WO2002034129A1 - Methode et appareil d'epreuve d'effort de capacite - Google Patents

Methode et appareil d'epreuve d'effort de capacite Download PDF

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Publication number
WO2002034129A1
WO2002034129A1 PCT/SE2001/002322 SE0102322W WO0234129A1 WO 2002034129 A1 WO2002034129 A1 WO 2002034129A1 SE 0102322 W SE0102322 W SE 0102322W WO 0234129 A1 WO0234129 A1 WO 0234129A1
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WO
WIPO (PCT)
Prior art keywords
monitoring
registering
automatically
test
ofthe
Prior art date
Application number
PCT/SE2001/002322
Other languages
English (en)
Inventor
Christer Jacobsson
Zita Frising
Original Assignee
Optovent Ab
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from SE0003863A external-priority patent/SE0003863D0/xx
Application filed by Optovent Ab filed Critical Optovent Ab
Priority to AU2001296194A priority Critical patent/AU2001296194A1/en
Publication of WO2002034129A1 publication Critical patent/WO2002034129A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
    • A61B5/0205—Simultaneously evaluating both cardiovascular conditions and different types of body conditions, e.g. heart and respiratory condition
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/08—Detecting, measuring or recording devices for evaluating the respiratory organs
    • A61B5/087—Measuring breath flow
    • A61B5/0873—Measuring breath flow using optical means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/145—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue
    • A61B5/1455—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue using optical sensors, e.g. spectral photometrical oximeters

