplitude modulated with resp. waveform (hence high freq. carrier signal provided)
□ Drift in frequency on either side of the signal obtained after amplitude modulation

 Output of diff AC amplifier passed through a synchronous detector

□ Synchronous detector used to recover message from the modulated signal
□ Synchronous = detector is synchronised with the carrier frequency
□ For the detector to work, one of its inputs should be the pure carrier signal (reference signal) and the other input should b e the AM signal
 Output of detector passed to a low-pass filter (to pass only the low freq. signal, i.e. the resp. signal alone)
□ This LPF is a part of the detector
 After LPF, we give the signal to a DC amplifier, which amplifies the resp. signal according to the requirements of the displa y unit
 Resp. signal displayed on display unit
○ We can also convert this impedance change to lung volume change
 This measurement is a function of electrode position and body size
 Due to these variations, this device is not normally used for quantitative volume measurements

○ Advantage
 Doesn't require the use of masks/tubes like in spirometers; hence doesn’t impede or block normal respiration
□ Hence can be used for resp. monitoring is sleep apnea and neonatal resp. monitoring

• Pneumotachometer
○ AKA Flow-sensing spirometer
○ Respiration flow rate meter
 Integrating flow over a period of time, we get volume measurements
 Hence quantitative measurements can also be done using this
○ Performs monitoring jobs in the ICU
○ Compact handheld device
○ Sterilized via gas sterilisation (ethylene oxide sterilisation)
○ Disposable bacterial filters can be placed at the entrance of these tubes
○ Volume information can also be obtained after processing primary data measured from this device
○ Advantage
 Doesn't impede respiration
 Available in various sizes, making it suitable for various flow ranges
○ Principle
 Breathing (flow of gas) is passed through a small tubing which contains a resistive element in it (which offers resistance in the path of breathing)
 When resistance offered to flow, the pressure on other side (P2) of resistive element drops

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  When resistance offered to flow, the pressure on other side (P2) of resistive element drops
□ P2<P1?
□ This difference in pressure, P1-P2 is proportional to flow rate
□ This pressure drop is very small 200mmHg
 Hence high quality device producing very little drift over time needs to be used
 Normally, differential pressure transducers are used

○ Types of Pneumotachometers based on the type of resistive element used

1. Fleisch Type (Resistive type)

□ Flow = V ' is measured in a tube having a small fixed resistance
□ Here resistance is offered by a bundle of capillaries (~100 in bundle)
□ Bundle arranged parallel to direction of flow
□ Offer a fixed (pre-determined) resistance value of R
□ Pressure drop across the resistance will relate linearly to the flow
□ P1-P2 = RxV ' (i.e V ' is directly proportional to V1-V2)
□ This^ holds good only as long as the flow is laminar in nature
□ In turbulent flow, the flow rate will be more than proportional than the pressure difference
□ To ensure laminar (smooth) flow, the tube is shaped in a trumpet like structure, i.e. diameter of tube increases in the centr e after which it
decreases
□ 2 small openings/tubes? go to the transducer
 Pressure transducers that can be used: Strain Gauge (resistive type), LVDT(diff. type based on inductance change), diff. capacitive
transducers
 Places across either side of the resistive element, allowing us to measure the pressure on both sides and then take their difference, giving
us V ' (flow rate)
 V ' can be integrated to obtain volume data
□ Disadvantage (for Fleisch Type)
- Variation in R can lead to drift in measurement of flow rate
 Resistance to flow can increase if there is an accumulation of secretions/water vapour condensations (from the exhaled moist air) over the
resistive element (capillary tube)
□ As a result resistance will be more than the value we fix it at
□ To minimise this condensation, a heating element is present which is used to heat the resistive portion to a temperature higher than
that of the body (>37 degree Celsius)
 Flow characteristics can also change with the viscosity of the gas measured
□ Inspired and expired have different gas concentrations and gas temperatures and hence differing viscosities?, despite having the same
flow rate

