# Patent

## Title
Pulse oximetry system with low noise cable hub

## Abstract

A pulse oximetry system for reducing the risk of electric shock to a medical patient can include physiological sensors, at least one of which has a light emitter that can impinge light on body tissue of a living patient and a detector responsive to the light after attenuation by the body tissue. The detector can generate a signal indicative of a physiological characteristic of the living patient. The pulse oximetry system may also include a splitter cable that can connect the physiological sensors to a physiological monitor. The splitter cable may have a plurality of cable sections each including one or more electrical conductors that can interface with one of the physiological sensors. One or more decoupling circuits may be disposed in the splitter cable, which can be in communication with selected ones of the electrical conductors. The one or more decoupling circuits can electrically decouple the physiological sensors.

## Background
RELATED APPLICATION
This application claims priority from U.S. Provisional Patent Application No. 61/252,062, filed Oct. 15, 2009, and entitled “Pulse Oximetry System with Low Noise Cable Hub,” and U.S. Provisional Application No. 61/265,730, filed Dec. 1, 2009, titled “Pulse Oximetry System with Acoustic Sensor,” the disclosures of both of which are hereby incorporated by reference in their entirety.
This application also relates to the following U.S. patent applications the disclosures of which are incorporated in their entirety by reference herein:













App. No.
Filing Date
Title
Attorney Docket







60/893,853
Mar. 08, 2007
MULTI-PARAMETER
MCAN.014PR




PHYSIOLOGICAL MONITOR



60/893,850
Mar. 08, 2007
BACKWARD COMPATIBLE
MCAN.015PR




PHYSIOLOGICAL SENSOR WITH





INFORMATION ELEMENT



60/893,858
Mar. 08, 2007
MULTI-PARAMETER SENSOR
MCAN.016PR




FOR PHYSIOLOGICAL





MONITORING



60/893,856
Mar. 08, 2007
PHYSIOLOGICAL MONITOR WITH
MCAN.017PR




FAST GAIN ADJUST DATA





ACQUISITION



12/044,883
Mar. 08, 2008
SYSTEMS AND METHODS FOR
MCAN.014A




DETERMINING A





PHYSIOLOGICAL CONDITION





USING AN ACOUSTIC MONITOR



61/252,083
Oct. 15, 2009
DISPLAYING PHYSIOLOGICAL
MCAN.019PR




INFORMATION



12/904,836
Oct. 14, 2010
BIDIRECTIONAL PHYSIOLOGICAL
MCAN.019A1




INFORMATION DISPLAY



12/904,823
Oct. 14, 2010
BIDIRECTIONAL PHYSIOLOGICAL
MCAN.019A2




INFORMATION DISPLAY



61/141,584
Dec. 30, 2008
ACOUSTIC SENSOR ASSEMBLY
MCAN.030PR


61/252,076
Oct. 15, 2009
ACOUSTIC SENSOR ASSEMBLY
MCAN.030PR2


12/643,939
Dec. 21, 2009
ACOUSTIC SENSOR ASSEMBLY
MCAN.030A


61/313,645
Mar. 12, 2010
ACOUSTIC RESPIRATORY
MCAN.033PR2




MONITORING SENSOR HAVING





MULTIPLE SENSING ELEMENTS



12/904,931
Oct. 14, 2010
ACOUSTIC RESPIRATORY
MCAN.033A




MONITORING SENSOR HAVING





MULTIPLE SENSING ELEMENTS



12/904,890
Oct. 14, 2010
ACOUSTIC RESPIRATORY
MCAN.033A2




MONITORING SENSOR HAVING





MULTIPLE SENSING ELEMENTS



12/904,938
Oct. 14, 2010
ACOUSTIC RESPIRATORY
MCAN.033A3




MONITORING SENSOR HAVING





MULTIPLE SENSING ELEMENTS



12/904,907
Oct. 14, 2010
ACOUSTIC PATIENT SENSOR
MCAN.033A4


61/252,099
Oct. 14, 2009
ACOUSTIC RESPIRATORY
MCAN.034PR




MONITORING SYSTEMS AND





METHODS



12/904,789
Oct. 14, 2010
ACOUSTIC RESPIRATORY
MCAN.034A




MONITORING SYSTEMS AND





METHODS



12/905,036
Oct. 14, 2010
PHYSIOLOGICAL ACOUSTIC
MCAN.046A




MONITORING SYSTEM



61/331,087
May 04, 2010
ACOUSTIC RESPIRATION
MASIMO.800PR2




DISPLAY



61/391,098
Oct. 08, 2010
ACOUSTIC MONITOR
MCAN-P001









Many of the embodiments described herein are compatible with embodiments described in the above related applications. Moreover, some or all of the features described herein can be used or otherwise combined with many of the features described in the applications listed above.