Definitions

  • the present invention concerns a capacity stress testing method and apparatus wherein a person exercises while certain parameters are monitored and/or registered.
  • stress test means a test where a test leader watches a test person who exercises under the influence of increasing load, while certain body functions and parameters are monitored and/or registered. Stress tests are today mainly used for forming a basis for a doctor to evaluate and diagnose coronary heart diseases and to estimate a person's maximum work load in relation to a normal value for the age.
  • parameters reflecting upon the heart function are registered during a stress test in order to reveal any diseases in the heart, especially in the coronary arteries. These parameters are normally registered by an electrocardiogram, for example the pulse rate and any arrhythmias. Further, the level of exertion ofthe person is monitored manually. Less notice is directed to the respiratory frequency, which according to prior art also is monitored manually by counting the number of breaths per minute. Sometimes the blood pressure is measured, too.
  • a cycle exerciser is used for stress tests. Normally the test starts at a level of load of 50 W and will be increased by 10 W/minute. In other countries other gear is used for stress tests, such as step machines and sloping treadmills. Most ofthe times the test is limited by subjective maximum exertion or pain experienced by the tested person, but sometimes the test is limited due to abnormal heart rhythm, severe increase/decrease in blood pressure or signs of widespread hypoxemia (lack of oxygen) in the heart muscle. All these signs give the doctor an indication of significant, underlying heart disease.
  • US 6 159 130 concerns means for sport training, either professionally or private.
  • the means may measure speed ofthe exercise device (for example a bicycle), ambient temperature and pressure. It may also measure the pulse, blood pressure, temperature, blood glucose and blood oxygen content ofthe training person.
  • the document also shows that the means enables the condition ofthe exercise device to be measured by means of different sensors. In connection with a bicycle, the sensors may measure the brakes (brake wear or brake force), gears (gear shift and gear wear), shaking ofthe bicycle, tightness ofthe chain or the power used. This device is inadequate for medical examinations and thus cannot be used in this field.
  • the object ofthe present invention is to provide a method which gives values of the parameters to be evaluated so that a doctor will obtain from only a single stress test a good basis for the evaluation and diagnose of possible capacity impairing diseases, such as heart and/or lung diseases.
  • the test person Using the capacity stress testing method ofthe invention according to claim 1, i.e. a cardiac pulmonary stress testing method, the test person will only have to perform a single stress test for the doctor to obtain a good basis for the evaluation and diagnosis of possible heart and/or lung diseases, for estimation ofthe grade of function impairment and for evaluation ofthe prognosis. Thanks to the provision of this method, it is very convenient and time-saving both for the test person and the health service. If the person is suffering from possible capacity impairing diseases, such as heart and/or lung diseases a stress test can be very painful and frightening and thus it is relieving for the test person to only have to perform one stress test.
  • possible capacity impairing diseases such as heart and/or lung diseases
  • the simultaneous monitoring ofthe oxygen saturation ofthe blood gives a synergetic effect which gives a clearer and more apprehensible basis for the doctor when he/she is to diagnose an underlying lung disease as the cause of breast pain or impaired conditions.
  • Another advantage is that since all the values are monitored and registered at one single occasion they all correspond to each other and will not be influenced by any differences in the test person's condition on different test days, or when the tests are carried out on the same day, increasing exertion after each test.
  • Lung function impairments are seen in a fast increasing respiratory rate at relatively low work loads, which is specially true for restrictive lung diseases, which causes a low respiratory volume. People with overweight or with neuro muscular diseases may also show a similar pattern of abnormally fast increasing respiratory rate at increasing work load. Therefore, a doctor has to evaluate the obtained values and facts.
  • Another problem is that not all ofthe values ofthe parameters are validated and quality assured. Therefore, also the monitoring and/or register ofthe respiratory rate should preferably be automatic, which gives validated and quality assured values.
  • the stress test leader will not have to observe and count the number of respirations per minute manually at the same time as he/she must evaluate the tested person's well being, such as pain and exertion, and signs of problems showing from the automatically monitored and or registered parameters.
  • the test will become more accurate and the leader may focus more on the test person.
  • the leader will be able to assure that the test person really exercise at the top of his/her capacity.
  • the respiratory rate will clearly indicate this. Since the respiratory rate is automatically monitored and/or registered there will not be any differences in counting due to personal and/or objective circumstances. Thus, the values are validated and quality assured and there will neither be any differences inter-individually nor inrra-individually.
  • blood pressure is monitored and/or registered and preferably automatically monitored. This will give an even more reliable and objective basis for the doctor's evaluation.
  • the pulse rate and oxygen saturation ofthe blood is preferably monitored and/or registered by a pulse oximeter. But of course the pulse rate may separately be monitored and/or registered by an apparatus especially made for this purpose.
  • a thermistor, capnography, transthoracic impedance plethysmography or preferably an optical sensor for sensing a flow of breathing air could be used.
  • the present applicant have earlier developed a reliable, real-time monitor and a method for monitoring and/or register breathing using an optical sensor.
  • the monitor comprises means for transmitting light and measuring reflecting light and an optical sensor.
  • the optical sensor comprises an optical fibre which at one end is connected to the monitor and at the other end is to be positioned in a breathing air flow of a patient. At the head ofthe fibre, the fibre end is cut preferably perpendicular to the extension ofthe fibre. Light is transmitted through the fibre which reflects at the flat end.
  • the invention also concerns a capacity stress testing apparatus comprising
