Wearable Wireless Pulse
`Oximetry for Physiological
`Monitoring
`
`Yitzhak Mendelson, Ph.D.
`Deptartment of Biomedical Engineering
`Worcester Polytechnic Institute
`
`PPL Workshop (Aug. 4th, 2008)
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`MASIMO 2006
`Apple v. Masimo
`IPR2022-01291
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`Oximetry for Physiological
`Monitoring
`
`Yitzhak Mendelson, Ph.D.
`Deptartment of Biomedical Engineering
`Worcester Polytechnic Institute
`
`PPL Workshop (Aug. 4th, 2008)
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`Presentation Outline
`
`• Motivation
`• Goal
`• Background
`• Development of a Wearable Pulse Oximeter
`• Measurement Validations
`• Future Development
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`Motivation
`Telemedicine using wearable sensors can
`provide useful information for emergency
`first responders and facilitate life saving
`rescues of:
`
`• Soldiers
`• Firefighters
`• Mountain climbers
`
`Operating in harsh and hazardous environments
`(cid:190) Operating over large geographical terrains
`
`3(cid:190)
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`Motivation
`• Data derived from sensors can provide input
`information in models developed to assess and
`predict the health status of wounded soldiers.
`• The reliability of the wearable sensors used
`and the data extracted is essential for the
`successful implementation of these predictive
`models.
`
`Wearable Sensors
`
`Predictive
`Models
`
`Health Status
`
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`Motivation
`Representative Technology Needs for
`Improved Incident Management:
`
`Personnel monitoring (physiological
`monitoring of firefighters) capability — In
`particular, integrated body-worn sensor
`suite to provide real-time health analysis
`and issue alarms to both wearer and
`command staff.
`
`DHS Leads: Federal Emergency Management Agency
`and Office of Emergency Communications
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`Motivation
`• Firefighters experience tremendous CV
`demands with high-levels of short-term
`strenuous physical workloads and overexertion.
`• Increased HR and core body temperature leads
`to increased physiological stress.
`• Risks related to exhaustion, overheating and
`inhalation of combustion products can lead to
`work injuries and fatalities.
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`What are the Needs
`
`Physiological Monitoring
`
`?
`
`Wearable
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`Our Goal
`
`Development of a
`Robust Wearable Pulse Oximeter
`for Field Applications
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`Background
`Pulse oximeters are commonly employed
`in nearly all hospital areas where patients
`are at an increased risk of developing
`hypoxemia
`(cid:131) OR (Anesthesia)
`(cid:131) ER
`(cid:131) ICU
`(cid:131) Ambulances
`…
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`Background
`• Appeared in the early 1980’s.
`• Gained overnight popularity.
`• By 1987, the standard of care for the
`administration of a general anesthetic in
`the USA included pulse oximetry.
`• Transformed monitoring hypoxemia from
`a crude and imprecise visual color
`assessment into a reliable, quick,
`noninvasive and objective measurement.
`• Now a mature technology in hospitals.
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`Background
`• Life depends on uninterrupted O2 supply.
`• Different organs and tissues can survive lack of O2 for
`different lengths of time: The brain is the most rapidly and
`irrevocably damaged organ.
`• Because the brain regulates breathing
`and circulation, supplying O2 to the whole body,
`deprivation of O2 supply to the brain can be fatal.
`• Mild cases of hypoxia can cause poor judgment and
`uncoordinated movement. Severe cases death is inevitable.
`• After ~5 min, cutting off blood supply to the brain causes
`cells to die.
`• Timing is everything!
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`Background
`PULSE OXIMETERS RELY ON SPECTROPHOTOMETRIC
`PRINCIPLES TO DERIVE SpO2 AND HR FROM A
`PULSATING VASCULAR TISSUE BED
`
`Blood depleted of O2
`appears purple
`12
`
`Blood rich in O2
`appears bright red
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`Background
`
`
`
`skin, bone
`
`Absorption dueto tissue,
`
`Time
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`Transmittance Mode
`
`Reflectance Mode
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`Advantage of Reflectance Mode
`
`Why the Forehead ?
`
`(cid:131) Does not impede hand movements.
`(cid:131) Easy sensor attachment.
`(cid:131) More motion tolerant location (skull provides
`mechanical support).