BACKGROUND
Hospitals, nursing homes, and other patient care facilities typically include patient monitoring devices at one or more bedsides in the facility. Patient monitoring devices generally include sensors, processing equipment, and displays for obtaining and analyzing a medical patient's physiological parameters. Physiological parameters include, for example, respiratory rate, oxygen saturation (SpO2) level, pulse, and blood pressure, among others. Clinicians, including doctors, nurses, and certain other medical personnel, use the physiological parameters obtained from the medical patient to diagnose illnesses and to prescribe treatments. Clinicians also use the physiological parameters to monitor a patient during various clinical situations to determine whether to increase the level of medical care given to the patient.
Many monitoring devices receive physiological signals from one or more sensors, such as pulse oximetry sensors, acoustic sensors, and the like. Medical cables attached to the sensors transmit signals from the sensors to the monitoring device.
SUMMARY
Certain implementations of a pulse oximetry system for reducing the risk of electric shock to a medical patient include a plurality of physiological sensors, where at least one of the physiological sensors has a light emitter that can impinge light on body tissue of a living patient and a detector responsive to the light after attenuation by the body tissue. The body tissue can include pulsating blood. The detector can generate a signal indicative of a physiological characteristic of the living patient. The medical apparatus may also include a splitter cable having a monitor connector that can connect to a physiological monitor, a plurality of sensor connectors that can each connect to one of the physiological sensors, and a plurality of cable sections each disposed between a sensor connector and the monitor connector, where each of the cable sections have one or more electrical conductors. The one or more electrical conductors for at least some of the cable sections may include a power line that can supply power to one or more of the plurality of physiological sensors, a signal line that can transmit the physiological signals from one or more of the physiological sensors to the physiological monitor, and a ground line that can provide an electrical return path for the power line. Further, the splitter cable may also have one or more decoupling circuits in communication with selected ones of the one or more electrical conductors. The one or more decoupling circuits may communicate physiological signals between one or more of the physiological sensors and the physiological monitor. The one or more decoupling circuits can electrically decouple the physiological sensors, such that the one or more decoupling circuits are configured to substantially prevent ground loops from forming in the ground line.
In certain embodiments, a medical apparatus for reducing the risk of electric shock to a medical patient when used with a pulse oximeter includes a plurality of physiological sensors. At least one of the physiological sensors can include a light emitter that can impinge light on body tissue of a living patient, where the body tissue has pulsating blood. The physiological sensor can also include a detector responsive to the light after attenuation by the body tissue, such that the detector can generate a signal indicative of a physiological characteristic of the living patient. The medical apparatus may also include a splitter cable that can connect the plurality of physiological sensors to a physiological monitor. The splitter cable may include a plurality of cable sections that each includes one or more electrical conductors that can interface with one of the physiological sensors. One or more decoupling circuits can be disposed in the splitter cable. The one or more decoupling circuits can be in communication with selected ones of the one or more electrical conductors. The one or more decoupling circuits can communicate physiological signals between one or more of the physiological sensors and the physiological monitor. The one or more decoupling circuits can electrically decouple the physiological sensors.
Various embodiments of a method for reducing the risk of electric shock to a medical patient as used with a pulse oximeter may include providing a plurality of physiological sensors, where at least one of the physiological sensors has a light emitter that can impinge light on body tissue of a medical patient and a detector that can generate a signal indicative of a physiological characteristic of the living patient responsive to the light after attenuation by the body tissue. The method can also include providing a medical cable assembly having one or more electrical conductors that can allow communication between the plurality of physiological sensors and a physiological monitor, such that the medical cable assembly can provide signals representing physiological information of a medical patient from the plurality of physiological sensors to the physiological monitor. Moreover, the method may include electrically decoupling the plurality of physiological sensors using one or more decoupling circuits disposed in the medical cable assembly. The one or more decoupling circuits may be in communication with the plurality of physiological sensors and with the physiological monitor.
Further, in certain embodiments, a cable hub includes a first signal conditioning circuit that can receive first signals from a first physiological sensor, a second signal conditioning circuit that can receive second signals from a second physiological sensor, decoupling circuitry that can electrically decouple the first and second signal conditioning circuits, a shield that can electromagnetically shield the first signal conditioning circuit at least in part, and a cable that can physically couple conductors from the first and second signal conditioning circuits to a connector that can be coupled to a physiological monitor.
A cable assembly can include, in certain embodiments, a hub assembly that can receive first and second cables, where the first and second cables can receive physiological signals from one or more physiological sensors. The hub assembly can include first circuitry that can be in communication with the first cable, second circuitry that can be in communication with the second cable, and local shielding disposed about the first circuitry.
A cable assembly can also include, in certain embodiments, a first cable connector that can receive a first sensor cable in communication with a first physiological sensor, a second cable connector that can receive a second sensor cable in communication with a second physiological sensor, a first circuit in communication with the first cable connector, a second circuit in communication with the second cable connector, and a shield disposed about the first circuit.
For purposes of summarizing the disclosure, certain aspects, advantages and novel features of the inventions have been described herein. It is to be understood that not necessarily all such advantages may be achieved in accordance with any particular embodiment of the inventions disclosed herein. Thus, the inventions disclosed herein may be embodied or carried out in a manner that achieves or optimizes one advantage or group of advantages as taught herein without necessarily achieving other advantages as may be taught or suggested herein.



