US 20100137731 A1
A capnometer adaptor includes a nanostructure sensor configured to selectively respond to a gaseous constituent of exhaled breath, such as to carbon dioxide. In certain embodiments, the adaptor includes an airway adaptor having at least one channel configured for the passage of respiratory gas; at least one nanostructure sensor in fluid communication with the passage, the sensor configured to selectively respond to at least one gaseous constituent of exhaled breath comprising carbon dioxide; and electronic hardware connected to the nanostructure sensor and configured to provide a signal indicative of a response of the sensor to the at least one gaseous constituent of exhaled breath. The sensor may be provided as a compact and solid-state device, and may be adapted for a variety of respiratory monitoring applications.
1. A capnometer; comprising: an airway adaptor having at least one channel configured for the passage of respiratory gas; at least one nanostructure sensor in fluid communication with the passage, the sensor configured to selectively respond to at least one gaseous constituent of exhaled breath; electronic hardware connected to the nanostructure sensor and configured to provide a signal indicative of a response of the sensor to the at least one gaseous constituent of exhaled breath.
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This application is a continuation of and claims priority from U.S. patent application Ser. No. 11/019,792, now issued as U.S. Pat. No. 7,547,931, filed Dec. 20, 2004, titled “NANOELECTRONIC CAPNOMETER ADAPTER INCLUDING A NANOELECTRONIC SENSOR SELECTIVELY SENSITIVE TO AT LEAST ONE GASEOUS CONSTITUTENT OF EXHALED BREATH,” which is a continuation-in-part of U.S. patent application Ser. No. 10/940,324, filed Sep. 13, 2004, titled “CARBON DIOXIDE NANOELECTRIC SENSOR,” which claims priority to U.S. Provisional Application No. 60/564,248, filed Apr. 20, 2004, titled “REMOTELY COMMUNICATING, BATTERY-POWERED NANOSTRUCTURE SENSOR DEVICES,” and which also claims priority to U.S. Provisional Application No. 60/531,079, filed Dec. 18, 2003, titled “NANOELECTRONIC CAPNOMETER ADAPTER,” and which is also a continuation-in-part of U.S. patent application Ser. No. 10/656,898, filed Sep. 5, 2003, titled NANOSTRUCTURE SENSOR DEVICE WITH POLYMER RECOGNITION LAYER.” All of which are incorporated herein by these references in their entireties for all purposes.
The present invention relates to an apparatus and method for mainstream patient airway medical monitoring, such as by using a capnometer.
The measurement of carbon dioxide levels in respiration is a standard procedure during intensive care and anesthesia and is a primary tool in the diagnosis and management of respiratory function. A need in this medical monitoring is to measure and track CO.sub.2 concentration in the breath, sometimes referred to as capnography.
To meet the necessary specifications of such capnography device, current technology relies on bulky and expensive non-dispersive infrared absorption (MAR) sensors to determine CO.sub.2 concentration. The high cost and limitations of this technology restrict the use of capnography to high value, controlled environments, such as surgical wards. In addition, it has been shown that capnography is particularly important in determining the proper placement of endotracheal tubes in emergency medical response.
There are two approaches to implement this detection method, mainstream and sidestream. Mainstream devices make use of a sensor located at the patient airway by means of an airway adapter. In contrast, sidestream device requires connection of a sample line to the airway, and a sensor located away from the patient. Notwithstanding the advantages of these approaches, each may be subject to certain limitations that may compromise the effectiveness of CO.sub.2 monitoring.
A comparison of exemplary limitations of prior-art apparatus and methods are listed below:
Mainstream Secretions and humidity block the sensor. A heating element is used to negate condensation. A bulky device is at the patient airway. The sensor must be sterilized and calibrated after each use. The sensor is not usable with non-intubated patients.
Sidestream Secretions block sample tubing. A necessity for a water trap. A slower response for CO.sub.2 changes. Reduced air flow decreases tidal volume. Additional sample tubing. A costly pump and suction system.
