1. Respiration Rate Apnea Monitor “Apnea Monitor.” From the publication: Core Medical Equipment. Geneva, Switzerland, 2011

2. 1.What are the 3 common technologies used for Apnea monitoring? 1.Which is the best technique to detect OBSTRUCTIVE apnea? 2.What are the causes for false alarms? Quiz

3. Apnea Central or diaphragmatic apnea Sleep Apnea (20%) –No respiratory effort, no nasal airflow, lack of neural input from central nervous system –Common in children –Sudden Infant Death Syndrome (SIDS)

4. Apnea Drcamachoent (Own work) [CC BY-SA 4.0 (http://creativecommons.org/licenses/by-sa/4.0)], via Wikimedia Commons

5. Apnea OBSTRUCTIVE Sleep ApneaOBSTRUCTIVE Sleep Apnea –The most common form of Apnea –Caused by upper airway obstruction –Respiratory movements persist

6. Apnea Monitor Respiration rhythm Cardiac activity (Optional) Oxygen saturation (Optional)

7. Apnea Monitoring Technologies Transthoracic Electric Impedance Pneumatic Abdominal Mouth and Nose Air Pressure/Temperature

8. Transthoracic BIA Heart rate and respiration 2 electrodes limitation

9. Transthoracic BIA Placed in the 5th intercostal space on each side of the neonate 55 kHz – 250 kHz 2 to 3 mV Applied Cardiopulmonary Pathophysiology 7: 57-62, 1998. @ 1998 Kluwer Academic Publishers. Retrieved from http://www.mikropolis.pl/_pdf/lu ng-diuresis.pdf

10. Transthoracic BIA 2 Eletrodes limitation To Monitor Lead Wire Impedance Tissue Impedance Lead Wire Impedance Electrode Impedance Lead Wire Impedance Cardiac Impedance Change Respiration impedance change Virginia Reid (2016), Transthoraic BIA [image]. Created from previous diagram (source unknown)

11. Limitations: Muscle movement artifacts Electrical noise Transthoracic BIA

12. Measures the motion of the abdomen Impedance of the abdomen does not change (no air) Linear variable displacement transducer (LVDT) or strain gauge Pneumatic Abdominal Sensor

13. Proximal airway pressure sensing pressure at the mouth and nose Distinguishes between central and obstructive apnea (BIA and Abdominal sensors can not) Thermistors monitor change in airway temperature-cooler room air for inspiration and warmer lung air for expiration. Thermistors and Pressure Sensors

14. Apnea Monitor Controls By Appendinisapprentice (Own work) [CC0], via Wikimedia Commons. Retrieved from https://commons.wikimedia.org/wiki/File:FluxMed_Respiratory_Mechanics_Monitor.jpg

15. National Heart Lung and Blood Institute (NIH) (National Heart Lung and Blood Institute (NIH)) [Public domain], via Wikimedia Commons. Retrieved from https://commons.wikimedia.org/wiki/File:Sleep_studies.jpg

16. Multiparameter Apnea Monitors NascarEd (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons

17. Robert Lawton (Own work) [CC BY-SA 2.5 (http://creativecommons.org/licenses/by-sa/2.5)], via Wikimedia Commons Examples

18. Electrodes extensive use may irritate baby's skin Patient’s Safety

19. Check batteries Check lead wires Confirm accuracy of each parameter monitored Check switches and display Check connectors Preventive Maintenance

20. Old Batteries Electrodes and cables contact The gel build up on the paddles and have to be cleaned with alcohol Common Problems

21. False negative alarms –Equipment vibration –ECG –Patient movement False positive alarms –loose electrodes or sensor –Weak breath Apnea Monitor False Alarms

22. Common Problems User error –Change a limit without consulting with the physician –Poorly attached leads and sensors

23. Test alarms on yourself Check your heart rate (max error 5 beats per minute) Check and compare respiration rate. Max 2 breaths/min error Test Procedures

24. Questions ?