2. Lilly Type (Resistive type)

□ Modification of Fleisch type
□ AKA Silver Man type
□ Same principle as Fleisch type
□ Flow pattern is assumed to be laminar in nature
□ Here resistive element = fine metal mesh/sieve/screen with known resistance
□ Advantage over Fleisch: Offers a larger dynamic range compared to the Fleisch type
 Hence we can measure widely varying flow ranges
 Mesh is heated to prevent condensation of water vapours

3. Turbine Flowmeter
□ Most commonly used type
□ Compact device (can be even used at bedside)
□ Small plastic tube within which there is a rotating turbine
□ Rotating turbine portion can be disposable in some models
□ Principle
 Respiration done into the tube, causing the turbine/blades to rotate.
 The no. of revolutions it makes per unit of time is proportional to the flow rate of the gas through the tube
 No. revolutions measured using a light source and a light detector (photocell)
 Each rotation cuts the light that falls on the detector, producing a pulsed output (electrical)
 By counting the no. of such pulses (via a pulse counter), we can measure the respiration rate
 Each pulse has a definite volume associated with it, so by adding all the pulses per minute, we can also measure the volume of the gas
□ Advantage
 Insensitive to the turbulent flow and gas composition, water vapour content and gas temperature
□ Disadvantage
 Inertia present to start the rotation of turbine, which needs to be minimised using light weight wein?
 Weight of turbine wein = 0.02gm

4. Hot-wire Anemometer
□ Anemos (greek) = wind
□ Measures resp. flow
□ Can also be used as a part of an equipment, where flow direction of gas is being measured also (eg. Ventilator)
 In such cases they use 2 heated elements (Pt wires) used within the tube
 Whichever wire cools faster indicates the direction of flow of gas
□ Principle
 Heated element (fine (order of a few micrometers) platinum wire) placed within a tube
 Platinum wire heated to a constant temperature
 When gas flows through this, the heated element cools down
 The rate of cooling of this wire proportional to the flow rate
 In order to maintain the temperature of the heated element, extra current would be drawn by it
 This extra current that it draws in is proportional to the flow rate
 Here, we are unable to measure the direction of flow
□ Disadvantage
 Very sensitive device (due to use of Pt wires)
 Highly sensitive to gas temperature and gas composition (exhaled air is warmer than inhaled air)
 More vulnerable to damage because of how fine the Pt wires are

5. Ultrasonic Type
□ Same principle as blood flow measurement (Doppler technique)
□ High frequency sound waves are passed into gas/respiratory path and the transit time is measured
□ Higher the transit time, the flow is travelling opposite to the sound wave and vice-versa
□ Change in frequency of ultrasound can be used to determine flow rate

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 □ Change in frequency of ultrasound can be used to determine flow rate

- Instruments for Quantitative Measurements and Monitoring

• Spirometer
○ Provides lung volume and capacity measurements
○ Bell-jar spirometer AKA Basic water sealed spirometer
 Both mechanical and electrical models available

○ Compact, handheld versions available today, but relatively bulky compared to other models?
○ Principle
 Bell-jar having a capacity of ~ 7-10L is suspended into a tank of water
 This tank of water seals the air (hence the name of device)
 Air tube going from patient's mouth into the air space of bell jar, the nose is clipped
 Weight suspended (via pulley) which holds the bell jar in such a position that the pressure within the bell jar is calibrated to atmospheric pressure
(atm?)
 When no breathing, bell is at rest, with a fixed volume within the bell above the water level
 During exhalation, pressure increases above atm, causing bell to rise
Similarly, during inspiration, pressure decreases below atm, causing bell to lower
 This changing bell pressure changes volume within bell, hence causing the position of the weight to change
 Pen connected to weight, which moves when weight moves
 Pen gets traced onto a writing device (mechanical version of spirometer) = recorder
□ Recorder = Chymograph
□ Here it is a rotating drum
□ Rotation speed of chymograph = 30-2000mm/min
When patient expires, negative portion of graph is obtained and vice-versa
□ This waveform/graph = spyrogram
□ Spyrogram used to make measurements
 In electrical analog of this device
□ Weight assembly and pen connected to a linear potentiometer (variable resistor?)
□ One end of POT = Vref or Vcc (i.e. fixed voltage)
□ Other end of POT = GND or -Vcc or -Vref
□ Pen connected to pointer, when it moves to extreme left of POT, E0 (output) = Vcc, right extreme = GND or -Vcc, at centre, E0 = 0V
□ E0 = 0V - given as calibration/reference value (no breathing assumed)
□ During breathing, E0 takes a value proportional to volume inspired/expired