  • the above means are adapted to operate simultanously.
  • the means for monitoring and/or register the respiratory rate is an optical sensor for sensing a breathing air flow and the means for monitoring and/or register the oxygen saturation ofthe blood is a pulse oximeter.
  • Fig.1 illustrates a diagram of the performance of a typical patient with
  • Fig. 2 illustrates a diagram ofthe performance of one patient with COPD and one normal person in relation to time.
  • Fig. 3 illustrates a diagram ofthe performance of one patient with COPD and one normal person in relation to degree of exertion.
  • the test leader which could be a nurse or a doctor, for example, will attach or connect electrodes, such as suction electrodes, of an apparatus for electrocardiogram recording at suitable places on the body ofthe test person. Any apparatus for electrocardiogram recording available on the market may be used.
  • a pulse oximeter is attached over a finger tip or ear lobe ofthe test person.
  • the pulse oximeter emits light (red and infrared) through perfused tissue, as in this case the finger tip or ear lobe, and detects the fluctuating signals caused by arterial blood pressure pulses.
  • the pulse oximeter determines functional oxygen saturation of arterial haemoglobin from this colour difference by measuring the ratio of absorbed red and infrared light as the blood volume fluctuates with each heart beat. Since steady conditions (steady venous blood flow, skin thickness, bone, finger nails, etc) do not cause fluctuations, the do not affect the saturation reading.
  • the respiratory rate is automatically monitored and/or registered during the stress test. This is preferably performed by an optical sensor apparatus according to the present applicant's technique described in EP 681 453.
  • An optical fibre is attached to the mouth and nose ofthe test person via a specially designed airway adapter, Airdapter ® .
  • the end ofthe optical fibre is dried by the passage of less humid, inhaled air.
  • the optical fibre is coupled to an electronic control unit which sends a light signal through the length ofthe fibre. The majority of this light is reflected back from the end ofthe optical fibre to an optical sensor within the control unit.
  • test person When all the equipment is attached, connected and activated, the test person starts to exercise.
  • a cycle ergometer is used, but of course any other suitable equipment may be used, such as a step machine or a sloping treadmill.
  • the stress test could be performed on a cycle ergometer and start with a load of 50 W. The load will be increased by 10 W per minute.
  • test leader evaluates the well being ofthe test person and the test person has to describe how he/she feels, like the experienced level of exertion and possible occurring pain.
  • the test will be stopped when the test person has exercised for a predetermined period of time or when the test person has reached his/her top level of exertion or pain.
  • the stress test will also be stopped if an abnormal heart rhythm occurs or the test person shows signs of widespread hypoxemia in the heart muscle.
  • the blood pressure is automatically monitored and/or registered during the stress test.
  • This may be done by any blood pressure meter apparatus available on the market.
  • Such an apparatus is usually attached to the wrist or upper arm ofthe test person.
  • an apparatus comprising both a pulse oximeter and an optical sensor.
  • the method according to the present invention is very helpful for a doctor to give a good basis for the evaluation ofthe parameters as a help when he/she shall correctly diagnose diseases as Chronic Obstructive Pulmonary Disease (COPD), astma, pulmonary emphysema or heart diseases.
  • COPD Chronic Obstructive Pulmonary Disease
  • COPD ulcerative colitis
  • Both COPD and asthma is characterised in that the patient has less flow rate of air than normal and especially when exhaling.
  • the patients with asthma have a too high resistance in the bronchial tubes and the patients with COPD have partly a too low alveolar pressure due to an inelastic lung and partly suffers from a dynamic compression ofthe air ways.
  • the next table shows a patient with good working capacity but during the exercise the heart beats a lot of extra beats, which may indicate that the heart is a limiting factor.
  • the lungs seem to function normally since the increase of respiratory rate and blood oxygen saturation are normal.
  • the next table shows a patient with a normal respiratory increase and a normal blood oxygen saturation.
  • the increase ofthe pulse rate though is rapid and could be an indication of an underlying heart disease.
  • a stress test according to the present invention was performed by a patient with COPD.
  • the patient interrupted the stress test due to shortness of breath after five minutes.
  • the achieved values are presented below in a table.
  • Fig. 1 is a diagram comprising values from table 4 illustrating the respiratory rate and the blood oxygen saturation during a stress test in relation to the load for the patient with COPD.
  • a corresponding stress test according to the present invention was performed by a healthy person ofthe same sex, age and size. The test person interrupted the stress test due to leg fatigue after ten minutes. The table is shown below.
  • Fig. 2 is a diagram illustrating a comparison between the stress test according to the present invention for the healthy person and the patient with COPD in relation to time. Below is the corresponding table of values.
  • Fig. 3 is a diagram illustrating a comparison between the stress test according to the present invention for the healthy person and the patient with COPD in relation to the degree of exertion. Below is the corresponding table of values.
  • the inventive method gives the doctor an indication of if the impairment ofthe patient is due to a lung disease or a heart disease. Thereafter the doctor may perform other tests to be able to diagnose which type of lung or heart disease it might be.
  • the inventive method ensures validated and quality assured data, gives the doctor a reliable basis for evaluating the condition ofthe patient and diagnosing possible diseases. Additionally, the method gives the personell carrying out the test increased possibilities to observe the well being ofthe test person.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Cardiology (AREA)
  • Physiology (AREA)
  • Engineering & Computer Science (AREA)
  • Medical Informatics (AREA)
  • Biophysics (AREA)
  • Pathology (AREA)
  • Pulmonology (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Physics & Mathematics (AREA)
  • Molecular Biology (AREA)
  • Surgery (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Measurement Of The Respiration, Hearing Ability, Form, And Blood Characteristics Of Living Organisms (AREA)