It is desirable, therefore, to provide an apparatus and method for monitoring CO.sub.2 or other gases in a patient's airway, that overcomes the limitations of the prior art.
The present invention overcomes the limitations of the prior art using a novel capnometer apparatus. A nanoelectronic capnometer system having aspects of the invention offers: (i) performance that matches or exceeds that of infrared technology, (ii) plug-and-play simplicity in a disposable package, (iii) the small size and low power consumption needed for wireless integration and (iv) the ability to incorporate arrays of sensors on a single chip. This CO.sub.2 sensing technology offers an order of magnitude reduction in the cost of the sensor component.
The capnometer comprises a nanoelectronic gas sensor integrated into an airway adapter for mainstream capnometry. The nanoelectronic sensor may comprise a solid-state nanotube or other nanostructure sensor, for example, as described in the parent application Ser. No. 10/940,324. The capnometer apparatus may further comprise an appropriate adapter fitting that maximizes sensor performance. Both the adaptor fitting and the sensor may be incorporated into a compact and relatively low-cost assembly. Instead of sterilizing the capnometer after use, the sensing unit may be discarded, thereby avoiding difficulties and costs associated with sterilization.
The nanoelectronic gas sensor may be configured to respond to a chemical of interest, for example, carbon dioxide, oxygen or anesthesia gases. It may be integrated into a fitting designed to be inserted into an intubated or non-intubated patient airstream, such as, for example, during anesthesia application and/or respiratory monitoring. The nanoelectronic gas sensor (“nanosensor”) itself may comprise a small packaged solid-state device incorporating a nanostructure sensor that is exposed to airflow on the inside of the tube and electronically connected to the outside of the tube. The fitting together with the enclosed nanosensor may be designed as a disposable device. A potentially reusable external electronics package that contains signal processing electronics may be socketed or snapped into place to make a secure connection with the sensor. This electronics module may include a microprocessor, memory cell, power supply (including a battery) and a wired or wireless connection to a monitor where the sensor output is stored and/or displayed.
Being extremely small with a nanometer-scale active sensing area, the sensor may readily be protected from contamination, and can therefore be located in the more desirable mainstream configuration for faster response times. At the same time, the low cost of the chip-scale sensor can make it possible to dispose the sensor and its associated adaptor after each use, thereby eliminating the problem of disinfection. The capnometer adaptor with its sensor may be very compact, cost-effective and convenient to use in a clinical setting. Iris anticipated, therefore, that the invention will greatly facilitate and enhance the beneficial practice of capnography.
One exemplary capnometer embodiment having aspects of the invention comprises: an airway adaptor having at least one channel configured to permit the passage of respiratory gas; at least one solid-state nanostructure sensor arranged adjacent the airway adaptor in communication with the passage, the sensor having a sensitivity to at least one gaseous constituent of exhaled breath; electronic circuitry connected to the solid state sensor and configured to receive at least a signal indicative of the concentration of the at least one gaseous constituent of exhaled breath; and an output device connected to the electronic circuitry and configured to provide at least one of a qualitative and a quantitative measure of the concentration of the at least one gaseous constituent of exhaled breath. Preferably, the at least one gaseous constituent of exhaled breath includes carbon dioxide and the solid-state sensor incorporates a nanostructure as a sensing element responsive to the at least one gaseous constituent.
In certain embodiments, the at least solid-state nanostructure sensor comprises: a substrate; a first nanostructure over the substrate; at least two conducting elements in electrical communication with the first nanostructure; and at least one recognition material operatively associated with the first nanostructure, the at least one recognition material configured for interacting with carbon dioxide.
In alternative embodiments, the airway adaptor is configured to be mated so as to transmit at least a portion of the exhalation flow of at least a one of: a respirator/resuscitation system, a endotracheal ventilator system, an sleep apnea treatment system, a sleep apnea diagnostic system, an anesthesia system, a cardiac function diagnostic system, a metabolic function measuring system, an asthma monitoring system, and a gastro-intestinal testing system.
A more complete understanding of the capnometer adaptor will be afforded to those skilled in the art, as well as a realization of additional advantages and objects thereof, by a consideration of the following detailed description of the preferred embodiment. Reference will be made to the appended sheets of drawings which will first be described briefly.
