GB2527030A - Electrode array - Google Patents

Abstract

An electrode array 1 for measuring impedance across a patients (e.g. an infant or a neonatal baby) lung comprises two or more electrodes 40 mounted on a substrate and being connectable to an electrical impedance segmentography monitor, and an adhesive surface (95 in figure 3) for attaching the electrodes to the patients skin. The array may comprise five electrodes distributed in an x-shaped configuration, with the four electrodes at the extremities of the cross positioned on the patients skin proximal to the quadrants of the lung, and the fifth on a position on the skin equidistant from the other four to be used as a reference electrode. The electrodes may be connected to wires 35-39 or printed tracks connectable to an electrical impedance segmentography (EIS) monitor. The substrate may be an adhesive liner 5 removably attached to the electrodes. It can be provided in two sections 10, 15 and at least one non-adhesive tab 25, 30 for assisting its removal. An EIS monitoring system may comprise an EIS monitor and two electrode arrays attached on a newborns chest and back, so that they are a mirror image of each other.

Description

ELECTRODE ARRAY

[0011 This invention relates to an electrode array for use in electrical impedance segmentography (EIS]. In particular, the electrode array is for neonatal use, ie for use on newborn babies (normally, although not exclusively, up to 28 days after birth).

10021 Background

[003] Electrical Impedance Segmentography (ETS] is a painless, low cost, non-invasive and radiation-free method which allows the user to continuously record the distribution of air and fluids in parts of the human body.

[0041 EIS is used (particularly in neonates] to monitor the impedance across the four quadrants of the lung. This is considered to be representative of the equivalent ventilation and shows changes in volume for each of these quadrants. Regional changes of lung ventilation, such as alveolar collapse and atelectasis, pneurnothorax, thoracic effusions, misplacement of tracheal tubes or surfactant can be diagnosed by x-ray, but cannot be monitored continuously in clinical routine at bedside in NICUs at present. In relation to this invention, the term "lung quadrant" is used to mean a portion of each lung defined by dividing each lung approximately into upper and lower halves by volume (ie resulting in four "quadrants" when considering both left and right lungs together). The term "upper" is used to mean the quadrant closer to the patient's head, and the term "lower" are used to mean the quadrant closer to the patient's feet.

[0051 Therefore methods to monitor regional ventilation of spontaneously breathing infants and especially of mechanically ventilated infants at bedside are required.

[006] Inhomogeneous distribution of air and ventilation between the right and left lungs, as well as within each lung, remains a major problem in neonatal intensive care. It constitutes a therapeutic dilemma, since increasing ventilatory support also increases the inhomogeneity and gas exchange disturbances. Alveolar collapse or overdistension of the lungs is associated with ventilation/perfusion mismatch.

[007] It is known to use x-rays on a regular basis to assess the regional distribution of ventilation, which largely affects the capability of the lung to exchange gases. For many therapeutic measures, such as adjustments of ventilator settings, recruitment manoeuvres, patient positioning, lung suction, and pneumothoraces, it is highly beneficial to get immediate feedback on a breath-by-breath basis to assess the efficiency of the measure. EIS, particularly the Angelie EIS System produced by SLE Limited, allows the production of images, real-time impedance curves and derived parameters which can provide this feedback immediately and in real-time.

[008] Newborn babies are small and have delicate anatomies, and so insertion of a tube into the airway tends to be a more complicated process than inserting a tube into an adult. Possible risks of a neonatal intubation include damage to areas of the body from the tube, or insertion of the tube into the wrong area, therefore affecting the oxygen getting into the body. Tubes may also become blocked, with blood or mucus, or may fall out of place. Once intubated, the carer has to perform safety checks to confirm that sufficient oxygen is getting to the baby. EIS allows the user to see where the air is going in the lungs and to monitor any changes in its distribution.

[009] Babies born prematurely often have respiratory systems that are highly fragile and still developing or in arrested development. EIS can help monitor the normal distribution of gas within a baby's lungs and give advanced warning of potential problems. Forced respiration combined with the newborn's fragile breathing organs can cause ruptures in the lungs, alveoli or both. Although surfactant may keep alveoli supple during flexing, constant mechanical ventilation can overwork even well-coated air sacs, causing tears. This is the most common reason for pneumothorax in newborns. If the alveoli don't break, the lungs themselves might tear and develop holes if stressed by the machine ventilator.

[00101 Further description of EJS can be found in the following references: [i) Electrical Impedance Segmentography, Regional Lung Ventilation in Infants, Judith C Weinknecht, June 2009; (H] Continuous Noninvasive Monitoring of Tidal Volumes by Measurement of Tidal Impedance in Neonatal Piglets, Kurth et al, PLoS ONE June 2011 v6.6; (iii) Continuous Noninvasive Monitoring of Lung Recruitment during High Frequency Oscillatory Ventilation by Electrical Impedance Measurement, An Animal Study, Burkhardtetal, Neonatology, May2012.

