Adaptive calibration pulsed oximetry method and device

Details Adaptive calibration pulsed oximetry method and device Adaptive calibration pulsed oximetry method and device

2002-07-15

2004-07-06

Jones, Mary Beth (Department: 3736)

Surgery

Diagnostic testing

Measuring or detecting nonradioactive constituent of body...

C600S323000, C600S330000

Reexamination Certificate

active

06760609

ABSTRACT:

A portion of the disclosure of this patent document contains material which is subject to copyright protection. The copyright owner has no objection to the facsimile reproduction by anyone of the patent document or the patent disclosure, as it appears in the Patent and Trademark Office patent file or records, but otherwise reserves all copyright rights whatsoever.
BACKGROUND OF THE INVENTION
This invention relates generally to oximeters that measure arterial blood oxygen saturation (S
a
O
2
) levels in tissues. More specifically, this invention relates to oximeters that use the pulsatile component of light of multiple wavelengths to determine the amount of arterial blood oxygen saturation.
The arterial blood oxygen saturation and pulse rate of an individual are of interest for a variety of reasons. For example, emergency or surgical care settings can use information regarding oxygen saturation to signal changing physiological factors, the malfunction of anesthesia equipment, or physician error. Similarly, in the intensive care unit, oxygen saturation information can be used to confirm the provision of proper patient ventilation or to optimize a gradual reduction and eventual removal from assisted ventilation.
The proper utilization of many lifesaving medical techniques and treatments depends upon the attending physician continually obtaining accurate and up-to-date information regarding various bodily functions of the patient. Heart rate, blood pressure, and arterial oxygen saturation are among the most critical information that a physician needs to determine an optimal course of treatment. Continuous provision of this information is crucial to allow the physician to immediately adopt a procedural course that will best meet a patient's needs.
Arterial oxygen saturation (S
a
O
2
) is expressed as a percentage ratio of hemoglobin which is bound to oxygen (i.e., oxygenated hemoglobin (HbO
2
or “oxyhemoglobin”)) to the total hemoglobin in the patient's blood (including both oxygenated (HbO
2
) and non-oxygenated hemoglobin (Hb)), as represented by the following equation:
S
a
O
2
=([HbO
2
]/([Hb]+[HbO
2
]))×100%
In a healthy patient, the S
a
O
2
value is generally above 95% since blood traveling through the arteries has just passed through the lungs and has been oxygenated. As blood courses through the capillaries, however, oxygen is off-loaded into the tissues and carbon dioxide is on-loaded into the hemoglobin. Thus, the oxygen saturation levels in the capillaries (S
c
O
2
) is always lower than in the arteries. Once the blood has provided oxygen to the body tissue, the blood returns to the heart through the veins. Accordingly, the blood oxygen saturation levels in the veins is even lower still (i.e., about 75%).
Importantly, if the patient's arterial oxygen saturation level is too high or too low, the physician can take corrective action, such as reducing or increasing the amount of oxygen being administered to the patient, only after he or she learns of the incorrect saturation level. Proper management of arterial oxygen saturation is particularly important in neonates where S
a
O
2
must be maintained high enough to support cell metabolism but low enough to avoid damaging oxygen-sensitive cells in the eye, which could cause impairment or complete loss of vision. Accordingly, in many applications, the continual provision of up-to-date information regarding the patient's pulse rate and oxygen saturation level is crucial to allow the physician to detect harmful physiological conditions before any observable physical manifestations of a substantial risk of injury arise. In settings such as operating rooms and in intensive care units, monitoring and recording these indicators of bodily functions is particularly important. For example, when an anesthetized patient undergoes surgery, it is generally the anesthesiologist's role to monitor the general condition of the patient while the surgeon proceeds with his tasks.
Typical techniques for measuring these characteristics include invasive procedures, such as using an inserted catheter to measure blood pressure and to extract periodic blood samples, or non-invasive techniques. Unfortunately, although invasive procedures are typically more accurate than non-invasive ones, they generally take several minutes to obtain results. These wasted minutes can be crucial in many medical situations as human tissue can begin to degenerate with lack of sufficient oxygen in just a few minutes. Non-invasive techniques are therefore generally preferred, not only because they avoid the painful insertion of needles or other instrumentation into a patient's body, but also because they offer a quicker response to changing physiological characteristics of the patient. Noninvasive techniques are also desirable when complex blood diagnostic equipment is not available, such as, for example, when a home health care provider performs a routine check-up in a patient's home.
The term “oximetry” has been adopted in the art to refer to noninvasive apparatus and methods for determining blood oxygen saturation levels. Conventional types of oximeters include finger oximeters, earlobe oximeters, and fetal oximeters. Conventional oximetry systems make use of the fact that the absorption characteristics of different blood components, namely, HbO
2
and Hb, differ depending on which wavelength of light (e.g., infrared or visible portions of the spectrum) is being used. Accordingly, typical noninvasive oximetric systems impinge at least both visible and infrared light upon a body part, such as a finger, and then estimate the S
a
O
2
level using the relative proportions of visible and infrared light transmitted through or reflected by the body tissue. Undesirably, however, these conventional systems inherently include some inaccuracy, which increases to a substantial error for low (50-70%) S
a
O
2
levels, due to, among other things, the inclusion of capillary blood as well as arterial blood in the light measurement readings.
In an effort to improve the accuracy of the S
a
O
2
values obtained using two wavelengths of light, some systems have utilized the pulsatile component of the transmitted or reflected light beam to distinguish variations in the detected intensity of the light beam which are due to changes in blood components from other causes. This approach is generally referred to as pulse oximetry. Using the pulsatile signal modulating the light beams for obtaining an S
a
O
2
estimate provides a significant improvement in accuracy over non-pulse oximetry systems.
“Pulsed oximeters” are therefore oximeters which measure the arterial component of the blood perfusion, to yield the arterial oxygen saturation (S
a
O
2
) level, using the pulsatile component of a light transmission signal. Companies have built special circuitry and developed algorithms to obtain good signal-to-noise ratios for this pulsatile measurement. These conventional circuits and algorithms typically yield a pulsatile factor (R) which is based in part on the ratio of the pulsatile component of light measurements at a red wavelength (eg., 600-800 nm) and at an infrared wavelength (eg., 800-1000 nm). More specifically, the pulsatile factor R is equal to a ratio of the pulsatile component divided by the steady-state component of light at the red wavelength to the pulsatile component divided by the steady-state component of light at the infrared wavelength, as shown by the equation:
R
=(
AC/DC
)
red
/(
AC/DC
)
infrared
The pulsatile factor R therefore properly corrects for variation in the power of the light sources and photodetectors comprising the measurement device. As will be discussed later, the ratio R does not, however, correct for the background tissue optics consisting of tissue thickness, tissue blood perfusion, light scattering, and boundary conditions such as bones and the air/tissue surface.
As explained above, traditional oximeters calibrate their pulsatile factor R measurement using non-invasive lig

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