BRIEF DESCRIPTION OF THE DRAWINGS
Various embodiments will be described hereinafter with reference to the accompanying drawings. These embodiments are illustrated and described by example only, and are not intended to limit the scope of the disclosure. In the drawings, similar elements have similar reference numerals.
FIG. 1 illustrates a perspective view of an embodiment of a physiological monitoring system;
FIGS. 2A and 2B illustrate block diagrams of example physiological monitoring systems having splitter cables;
FIG. 3 illustrates a block diagram of another embodiment of a physiological monitoring system having multiple cables;
FIG. 4 illustrates a block diagram of yet another embodiment of a physiological monitoring system having multiple cables;
FIGS. 5A through 5C illustrate embodiments of decoupling circuits;
FIG. 6A illustrates a side view of an example splitter cable;
FIG. 6B illustrates a bottom view of the example splitter cable of FIG. 6A;
FIG. 7 illustrates a perspective view of an example sensor and cable assembly;
FIGS. 8A and 8B illustrate block diagrams of example cables that include one or more information elements;
FIG. 8C illustrates an embodiment of a circuit for communicating with one or more information elements and a sensor;
FIG. 9 illustrates a block diagram of exemplary forms of data that can be stored in an information element;
FIG. 10 illustrates an embodiment of a physiological monitoring system having multiple networked physiological monitors;
FIGS. 11 and 12 illustrate flowchart diagrams of example cable management processes;
FIGS. 13 and 14 illustrate flowchart diagrams of example patient context management processes;
FIG. 15 is a top perspective view illustrating an embodiment of a sensor assembly and cable;
FIG. 16 illustrates an embodiment of a coextruded cable;
FIGS. 17A and 17B illustrate embodiments of a splitter cable or cable hub;
FIG. 18 illustrates an embodiment of the sensor assembly of FIG. 15 applied to a patient; and
FIG. 19 illustrates an embodiment of a patient monitoring system.