[0011] A problem with current EIS systems relates to the attachment of the electrodes to the body of the newborn. In order to obtain correct monitoring of the newborn's lung function) ten electrodes are normally attached to its torso. Five electrodes are attached to the newborn's chest, and five to its back. Four of each of the two sets of five electrodes measure lung function whereas one of each of the two sets of five electrodes is a reference electrode. The electrodes are normally attached such that the electrodes on the newborn's back are a mirror image of those on the chest. In addition, the electrodes are usually attached in the form of a cross [XJ, with one electrode [for measuring lung function] at each of the four extremities of the cross, and one reference electrode at the centre of the cross.

[0012j It is time-consuming to apply ten individual electrodes to a newborn. In addition, it may be necessary to apply and remove the electrodes several times during a newborn's treatment. The application and removal of the electrodes can cause stress to the newborn, particularly if they have other health problems.

[0013j Any method of ameliorating these problems must also meet several other competing requirements. For example, the electrodes should not interfere with other monitoring equipment such as chest drains, belly button attachments, temperature sensor patches, transcutaneous 02 and CO2 probes, ECG, auscultation and heart ultrasound. Furthermore, since a newborn's skin is especially sensitive, the electrodes should minimise damage to the skin. In addition) the device needs to be comfortable for the newborn, which may be lying on its front) side or back. The electrodes should also minimise restriction to the movement or breathing of the newborn.

[0014] From a user's point of view, any method of ameliorating the problems shoukl allow quick application of the electrodes to the patient It should also be easy to use and easy to understand how to use. It is advantageous if the application process can be carried out by one person.

100151 Summary of the invention

[00161 This invention relates to an electrode array suitable for adhesion to a patient's skin, the array comprising: (i] two or more electrodes which are mounted on a substrate and are connectable to an electrical impedance segmentography monitor, (H] an adhesive surface for attaching the electrodes to the patient's skin.

[0017] In this way, several electrodes can be applied to a patient's skin in a single step, thereby reducing any distress caused to a patient during the application process.

[0018] In relation to this invention, the word "proximal" is used to refer to the side of the electrode array that is to be applied to the patient's body. The word "distal" is used to the side of the electrode array that faces away from the patient's body.

[0019] The number of electrodes in the array can vary. Preferably, at least one of the electrodes is suitable for measuring the impedance across a patient's lung.

Preferably, at least one of the electrodes (most preferably one] is suitable for use as a reference electrode, ie an electrode which does not measure the impedance across a patient's lung. In a preferred embodiment the electrode array comprises five electrodes. By providing five electrodes, four can be used to monitor the impedance across the four quadrants of the patient's lung. The fifth electrode can be used as the reference electrode.

[00201 It is preferred that the adhesive surface is provided on and/or around each of the electrodes. This is so that the electrodes can be attached to the patient's skin.

Preferably, the adhesive surface comprises a hydrogel adhesive. Hydrogel adhesives can provide good adhesion, strength and flexibility whilst also being air and water permeable.

[0021] In some embodiments, the electrodes are connected to wires or printed tracks which are connectable to an electrical impedance segmentography monitor.

In some embodiments, printed tracks are preferred in order to provide improved comfort for the patient This is because printed tracks are flatter than wires and can therefore be more comfortable for a patient to lie on.

[0022] In some embodiments, the substrate is an adhesive liner which is removably attached to a distal side of the electrodes. The liner allows the user to more easily apply the electrode array to the patient. It is preferred that the adhesive liner is provided in two sections. In some embodiments, these two sections are of approximately equal size. Preferably, the adhesive liner is provided with at least one non-adhesive tab for assisting the user in removing the liner. If the adhesive liner is in two sections, these tabs may be provided adjacent to where the two sections meet. Preferably, the electrodes are arranged on the adhesive liner such that, in use, each of four of the electrodes has a position on the patient's skin proximal to each of the four quadrants of the patient's lung. Preferably, in use, a further electrode has a position on the patient's skin approximately equidistant from these four electrodes. For example, the electrodes may be arranged such that an electrode is provided proximal to each of four corners of the removable adhesive liner, and that one electrode is provided approximately at the centre of the removable adhesive liner.

[0023] This invention also relates an electrical impedance segmentography monitoring system comprising: (iJ an electrical impedance segmentography monitor, and (H] two electrode arrays as described above which are connectab'e to the monitor.

[0024] This invention will be further described by reference to the following Figures which are not intended to limit the scope of the invention claimed, in which: Figure 1 shows a distal view of an electrode array according to a first embodiment of the invention, with the positions of the electrodes shown in dashed lines.

Figure 2 is identical to Figure 1, but without the dashed lines.

Figure 3 shows a proximal view of the first embodiment of the invention.

Figures 4a-4c show distal views of three stages of applying the first embodiment of the invention to a patient.

Figures 5a and 5b show distal views of further versions of the first embodiment of the invention with the connecting wires in alternative positions.