The embodiment of the invention incorporates a nanoelectronic capnometer into an adapter for patient airway monitoring. The resulting device seamlessly integrates into a mainstream capnography setup and delivers performance advantages over that of today's mainstream and sidestream NDIR capnometers.
The nanoelectronic sensor 12 may be disposed in fluid communication with respired air passing through channel 19. In order to provide a sample volume to the capnometer, a small window or opening 13 may be provided between the sensor 12 and channel 19. The sample window may be provided with membranes and/or filters 18 to reduce condensation, block patient secretions, and overall maintain stability of the sensor. For example a gas-permeable hydrophobic membrane, e.g. a PFC membrane, may be used.
When using a nanotube electronic sensor, it is not necessary to maintain a clear optical path between a transmitter and receiver, unlike prior-art NDIR sensors for carbon dioxide sensing. Furthermore, the active sensing area of a nanotube sensor is extremely small, so one may readily protect the sensor from contamination in the patient airstream. For example, very little power is required to heat the sensor to a stable temperature at which condensation is prevented. And the sensor may be protected from non-volatile contaminants by a simple mechanical filter and/or gas permeable membrane, which need only be large enough to minimize the likelihood of excessive filter blockage during the anticipated life of the sensor. For reusable sensors, filter units may be removed and disposed between use, and then replaced with a new filter unit. For most applications, however, it may be desirable to dispose and replace the entire unit 10, including any associated filters.
The unit 10 may be comprised primarily of a mechanically stable housing 14. Housing 14 may be comprised of any suitable plastic or other material with similar chemical and physical properties for use in medical tube fittings, as known in the art.
The capnometer sensor 12 may be based on nanoscale components as described in the parent patent application Ser. No. 10/940,323 and herein, for selectively sensing carbon dioxide. Sensing of other gases may also be achieved using a suitably configured nanotube sensor, for example, a sensor as described in U.S. provisional application Ser. No. 60/457,697 filed March 2003 and Ser. No. 60/468,621 filed May 2003, and U.S. non-provisional application Ser. No. 10/177,929 filed June, 2002, Ser. No. 10/656,898 filed Sep. 5, 2003, Ser. No. 10/655,529 filed Sep. 4, 2003, Ser. No. 10/388,701 filed Mar. 14, 2003, and Ser. No. 10/345,783 filed Jan. 16, 2003; each of which is incorporated herein by reference.
Sensing for two or more gases, for example, carbon dioxide and oxygen, may be accomplished using one or more sensors like sensor 12. A single sensor may include a plurality of nanotube sensors, each configured to sense a different gas. In addition, or in the alternative, a plurality of nanotube sensors may be each configured to sense the same gas, for purposes of redundancy. It should be appreciated that the extremely small scale of a nanotube sensor makes it possible to cost-effectively incorporate numerous nanometer-scale sensors in a single gas sensing unit 12, which may essentially consist of a very compact silicon chip or other device. In the alternative, one or more nanotube sensing devices may be assembled together into a sensing unit with multiple sensors. Since each device may be quite small, space and/or cost need not be limiting concerns.
A capnometer according to the invention may readily be configured to operate wirelessly.
In the alternative, a capnometer 30 may be designed to function with all electronics 31 separate from the sensor 32, as shown in
It also is desirable to provide disposable capnometer sensing adaptors, wherein the sensing package is installed directly in the main air channel of the respiratory stream.
Alternatively, one may dispose the sensing unit more directly in the airstream. For example,
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Embodiments of this invention include a new sensing technology for carbon dioxide (CO.sub.2) that uses nanoelectronic components. A tiny, low-cost nanosensor chip can offer: (i) performance that matches or exceeds that of infrared technology, (ii) plug-and-play simplicity with both digital and analog control systems, and (ii) the small size and low power consumption needed for wireless integration.
Field effect transistors made from semiconducting single-walled carbon nanotubes (NTFETs) have been used as the platform for sensitive chemical sensors.