DETAILED DESCRIPTION
Multiple sensors are often applied to a medical patient to provide physiological information about the patient to a physiological monitor. Some sensors, including certain optical and acoustic sensors, interface with the monitor using a cable having power, signal, and ground lines or wires. One or more these lines can pose an electric shock hazard when multiple sensors are attached to the patient. If an electrical potential exists in the ground line, for instance, a ground loop can form in the patient or in the ground line, allowing unwanted current to pass through the patient through the ground line. Power fluctuations or surges, such as from a defibrillator, can potentially harm the patient and damage the monitor or the sensors.
This disclosure describes decoupling circuitry that can be used to prevent or substantially prevent ground loops and other current loops from forming. Using decoupling circuitry in this manner can be referred to as providing sensor isolation, patient isolation, patient protection, sensor decoupling, or the like. Currently-available physiological monitors that connect to one sensor at a time using a single cable may not have this decoupling circuitry. Upgrading these monitors to receive two or more sensors can create the shock hazard described above unless protective circuitry is added to these monitors. For existing single-sensor monitors, adding this circuitry might require a costly upgrade of the monitors' internal components. For new single-sensor monitors, the decoupling circuitry could be added during manufacturing. But this approach would be cost-inefficient for buyers who wish to use only one sensor with the device.
Accordingly, in certain embodiments, the decoupling circuitry is provided in a medical cable assembly. The medical cable assembly includes, in some embodiments, a splitter cable that interfaces multiple physiological sensors with a single sensor port on a physiological monitor. Advantageously, in certain embodiments, the medical cable assembly allows multiple sensors to connect to a monitor while reducing the risk of electric shock to a patient.
Turning to FIG. 1, an embodiment of a physiological monitoring system 100 for monitoring a medical patient is shown. The physiological monitoring system 100 includes a physiological monitor 110 coupled with a sensor assembly 150 through a cable 130. The monitor 110 includes various visual indicia and user controls 105 for displaying sensor parameters, alarms, and the like and for receiving user input. The sensor assembly 150 could include any of a variety of physiological sensors. For example, the sensor assembly 150 could include one or more optical sensors that allow the measurement of blood constituents and related parameters, acoustic respiratory sensors, electrocardiograph sensors, and the like.
More generally, the sensor assembly 150 can include one or more sensors that measure one or more of a variety of physiological parameters, including oxygen saturation, carboxyhemologbin (HbCO), methemoglobin (HBMet), fractional oxygen, total hemoglobin (HbT/SpHb), pulse rate, perfusion index, electrical heart activity via electrocardiography, and blood pressure. Other examples of physiological parameters that may be measured include respiratory rate, inspiratory time, expiratory time, inspiration-to-expiration ratio, inspiratory flow, expiratory flow, tidal volume, end-tidal CO2 (ETCO2), CO2, minute volume, apnea duration, breath sounds, rales, rhonchi, stridor, changes in breath sounds such as decreased volume or change in airflow, heart rate, heart sounds (e.g., S1, S2, S3, S4, and murmurs), and changes in heart sounds such as normal to murmur or split heart sounds indicating fluid overload.
In some embodiments, the sensor assembly 150 can be an optical sensor having one or more emitters, such as light emitting diodes. The emitters may emit multiple wavelengths of light that impinge on body tissue of a living patient, such as a finger, foot, ear, or the like. The emitters may also emit non-visible radiation. The sensor assembly 150 may further include one or more detectors that can receive light attenuated by the body tissue of the patient. The detectors can generate physiological signals responsive to the detected light. The sensor assembly 150 can provide these physiological signals to the monitor 110 for processing to determine one or more physiological parameters, such as certain of the parameters described above. An example of such a sensor assembly 150 is described in U.S. Publication No. 2006/0211924, filed Mar. 1, 2006, titled “Multiple Wavelength Sensor Emitters,” the disclosure of which is hereby incorporated by reference in its entirety.
The cable 130 is connected to the sensor assembly 150 and to the monitor 110. In some embodiments, the cable 130 includes two or more cables or cable assemblies, although it should be noted that the cable 130 can also be a single cable 130. In the illustrated embodiment, the cable 130 includes a sensor cable 112 and an instrument cable 114. The sensor cable 114 is connected directly to the sensor assembly 150 through connectors 133, 151, and the instrument cable 114 is connected directly to the monitor 110 through a connector 131. The sensor cable 112 is connected to the instrument cable 114 through connectors 135, 137.
In certain embodiments, the sensor cable 112 is a lightweight, flexible cable used for a single medical patient and disposed of after use with that patient. In contrast, the instrument cable 112 of certain embodiments is used for multiple patients and may be more durable than the sensor cable 112. For example, the instrument cable 112 may be thicker, stiffer, or heavier than the sensor cable 112. Advantageously, in certain embodiments, the lightweight, flexible characteristics of the sensor cable 112 make the sensor cable 112 more comfortable to attach to a patient. A patient with a sensor assembly 150 attached to her finger, for instance, could more easily move her hand with a lightweight sensor cable 112 attached to the sensor assembly 150. However, if some or all of the cable 130 were lightweight and flexible, it might be less durable. Hence, a portion of the cable 130 (e.g., the instrument cable 114) is stronger and more durable, yet potentially heavier and less flexible. The instrument cable 114 could therefore be used for multiple patients, while the sensor cable 112 might be used for fewer patients, such as a single patient.
While the physiological monitor 110 of FIG. 1 is shown connecting to a single sensor assembly 150, it may be advantageous in certain embodiments to connect to multiple sensors, such as sensors that monitor different physiological parameters. For instance, the physiological monitor 110 could connect to a pulse oximetry sensor and an acoustic sensor that measures respiratory rate, heart sounds, and related parameters. One way to provide multiple sensor functionality to the physiological monitor 110 is to provide a splitter cable between the monitor and the cable 130 (see FIGS. 2 and 6). A splitter cable reduces or eliminates a need to build a second cable port into the chassis of the physiological monitor 110 to accommodate a second cable 130. Consequently, using a splitter cable can reduce costs. Moreover, using a splitter cable can reduce cross-talk noise between signal lines from the sensors.