Figure 6 shows a proximal view of an electrode array according to a second embodiment of the invention.

Figure 7 shows an end-on view of the second embodiment of the invention.

Figure 8 shows a proximal view of the second embodiment of the invention with the connecting tracks depicted.

[0025] Figures 1-4c depict an electrode array 1 according to a first embodiment of the invention. As shown in Figures 1-3, 4a and 4b, the electrode array 1 comprises removable adhesive liner S on its distal side. Removable adhesive liner 5 comprises two sections 10, 15. These two sections 10, 15 divide the adhesive liner in half The two sections 10, iS meet at centre line 20 of the removable adhesive liner 5.

[0026] As depicted in Figures 1,2) 4a and 4b, non-adhesive tabs 25, 30 are provided on the distal side of each of the two sections 10, 15 respectively. These tabs 25, 30 provide the user with gripping surfaces to assist them in removing each of the two sections 10, 15 of the removable adhesive liner 5. The arrows on tabs 25, 30 in Figures 1, 2, 4a and 4b indicate the direction in which the tabs 25, 30 should be pulled by the user in order to facilitate removal.

[0027] Also shown in Figures 1-Sb are five wires 35, 36, 37, 38, 39, each of which is at one end connected to an electrode (shown in Figures 1, 3, 4b and 4c, and discussed below) and at the other end connected to adapter 40. Adapter 40 is shaped so that it can be connected to an electrical impedance segmentography monitor (not shown]. The wires 35, 36, 37, 38, 39 connect to the electrodes in a direction approximately at right angles to centre line 20, and connect to adapter 40 in approximately the same direction.

[0028] As shown in Figures 1 (in dashed lines], 3, 4b and 4c, each of the five wires 35, 36, 37, 38, 39 are electrically connected to an electrode 45, 50, 55, 60, 65 respectively. The electrodes 45, 50, 55, 60, 65 are provided on the proximal side of the removable adhesive liner 5. The electrodes 45, 50, 55, 60, 65 are arranged such that an electrode 45, 50, 55, 60 is provided proximal to each of four corners of the removable adhesive liner 5, and that one electrode 65 is provided approximately at the centre of the removable adhesive liner 5.

[0029] As shown in Figure 3, each electrode 45, 50, 55, 60, 65 has a proximal circular face 70, 75, 60, 85, 90 which in use contacts the patient's skin. Surrounding each proximal circular face 70, 75, 60, 85, 90 is an adhesive surface 95, 100, 105, 110, 115 so that each electrode 45, 50, 55, 60, 65 can be attached to a patient's skin.

[0030] The two sections 10, 15 of the removable adhesive liner S are divided such that each section covers two of the corner electrodes (45, 55 or 50, 60) in their entirety, are approximately half of the centre electrode 65.

[0031] Figures 4a-4c depict the process of attaching the electrode array 1 to a patient's body. Figure 4a shows an identical view of the electrode array 1 to that of Figure 2, except that it has been applied to patient's chest 120. Like features are numbered identically to those features in Figures 1-3.

[00321 Figure 4b shows the electrode array 1 once one of the sections 15 has been removed. Thus, the whole of corner electrodes 50, 60, as well as half of centre electrode 65, are shown adhered to the patient's chest 120.

[0033] Figure 4c shows the electrode array 1 once both of the sections 10, 15 of removable adhesive linerS has been removed. Thus, all of the electrodes 45, 50, 55, 60, 65 are shown adhered to the patient's chest 120.

[0034] Figures 5a and Sb show two alternative wiring configurations for the electrode array 1 of the first embodiment. Like features to the configuration in Figure 2 are numbered identically. In Figure 5a the wires 35, 36, 37, 38, 39 connect to the electrodes in a direction approximately at parallel to centre line 20, and connect to adapter 40 in approximately the same direction. In Figure Sb the wires 35, 36, 37, 38, 39 connect to the electrodes in a direction approximately at right angles to centre line 20, but connect to adapter 40 in a direction about 30 degrees from being at right angles from centre line 20.

[0035] Figures 6-8 depict an electrode array 301 according to a second embodiment of the invention. Like features with the first embodiment are numbered identically.

The second embodiment is identical to the first embodiment except that wires 35, 36, 37, 38, 39 have been replaced with electrical tracks 335, 336, 337, 338, 339. In addition, the second embodiment is shown in Figures 6-8 without the removable adhesive liner 5. However, in use the electrode array 301 would be provided on such a liner 5 in a similar way to the first embodiment. Figures 6 and 8 show a proxima' view of the electrode array 301. Figures 6 and 8 are identical except that in Figure 8 the individual connections 335a, 335b, 336a, 336b, 337a, 337b, 338a, 338b, 339a, 339b in the tracks 335, 336, 337, 338, 339 are shown. Figure 7 depicts an end-on view of the electrode array 301, when viewed from the adapter 40.