Two conductive elements 808, 810 may be disposed over the substrate and electrically connected to nanostructure 806. Elements 808, 810 may comprise metal electrodes in direct contact with nanostructure 806. In the alternative, a conductive or semi-conducting material (not shown) may be interposed between elements 808, 810 and nanostructure 806. A functionalization material 815 reactive with carbon dioxide is disposed on nanostructure sensing device 802 and in particular, on nanostructure 806. Material 815 may be deposited in a continuous layer, or in a discontinuous layer. Material 815 may comprise more than one material and/or more than one layer of material.
Device 802 may further comprise a gate 812. Device 802 may further comprise a layer of inhibiting material 814 covering regions adjacent to the connections between the conductive elements 808, 810 and the first nanostructure 806. The inhibiting material may be impermeable to at least one chemical species, such as carbon dioxide. The inhibiting material may comprise a passivation material as known in the art, such as silicon dioxide. Further details concerning the use of inhibiting materials in a NTFET are described in prior application Ser. No. 10/280,265, filed Oct. 26, 2002, which is incorporated by reference herein.
In addition, system 800 may further comprise a second nanostructure sensing device (not shown) like device 802. It may be advantageous to provide the second device with a functionalization layer that incorporates a material different from that incorporated into layer 815.
System 800 may further include a nanostructure sensing device circuit 816. Circuit 816 may include one or more electrical supplies 818, a meter 820 in electrical communication with the electrical supply or supplies 818, and electrical connections 822 between the first nanostructure sensing device 802 and both the electrical supply and the meter. System may further comprise a signal control and processing unit (not shown) as known in the art, in communication with the first nanostructure sensing device circuit.
The carbon nanotube acts not as the sensing element itself but as a sensitive transducer. There are various designs for the basic platform; these include devices with one or only a few nanotubes and devices with a network of nanotubes. A useful nanotube network device architecture has been described in commonly-owned application Ser. No. 10/177,929, filed on Jun. 21, 2002, which is included by reference herein. The nanotube transducers can be chemically functionalized to provide desired sensitivity and selectivity. They can even be made sensitive to a variety of inert gases. The functionalization approach relies on the ability of basic inorganic compounds and organic polymers as well as aromatic compounds with electron-donating functionalities to provide electrons to nanotubes, thus resulting in n-doping of NTFETs.
Sensitivity to CO.sub.2 can be achieved through functionalization also. The functionalization layer has two main functions: 1) it selectively recognizes carbon dioxide molecules and 2) upon the binding of CO.sub.2 it generates an amplified signal that is transferred to the carbon nanotube transducer. In the presence of water, carbon dioxide forms carbonic acid which dissociates and alters the pH of the functionalization layer, thus protonating the electron donating groups and making the NTFET more p-type. Basic inorganic compounds (e.g., sodium carbonate), pH-sensitive polymers, such as polyaniline, poly(ethyleneimine), poly(o-phenylenediamine), poly(3-methylthiophene), and polypyrrole, as well as aromatic compounds (benzylamine, naphthalenemethylamine, antracene amine, pyrene amine, etc.) can be used to functionalize NTFETs for CO.sub.2 sensing. The functionalization layer can be constructed using certain polymeric materials such as polyethylene glycol, poly(vinyl alcohol) and polysaccharides, including various starches as well as their components amylose and amylopectin.
Materials in the functionalization layer may be deposited on the NTFET using various different methods, depending on the material to be deposited. For example, inorganic materials, such as sodium carbonate, may be deposited by drop casting from 1 mM solution in light alcohols. The functionalized sensor may then be dried by blowing with nitrogen or other suitable drying agent. Polymeric materials may be deposited by dip coating. A typical procedure may involve soaking of the chip with the carbon nanotube device in 10% polymeric solution in water for 24 hours, rinsing with water several times, and blowing the chip dry with nitrogen. Polymers which are not soluble in aqueous solutions may be spin coated on the chip from their solutions in organic solvents. Values of polymer concentrations and the spin coater's rotation speeds may be optimized for each polymer. Further details pertaining to polymer recognition layers may be described in commonly-owned parent application Ser. No. 10/658,898, filed Sep. 5, 2003, which is also incorporated by reference herein.