However, as described above, upgrading the physiological monitor 110 to receive input from multiple sensors using a splitter cable or the like can create electrical shock hazards to the patient due to the possibility of conductive paths forming through the sensors, cabling, and the patient. For example, if an acoustic sensor is placed on the chest and a defibrillator paddle touches the acoustic sensor, a surge of current could discharge through a conductive path formed in the patient between the acoustic sensor and a second sensor, and through the physiological monitor 110. This current surge could injure the patient and damage the monitor 110.
Consequently, various embodiments of the cable 130 or an attached splitter cable can include one or more decoupling circuits (not shown) for reducing the risk of electric shock to the patient. Each decoupling circuit can electrically decouple the sensor assembly 150 from the monitor 110 or can decouple multiple sensor assemblies 150. In addition to having its ordinary meaning, electrical decoupling can mean breaking a conductive path (e.g., by providing a dielectric between two conductors) or increasing the resistance between conductors. Electrical decoupling can be accomplished using transformers and/or optocouplers, as described below. The electrical decoupling of the decoupling circuit can prevent or reduce harmful current surges from harming the patient. Example decoupling circuits are described below with respect to FIGS. 2 through 6.
In addition to including decoupling circuitry in the cable 130 or in an attached splitter cable, it may be desirable to include other circuitry in the cable 130 or splitter cable. For example, the cable 130, a splitter cable, and/or the sensor assembly 150 may include one or more information elements (not shown), which can be memory devices such as EEPROMs or the like. In one embodiment, the information element stores cable management information, patient context information, and/or physiological information. Example information elements are described below with respect to FIGS. 6 through 14.
FIGS. 2A and 2B illustrate embodiments of physiological monitoring systems 200A, 200B interfacing with multiple sensor assemblies 250. The physiological monitoring systems 200A, 200B each include a physiological monitor 210, a splitter cable 220, two cables 230, and two sensor assemblies 250. The physiological monitoring systems 200A, 200B may include all of the features of the physiological monitoring system 100 described above.
In the physiological monitoring system 200A of FIG. 2A, a patient decoupling circuit 240a is provided in one of the cables 230b. In the physiological monitoring system 200B of FIG. 2B, the patient decoupling circuit 240b is provided in the splitter cable 220b. These patient decoupling circuits 240a, 240b can reduce or prevent ground loops from forming in the patient and/or in the physiological monitoring system 200. Although not shown, a decoupling circuit could instead be provided in one or both of the sensor assemblies 250.
The physiological monitor 210 processes and outputs physiological information received from sensors included in the sensor assemblies 250a, 250b. The physiological monitor 210 of certain embodiments includes a power decoupling circuit 215, a processing board 217, and a connector 219. The power decoupling circuit 215 may be a transformer or the like that decouples power (e.g., AC electrical power) received from a power source (such as an electrical outlet) and the circuitry of the physiological monitor 210. The power decoupling circuit 215 prevents or substantially prevents current spikes from damaging the other components of the physiological monitor 210 or the patient. In embodiments where the physiological monitor 210 receives power from another source, such as batteries, the power decoupling circuit 215 may not be included.
The processor 217 of certain embodiments is a microprocessor, digital signal processor, a combination of the same, or the like. The processor 217 receives power from the power decoupling circuit 215. In some implementations, the processor 217 processes physiological signals received from the sensors 250 and outputs the processed signals to a display, storage device, or the like. In addition, the processor 217 may communicate with an information element (e.g., a memory device) included in a cable or sensor. Information elements are discussed in greater detail below with respect to FIGS. 6 through 14.
The connector 219 includes a physical interface for connecting a cable assembly to the physiological monitor 210. In the embodiment shown in FIGS. 2A and 2B, a single connector 219 is provided. Additional connectors 219 may also be included in some implementations. One embodiment of a physiological monitor having additional connectors 219 is described below with respect to FIG. 3.
The splitter cable 220 is provided in some embodiments to enable the physiological monitor 210 having one connector 219 to interface with multiple sensors 250. The splitter cable 220 interfaces with the connector 219 through a monitor connector 221 in the splitter cable 220. In the depicted embodiment, where the splitter cable 220 interfaces with two sensors 250, cable sections 222 of the splitter cable 220, which branches into two sections generally forming a “Y” shape or the like. Thus, the splitter cable 220 can be a Y cable or the like. While the splitter cable 220 is shown forming a “Y” shape, other configurations and shapes of the splitter cable 220 may be used. For example, the splitter cable 220 could branch into more than two cable sections 222 to interface with more than two sensors 250.
The cable sections 222 are shown connected to the monitor connector 221 and two cable connectors 223. In some embodiments, the cable sections 222 branch into more than two parts and connect to more than two cable connectors 223. In addition, in some embodiments the splitter cable 220 couples directly to two or more sensors 250.
Some embodiments of the splitter cable 220 include one or more lines, conductors, or wires per cable connector 223. One line might be provided, for example, to interface with one or more electrocardiograph (ECG) sensors. Two or three lines might be provided per cable connector 223, for example, to interface with an optical or acoustic sensor. For instance, three lines might be provided, including a power line, a signal line, and a ground line (see FIGS. 4 and 5). The power line powers the sensor 250, the signal line receives signals from the sensor 250, and the ground line acts as an electrical return path for the power and/or signal lines. In some embodiments, one or more of the lines coming from one sensor 250a are placed at a predetermined distance from one or more of the lines coming from another sensor 250b to reduce cross-talk interference between the sensors 250. One or more electromagnetic shielding and/or insulating layers may also be provided to help reduce cross-talk. Lines from different sensors may merge into a shared line that connects electrically to the monitor 210, and some form of multiplexing might be used to allow the different sensors to communicate along the shared lines.
The cables 230a, 230b interface with the splitter cable 220 in the depicted embodiment through cable connectors 231. In certain embodiments, each cable 230 also includes a cable section 232 and a sensor connector 233 that connects to a sensor 250. The cable section 232 in some implementations includes one or more lines or wires for communicating with the sensor 250. For example, a power line, sensor line, and ground line may be provided that correspond to the power line, sensor line, and ground line in the example splitter cable 220 described above.