○ Bellow type spirometers (not in syllabus - NiS)

 Here, E0 = Vcc(fixed voltage provided)* [volume of bellows at the wiper position]/maximum value of bellows
 Maximum value of bellows = Area (pi*r^2) * Maximum height of bellows
○ E0 can be converted to digital form via ADC (analog to digital convertors)
○ Ultrasonic type spirometers (NiS)

• Nebuliser
○ Provides medication in aerosol form i.e. it is nebulising the medication (as aerosols are better absorbed in the respiratory tract)
○ Aerosols given by mixing with oxygen and fed via mask?
○ For asthmatic patients
• Humidifier
○ Adds water vapour to air
• Pulse-Oximeter
○ Measures oxygen saturation in blood (in %)
• Infant Respiration Monitors
• Apnea Monitors
○ Apnea = cessation of breathing for a short period of time (after which breathing continues)
○ Commonly occurs during sleep (sleep apnea)
• Capnometers
○ Monitors CO2 levels in blood
• Body Plethysmographs
○ Respiration rate and volume measurement
○ Subject inside a chamber-like arrangement having fixed volume
○ As subject inhales or exhales, the volume/pressure change within the (closed) chamber is monitored
○ Non-invasive type
• Gas Electrode
○ For pH and other gas measurements present in breathing air?
• Gas Regulators
○ Regulates gas entering patient's body
○ Ensures that respiratory gases are given at a set/prescribed pressure level
○ If pressure is too high, it can lead to rupture alveoli (as they are thin membraned)

- Volume and Capacities of the Respiratory System

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 - Volume and Capacities of the Respiratory System
1. Tidal Volume
○ Volume of gas inspired/expired i.e. exchanged with each breath during normal/quiet breathing
○ TV ~ 500ml (0.5L)

2. Minute Volume
○ Volume of gas exchanged per minute during quiet breathing
○ MV = RR * TV

3. Respiration Rate
○ No. of breathes per min (value?)
○ In resting state, 12-20 breathes/min
○ Exercise, 40-45 breathes/min

4. Inspiratory Reserve Volume

○ Volume of gas that can be inspired from the normal end tidal volume i.e. above/after tidal volume
○ IRV = Vital Capacity (VC) - TV + Function Residual Capacity(FRC)
○ IRV ~ 2000-3000ml (2-3L) in adults

5. Expiratory Reserve Volume

○ Volume of gas that can be forcefully expired after normal expiration
○ ERV = FRC - RV

6. Residual Volume
○ Volume of air that remains in the lungs after maximal forced expiration
○ RV ~ 1200ml

- Respiration/Pulmonary Capacities = Relation between different Respiration Volumes

1. Vital Capacity
○ Maximum volume that can be inspired by voluntary effort after maximal expiration (i.e. after clearing the lungs)
○ Irrespective of time
○ VC reduced in obstructive lung diseases like asthma as lung elasticity reduces, thus enabling patient to take in less air
○ VC ~ 5L
○ VC = IRV + TV + ERV or
○ VC = Inspiratory Capacity (IC) + ERV

2. Functional Residual Capacity

○ Volume remaining in the lungs (residual capacity) after normal expiration
○ FRC ~ 2.2L
○ FRC = ERV + RV

3. Total Lung Capacity

○ Volume (of gas) in the lungs at the point of maximal inspiration
○ TLC = 5700 - 6200 ml (~6L) in adults
○ TLC = VC + RV

4. Inspiratory Capacity
○ Maximum volume that can be inspired form the resting end expiratory position
○ IC = TV + IRV
- Check graph in textbook (TV = sine wave)
- In resting/normal state, a person inspires/expires ~0.5L (TV)
- With exercise, respiratory volume increases 8-10x
- Respiratory disease suspected if the resp. volumes/capacities/rate are not within their normal range

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