`(cid:131) Provides strong and clean PPG signals.
`
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`COTS Pulse Oximeters
`Designed for Clinical Settings
`(Patient movement relatively constrained)
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`Commercial Sensors
`
`PD
`
`Adhesive
`
`LEDs
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`Principle
`• Several prominent features can be
`extracted from the Photoplethysmogram
`(PPG).
`• Monitoring multiple variables using a
`single sensor has distinct advantages.
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`Principle (SpO2)
`
`Principle (SpO.)
`
`PLETHYSMOGRAPHIC COMPARISON
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`Principle (HR)
`
`IR PPG
`Principle (HR)
`
`IR PPG
`
`Beat-to-Beat Intervals
`
`}t#—————|———1»|
`
`
`
`Amplitude
`
`0.5
`
`|
`
`1.5
`
`2
`
`2.5
`Time (sec)
`
`3
`
`3.5
`
`4
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`Principle (RR)
`
`IR PPG
`
`INSPIRATION
`
`INSPIRATION
`
`EXPIRATION
`
`EXPIRATION
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`Use of Commercial Pulse Oximeters
`as a Wearable Device in the Field is
`Challenging
`
`• Must operate reliably under adverse
`environmental conditions.
`• Can not limit normal activities.
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`Design Criteria
`(cid:190) Multiple physiological variables
`(cid:190) Low power consumption
`(cid:190) Cost effective
`(cid:190) Small size
`(cid:190) Light weight
`(cid:190) Easy sensor attachment
`(cid:190) Transparent to user (“wear-and-forget”)
`(cid:190) Adequate computation power
`(cid:190) Wireless communication
`(cid:190) Improved immunity to motion artifacts
`
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`Wearable Pulse Oximeter
`
`Battery Module
`
`USB-Based Receiver
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`User Interface
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`Measurement Validation (rest)
`
`Increase in HR
`During
`Hyperventilation
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`Measurement Validation (rest)
`
`Response to
`Voluntary
`Hypoxia
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`Measurement Validation (rest)
`
`C apnograph
`
`W P I
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`20
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`15
`
`10
`
`5
`
`0
`
`Breathing Rate (b/m)
`
`15
`
`65
`
`115
`
`165
`
`215
`
`265
`
`315
`
`365
`
`T ime (s )
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`Limitations of Pulse Oximetry
`• Highly reliable when used on motionless
`subjects.
`• Motion artifacts can obscure the true PPG
`signal with noise, leading to inaccurate
`readings, false alarms, dropouts, and
`missed true alarms.
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`Adaptive Noise Cancellation in
`Pulse Oximetry
`
`Resting
`
`2 mph
`
`4 mph
`
`2 mph
`
`Resting
`
`Masimo (Finger)
`With ANC
`Without ANC
`
`Time (s)
`
`HR (BPM)
`
`SpO2(%)
`
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`Future Developments
`
`• Firefighters can experience inhalation of CO (e.g.
`malfunctioning furnaces) and Cyanide (e.g.
`burning plastic products).
`• Acute CO and HCN poisoning renders the blood
`unable to carry sufficient amount of O2.
`• Symptoms of acute exposure include general
`weakness, headache, confusion, anxiety, nausea
`and vomiting.
`• If exposure is severe, unconsciousness and
`death.
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`Future Developments
`• Traditional testing of HbCO and MetHb involves
`blood sampling and waiting for lab results.
`• Conventional pulse oximeters use only
`two wavelengths of light.
`(cid:190) They cannot distinguish between HbO2, HbCO
`and MetHb.
`(cid:190) Provide false readings when CO and MetHb
`levels are elevated.
`
`• Multi-wavelengths to measure SpO2, HR, HbCO
`and MetHb, simultaneously.
`
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`ACKNOWLEDGEMENTS
`Development Supported by:
`(cid:190) WPI/BEI
`(cid:190) USAMRMC/TATRC
`(cid:190) Advanced Body Sensing
`(cid:190) PSI/QinetiQ
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`Thank You!
`Yitzhak Mendelson, Ph.D.
`Tel: (508) 831-5103
`Email: ym@wpi.edu
`http://www.wpi.edu/Academics/Depts/BME/People/yxm.html
`http://www.absensing.com/
`
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