In an embodiment, one of the cables 230 includes the decoupling circuit 240a. In FIG. 2A, for example, the decoupling circuit 240a is shown in the cable section 232 of the cable 230b. The decoupling circuit 240a may also be placed in the cable connector 231 or the sensor connector 233, or in a combination of one or more of the connectors 231, 233 and/or the cable section 232. In another exemplary embodiment, FIG. 2B shows that the decoupling circuit 240b can be included in one of the cable sections 222 of the splitter cable 220b. The decoupling circuit 240b may also be placed in the monitor connector 221 or the sensor connector 223, or in a combination of the cable sections 222 and/or one or more of the connectors 221, 223.
Multiple decoupling circuits 240 may also be provided in one or more of the cables 230 and/or in the splitter cable 220 in other embodiments. In particular, in one embodiment when N cables 230 are provided (or one splitter cable 220 with N connectors 223), N−1 decoupling circuits 240 are provided in N−1 of the cables 230 or in the various sections of the splitter cable 220.
The decoupling circuit 240 of certain embodiments electrically decouples a sensor 250 from the physiological monitor 210. In addition, the decoupling circuit 240 can electrically decouple one sensor (e.g., the sensor 250b) from another sensor (e.g., the sensor 250a) in certain embodiments. The decoupling circuit 240 can be a transformer, an optocoupler, a DC-DC converter, a switched-mode converter, or the like or a combination of the foregoing. In addition, the decoupling circuit 240 can include one or more optical fibers. An optical fiber may be used in place of the signal line, for example. More detailed embodiments of the decoupling circuit 240 are described below with respect to FIGS. 4 and 5.
The sensors 250 connect to the sensor connectors 233 of the cables 230. In an embodiment, one of the sensors 250 is an optical sensor, such as a multiple wavelength oximetry sensor. The other sensor 250 in one embodiment is an acoustic sensor. In addition, the sensor 250 may be an acoustic sensor that also monitors ECG signals, such as is described in U.S. Provisional Application No. 60/893,853, titled “Multi-parameter Physiological Monitor,” and filed Mar. 8, 2007, the disclosure of which is hereby incorporated by reference in its entirety. Many other types of sensors 250 can also be used to monitor one or more physiological parameters.
FIG. 3 illustrates another embodiment of a physiological monitoring system 300 having multiple cables 230. The physiological monitoring system 300 may have certain of the features of the physiological monitoring systems 100, 200 described above. For example, like the physiological monitoring system 200 described above, the physiological monitoring system 300 includes a physiological monitor 310, two cables 230, and two sensors 250. In the physiological monitoring system 300, a decoupling circuit 240 is provided in one of the cables 230b. 
Like the physiological monitor 210, the physiological monitor 310 includes a power decoupling circuit 215 and a processor 217. Unlike the physiological monitor 210, however, the physiological monitor 310 includes two connectors 319 for interfacing directly with two cables without using a splitter cable. To save costs for users who will use only one sensor 250 with the physiological monitor 310, a decoupling circuit 240 is not provided in the physiological monitor 310. Instead, the decoupling circuit 240 can be provided in a separate cable 230b that can be used with the physiological monitor 310.
For example, a user might use one cable 230a and sensor 250a at a time with the physiological monitor 310. Since only one sensor 250a is being used, ground or other current loops are less likely to form in the patient. If the user later wishes to use additional sensors 250, the user can obtain a cable 230b having the decoupling circuit 240. Using the cable 230b can beneficially allow the user to continue using the physiological monitor 310 without performing an upgrade to the physiological monitor's 310 internal components.
FIG. 4 illustrates another embodiment of a physiological monitoring system 400 having multiple cables 430. The physiological monitoring system 400 may have certain of the features of the physiological monitoring systems 100, 200, 300 described above. For example, like the physiological monitoring systems described above, the physiological monitoring system 400 includes a physiological monitor 410, two cables 430, and two sensors 450. The features described with respect to FIG. 4 may also be applied to a monitoring system having a splitter cable instead of multiple cables.
In the depicted embodiment, the cables 430 are shown connected to the physiological monitor 410 and to the sensors 450. Connectors 419 in the physiological monitor 410 couple with connectors 431 of the cables 430, and connectors 433 of the cables couple with connectors 451 of the sensors 450. A cable section 432 extends between the connectors 431, 433 of each cable.
The cable 430a includes a power line 462a, a ground line 464a, and a signal line 466a extending from the connector 431 to the connector 433. These lines form electrical connections with corresponding power, ground, and signal lines in the connector 419a of the physiological monitor 410 and in the connector 451a of the sensor 450a. Likewise, the cable 430b includes a power line 462b, a ground line 464b, and a signal line 466b. These lines form electrical connections with corresponding power, ground, and signal lines in the connector 419b of the physiological monitor 410. In addition, these lines extend from the connector 431 to a decoupling circuit 440. A power line 472, ground line 474, and signal line 476 extend from the decoupling circuit 440 to the connector 431 to form electrical connections with corresponding power, signal, and ground lines in the connector 451b of the sensor 450b. The cable section 432 can also include one or more electrical insulation and shielding layers, materials, or fillers. Although not shown, one or more of the cables 430a, 430b may also include one or more communications lines for communicating with information elements.
In the depicted embodiment, the ground line 464a is connected to the ground line 464b in the physiological monitor 410 through line 464c. When both sensors 450 are placed on a patient, the ground lines 464a and 474b may also be in electrical communication through the patient, as illustrated by the dashed line 484. If the decoupling circuit 440 were not present in one of the cables 430, a ground loop might be formed along the lines 464a, 464b, 464c, 474, and 484 (illustrated with bold lines) due to, for example, a difference in electrical potential in the lines 464a, 464b, 464c, and 474. While not shown in bold, current loops might also form in some cases among the power lines 462a, 462b, 472 or the signal lines 466a, 466b, 476.
Advantageously, in certain embodiments, the decoupling circuit 440 reduces the risk of a ground or other loop forming by decoupling one or more of the power lines 462b, 472, the signal lines 464b, 474, or the ground lines 464b, 474. More detailed embodiments illustrating how the decoupling circuit 440 could decouple one or more lines is described below with respect to FIGS. 5A through 5C and FIG. 8C.
While only one decoupling circuit is shown, in other embodiments, multiple decoupling circuits may be provided in one cable 430. For instance, a first decoupling circuit could be connected to the power line 462b and the ground line 466b, and a second decoupling circuit could be connected to the signal line 464b and to the ground line 466b. In addition, in certain embodiments, there may be a decoupling circuit in each cable 430a, 430b. 