Capnometers having aspect of the invention may be included in many different sorts of medically useful system, both as permanent, semi-disposable, or completely disposable components. Likewise, a variety of different arrangements of the sensors, signal and power circuitry and data display and recordation subsystems are practical.
Note that capnometers having aspects of the invention may include a wide variety of data acquisition, storage, processing and output devices. For example, the capnometer signal may be used to determine respiration rate, and inhaled gas composition, in addition to exhaled breath composition, such as end-tidal CO2 values. In addition to discrete point values, a real-time and continuous profile of breath composition may be determined and displayed, e.g as a plot of CO2 concentration versus time.
Capnometers having aspects of the invention can be embedded into standard embodiments for breath monitoring commonly found in emergency medicine, ex: airway adapters, masks, ambubags, and laryngeal masks etc. The construction of the sensor assembly is flexible to address most airway monitoring environments. The sensor may be used in hospital, prehospital, and out-of-hospital settings, so as to provide highly valuable monitoring information to all health care providers whether they are doctors, nurses, respiratory technicians or EMTs.
Among the applications where the capnometers having aspects of the invention could provide significant healthcare benefits are: Endotracheal Tube Verification Breathing Quality Assessment Intra and Inter-Hospital Transport Adequacy of CPR
Table 1 shows example specifications of a disposable capnometer adapter having aspects of the invention, configured to provide a typical Emergency Medical Services/Emergency Department with a small, noninvasive, and disposable in-line sensor that continuously monitors varying CO2 levels and delivers accurate measurement of end tidal carbon dioxide concentrations. For example, the device may have a bar graph to continuously track CO2 concentration. The operating lifetime of the sensor, 6 hours, is more than sufficient to accommodate long transport times.
TABLE-US-00001 TABLE 1 Specification: Example: Technology Nanotube Sensor Display Bar Graph Range 0-6% (0-48 mm Hg) Resolution 1% mm Hg) Response Time 500 ms Shelf Life 1 Year Use Life 6 Hours
Additional applications include: Anesthesia-Capnography—used to monitor adequacy of ventilation, verification of proper intubation and quality of respiration during surgical procedures requiring anesthesia. It also applies to post-op, intensive care and critical care monitoring. Emergency Medical Services/Emergency Department—An end tidal CO2 value is a predictor of cardiac output and an indicator of adequate respiration. Many situations in the EMS could benefit from reporting of this value: cardiac arrest, respiratory arrest, trauma, seizures, shock, diabetic ketoacidosis, asthma, intra/inter hospital transport and most importantly, endotracheal tube placement. Procedural Sedation—The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has supported the continuous monitoring of respiration during sedation. Patients receiving care at offices should be given equal care as in the operating room whether intubated or nonintubated, including tracking expired CO2 values for patents. Asthma—Monitoring of CO2 can assess the severity of a bronchospasm and notify successful medication or treatment. Sleep Apnea—The monitoring of CO2 levels can be used to screen for apnea, the stoppage of breathing. In addition to diagnostic applications, CO2 monitoring can show efficacy of therapeutic machines. Metabolic Testing—Various types of metabolic testing track expired CO2 levels and volumes as a means to garner a metabolic assessment, including one's resting metabolic rate. Gastro-Intestinal Testing—CO2 measurement is needed to monitor and capture alveolar respiratory gas as part of sampling for various breath testing: lactose/fructose intolerance, bacterial overgrowth, and H. Pylori (peptic ulcers).
Having thus described a preferred embodiment of the nanoelectronic capnometer sensor, it should be apparent to those skilled in the art that certain advantages of the within system have been achieved. It should also be appreciated that various modifications, adaptations, and alternative embodiments thereof may be made within the scope and spirit of the present invention. A wide variety of support structure and/or adaptor geometries may be suitable, and the invention is not limited to the particular shapes depicted in the schematic diagrams.