Abstract

L'invention porte sur une méthode d'épreuve d'effort de capacité à la fois pratique et rapide comprenant les étapes consistant: à soumettre une personne passant l'épreuve à un exercice physique ; à contrôler et/ou à enregistrer automatiquement la saturation en oxygène dans le sang ; et à contrôler et/ou enregistrer automatiquement le rythme cardiaque, la fonction cardiaque étant contrôlée et/ou enregistrée automatiquement par électrocardiogramme et le rythme respiratoire étant contrôlé et/ou enregistré automatiquement . L'invention concerne également un appareil permettant d'appliquer la méthode. La méthode et l'appareil de l'invention permettent d'obtenir des données validées et de qualité, et fournissent au médecin une base fiable pour évaluer l'état du patient et diagnostiquer d'éventuelles maladies. Ladite méthode offre, en outre, à la personne chargée de conduire l'épreuve, davantage de moyens de juger de la bonne santé de la personne passant l'épreuve.
PCT/SE2001/002322 2000-10-24 2001-10-23 Methode et appareil d'epreuve d'effort de capacite WO2002034129A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
AU2001296194A AU2001296194A1 (en) 2000-10-24 2001-10-23 Capacity stress testing method and apparatus

Applications Claiming Priority (4)

Application Number Priority Date Filing Date Title
SE0003863-8 2000-10-24
SE0003863A SE0003863D0 (sv) 2000-10-24 2000-10-24 Exercise testing method
US24270300P 2000-10-25 2000-10-25
US60/242,703 2000-10-25

Publications (1)

Publication Number Publication Date
WO2002034129A1 true WO2002034129A1 (fr) 2002-05-02

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Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
GB2448323A (en) * 2007-04-10 2008-10-15 Mark Sinclair Varney Respiratory Rate Measuring Apparatus
US20130102855A1 (en) * 2009-12-21 2013-04-25 Koninklijke Philips Electronics N.V. Bode index measurement
US11051766B2 (en) 2017-06-30 2021-07-06 Koninklijke Philips N.V. Modifying a patient interface computer system based on an equivalent effort parameter

Citations (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0029349A2 (fr) * 1979-11-14 1981-05-27 Critikon, Inc. (a New Jersey corp.) Appareil de mesure automatique de la pression sanguine
US5010888A (en) * 1988-03-25 1991-04-30 Arzco Medical Electronics, Inc. Method and apparatus for detection of posterior ischemia
WO1994016620A1 (fr) * 1993-01-19 1994-08-04 Optovent Ab Procede, detecteur et dispositif de detection de la respiration
US5680866A (en) * 1996-03-29 1997-10-28 Battelle Memorial Institute Artificial neural network cardiopulmonary modeling and diagnosis
US5694939A (en) * 1995-10-03 1997-12-09 The United States Of America As Represented By The Administrator Of The National Aeronautics And Space Administration Autogenic-feedback training exercise (AFTE) method and system
FI104697B (fi) * 1998-05-20 2000-03-31 Polar Electro Oy Mittausmenetelmä ja -järjestelmä
WO2000042911A1 (fr) * 1999-01-25 2000-07-27 Masimo Corporation Sphygmo-oxymetre universel a fonction d'amelioration

Patent Citations (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0029349A2 (fr) * 1979-11-14 1981-05-27 Critikon, Inc. (a New Jersey corp.) Appareil de mesure automatique de la pression sanguine
US5010888A (en) * 1988-03-25 1991-04-30 Arzco Medical Electronics, Inc. Method and apparatus for detection of posterior ischemia
WO1994016620A1 (fr) * 1993-01-19 1994-08-04 Optovent Ab Procede, detecteur et dispositif de detection de la respiration
US5694939A (en) * 1995-10-03 1997-12-09 The United States Of America As Represented By The Administrator Of The National Aeronautics And Space Administration Autogenic-feedback training exercise (AFTE) method and system
US5680866A (en) * 1996-03-29 1997-10-28 Battelle Memorial Institute Artificial neural network cardiopulmonary modeling and diagnosis
FI104697B (fi) * 1998-05-20 2000-03-31 Polar Electro Oy Mittausmenetelmä ja -järjestelmä
WO2000042911A1 (fr) * 1999-01-25 2000-07-27 Masimo Corporation Sphygmo-oxymetre universel a fonction d'amelioration

Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
GB2448323A (en) * 2007-04-10 2008-10-15 Mark Sinclair Varney Respiratory Rate Measuring Apparatus
US20130102855A1 (en) * 2009-12-21 2013-04-25 Koninklijke Philips Electronics N.V. Bode index measurement
US11051766B2 (en) 2017-06-30 2021-07-06 Koninklijke Philips N.V. Modifying a patient interface computer system based on an equivalent effort parameter

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Publication number Publication date
AU2001296194A1 (en) 2002-05-06

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