FIG. 5A illustrates a more detailed embodiment of a decoupling circuit 540a suitable for use with any of the embodiments discussed herein. The decoupling circuit 540a may include all the features of the decoupling circuits 240, 340, and 440 described above. For example, the decoupling circuit 540a may be included in a medical cable assembly, such as a splitter cable, medical cable, or the like, or in a sensor assembly. The decoupling circuit 540a can decouple electrical signals and prevent or reduce ground or other conducting loops from forming and can protect against current surges in a multi-sensor physiological monitoring system.
The decoupling circuit 540a is shown within dashed lines. The decoupling circuit 540a of various embodiments receives a signal line 562a, a power line 566a, and a ground line 564a. These lines can be connected to a physiological monitor (not shown). In addition, the decoupling circuit 540a receives a signal line 572a, a power line 576a, and a ground line 574a, which may be connected to a sensor (not shown).
In an embodiment, the power line 566a provides power from a physiological monitor to the decoupling circuit 540a, which provides the power to the sensor through the power line 576a. The signal line 572a provides a physiological signal from the sensor to the decoupling circuit 540a, which provides the physiological signal to the monitor through the signal line 562a. The ground lines 564a and 574a act as return paths for their respective signal and power lines 562a, 566a, 572a, 576a. 
The decoupling circuit 540a, in some implementations, includes an optocoupler 542a and a transformer 544a. The optocoupler 542a receives physiological signals from the sensor line 572a and provides the signals to the sensor line 562a optically using, for example, a photodiode 546a and a phototransistor 548a. Because the signals are transmitted optically, in certain embodiments there is no electrical contact between the signal lines 562a, 572a. Similarly, the transformer 544a provides power from the power line 566a to the power line 576a without electrical contact between the lines 566a, 576a. Through mutual inductance, electromagnetic energy is transferred from one winding 550a of the transformer 544a to another winding 552a. Because the signals are transmitted using mutual inductance, there is no electrical contact between the power lines 566a, 576a. 
In certain embodiments, because the power lines 566a, 576a and signal lines 562a, 572a are electrically decoupled, the ground lines 564a, 574a can also be electrically decoupled. As shown, a ground line 543a of the optocoupler 542a on the monitor side connects to the ground line 564a, and a ground line 553a of the optocoupler 542a on the sensor side connects to the ground line 574a. As a result, the risk of ground loops forming in the patient may be reduced or eliminated.
Many other configurations of the decoupling circuit 540a may be employed. For instance, a second optocoupler 542a may be used in place of the transformer 544a, or a second transformer 544a may be used in place of the optocoupler 542a. In addition, some forms of DC-DC converters or switched mode converters may be used in place of either the optocoupler 542a or the transformer 544a. Alternatively, one or more optical fibers may be used.
Moreover, one or more optical fibers can be used instead of the optocoupler 542a or the transformer 544a. Because the optical fibers transmit optical, rather than electrical signals, using optical fibers in certain embodiments beneficially reduces the likelihood of ground loops forming in the patient. In one example embodiment, the optocoupler 542a in FIG. 5A is replaced with an optical fiber, but the transformer 544a is still included in the decoupling circuit 540a. The optical fiber allows signals to be transmitted through the signal line while preventing current from passing through the signal line. In addition, if optical fibers are used for the signal lines of multiple sensors, the optical fibers can also reduce cross-talk interference among the signal lines.
FIG. 5B illustrates an embodiment of a circuit 500B that includes a decoupling circuit 540b. The decoupling circuit 540b may include all the features of the decoupling circuits 240, 340, and 440 described above. For example, the decoupling circuit 540b may be included in a medical cable assembly, such as a splitter cable, medical cable, or the like, or in a sensor assembly.
The decoupling circuit 540b is shown decoupling a signal line 562b connected to a monitor from a signal line 572b connected to a sensor. In the depicted embodiment, the decoupling circuit 540b is an analog optocoupler. The decoupling circuit 540b includes a transmitting photodiode 541 and two receiving photodiodes 545a, 545b for feedback control.
The transmitting photodiode 541 receives physiological signals from the signal line 572b via a feedback circuit 557 (described below). The transmitting photodiode 541 transmits the physiological signals to both of the receiving photodiodes 545a, 545b. The receiving photodiode 545b transmits the signals it receives from the transmitting photodiode 541 to the monitor via signal line 562b. The receiving photodiode 545a transmits the signals it receives to a feedback circuit 557.
Many diodes are inherently unstable due to nonlinearity and drift characteristics of the diodes. As a result of such instability, the signal produced by the transmitting photodiode 541 may not correspond to the signal provided by the signal line 572b from the sensor. The receiving diode 545a can therefore be used as a feedback diode to provide a received signal to the feedback circuit 557.
The feedback circuit 557 can include an amplifier or the like that adjusts its output provided to the transmitting photodiode 541 based at least partly on a difference between the signal of the transmitting photodiode 541 and the receiving diode 545a. Thus, the feedback circuit 557 can correct for errors in the transmitted signal via feedback from the feedback or receiving diode 545a. 
FIG. 5C illustrates another embodiment of a circuit 500C that includes a decoupling circuit 540c. The decoupling circuit 540c may include all the features of the decoupling circuits 240, 340, and 440 described above. For example, the decoupling circuit 540c may be included in a medical cable assembly, such as a splitter cable, medical cable, or the like, or in a sensor assembly.
The decoupling circuit 540c is shown decoupling a power line 566c connected to a monitor from a power line 576c connected to a sensor. The decoupling circuit 540c can be used together with the decoupling circuit 540b of FIG. 5B in some embodiments. For example, the decoupling circuits 540b, 540c may be provided on the same circuit board. Like the decoupling circuit 540b, the decoupling circuit 540c uses feedback to dynamically correct or control the output of the decoupling circuit 540c. 
The decoupling circuit 540c in the depicted embodiment is a flyback transformer having two primary windings 550c, 551c and one secondary winding 552c. The primary winding 550c receives power (VIN) from the power line 566c. A switched mode power supply 560 also receives power (VIN) from the power line 566c. In an embodiment, the switched mode power supply 560 is a DC-DC converter or the like. A switch pin 562 of the power supply 560 can be enabled or otherwise actuated to allow power (VIN) to cycle through the primary winding 550c. The switch pin 562 may cause the power to be switched according to a predetermined duty cycle. Feedback may be used, as described below, to maintain a stable or relatively stable duty cycle.
As the primary winding 550c is being energized, the primary winding 550c may store energy in itself and in a core 563 of the transformer. Through inductive coupling, this energy may be released into the secondary winding 552c and into the primary winding 551c. The polarity of the windings 552c, 551c (as indicated by the dots on the windings) may be the same to facilitate the transfer of energy. Likewise, the polarity of the windings 552c, 551c may differ from the polarity of the winding 550c. 
Like the feedback receiving photodiode 545a described above, the primary winding 551c acts as a flyback winding in certain embodiments to transmit the received power as a feedback signal. A rectifier 565 rectifies the power received from the primary winding 551c and provides a feedback power VFB to a feedback pin 566 of the power supply 560. The power supply 560 may then use the difference between the received feedback power VFB and the transmitted power VIN to adjust VIN to compensate for any error in the transmitted power. For example, the power supply 560 can adjust the duty cycle described above based at least partly on the error, e.g., by increasing the duty cycle if the VFB is low and vice versa. This flyback operation can advantageously maintain a stable or substantially stable power duty cycle despite varying load conditions on the decoupling circuit 540c. 
The secondary winding 550c can provide an output to a linear power supply 570, which may rectify the received power, among other functions. The linear power supply 570 may provide the power to the power line 576c for transmission to the sensor.
FIGS. 6A and 6B illustrate an example splitter cable 620. FIG. 6A depicts a side view of the splitter cable 620 while FIG. 6B depicts a bottom view of the splitter cable 620. The splitter cable 620 includes a housing 607 that includes a circuit board 640 having a decoupling circuit, show in phantom. The housing 607 further includes wires 642, also shown in phantom, in communication with the circuit board 640 and with first cable sections 630a, 630b and a second cable section 622 of the splitter cable 620. The housing 607 is also shown connected to the second cable section 622, which in turn connects to a connector 621. In an embodiment, the connector 621 is used to connect the splitter cable 620 to a physiological monitor.
The housing 607 of the splitter cable 620 further connects to one of the first cable sections 630a through a connector 631. Another one of the first cable sections 630b is integrally coupled to the housing 607 of the splitter cable 620 in the depicted embodiment. In one implementation, the splitter cable 620 and the cable 630b are used to obtain physiological information from a single sensor, and the cable 630a may be added to the splitter cable 620 to obtain physiological information from an additional sensor. It should be noted that in an alternative embodiment, the first cable section 630b is not integrally attached to the housing 607 but instead attaches to the housing a second connector. Or, both of the first cable sections 630 could be integral to the housing 607.
The circuit board 640 interfaces with both first cable sections 630a, 630b and with the second cable section 622. The circuit board 640 may include, for example, one or more integrated circuits or discrete circuit components that together are implemented as a decoupling circuit. In addition, the circuit board 640 can include one or more information elements for storing various forms of data.
Turning to FIG. 7, additional embodiments of cable assemblies 730 will be described. As explained above with respect to FIG. 1, cable assemblies having two separate cables may be provided in some embodiments. These separate cables can include a sensor cable 712 and an instrument cable 714. In one embodiment, the sensor cable 712 is a short, lightweight cable, adapted to facilitate comfortable attachment of sensors to a medical patient. In certain embodiments, the instrument cable 714 is a heavier, sturdier cable, acting as a durable interface between the sensor cable 712 and a monitor. Sensor cables 712 and instrument cables 714 may be periodically replaced. Periodic replacement is advantageous in certain embodiments for a wide variety of reasons. For example, the cable can become soiled or damaged, causing cable failure, inaccurate results, or patient cross-contamination.
In addition, one or more decoupling circuits or information elements (see FIGS. 7 and 8) may be incorporated into the cable assembly 730 in certain embodiments. The information elements may store cable management information related to usage of the cable assembly and devices connected to the cable assembly. The information elements may also store patient context information related to patient identification and patient movement (flow) among hospital departments, thereby tracking the patient's progress throughout the hospital. Examples of patient context information are described more fully in U.S. patent application Ser. No. 11/633,656, titled “Physiological Alarm Notification System,” filed Dec. 4, 2006, which is hereby incorporated by reference in its entirety. Moreover, the information elements can store physiological information in some implementations.
Referring again to FIG. 7, a sensor cable 712 is shown connected to a sensor assembly 750. The sensor cable 712 may include a flexible cable section 732 having an elongated shape, a connector 751 for interfacing with a sensor assembly 750, and a connector 737 for interfacing with an instrument cable 714. The flexible nature of the cable section 732 in one embodiment is provided to enable greater patient comfort, as the patient can move more easily with a flexible sensor cable 712 attached.
The depicted example instrument cable 714 includes a stiff or relatively rigid, durable cable section 734 having an elongated shape, a connector 735 for interfacing with the sensor cable 712, and a connector 731 for interfacing with a physiological monitor. As the instrument cable 714 of various embodiments is not connected directly to the patient, the instrument cable section 734 may be less flexible (and more durable) than the sensor cable section 732, thereby extending the life of the instrument cable 714.
Decoupling circuitry and/or information elements may be included within the sensor cable 712, the instrument cable 714, or both. The decoupling circuits and/or information elements may be placed in any of the connectors 737, 751, 735, or 731 or in either cable section 732, 734. In other embodiments, one or more information elements may be included in any of the splitter cables described above. In alternative embodiments, the sensor cable 712 can be a splitter cable.
FIGS. 8A and 8B illustrate example layouts of a physiological monitoring system 800. FIGS. 8A and 8B illustrate various information elements 860, 862, and 864. The information elements 860, 862, and 864 may be used to store cable management information, patient context information, and/or physiological information. Although not shown, the information elements 860, 862, and 864 may also be used in the splitter cable embodiments described above. Moreover, decoupling circuitry may be included in the cables of FIGS. 8A and 8B.
Referring to FIG. 8A, a physiological monitoring system 800A includes a physiological monitor 810 that communicates with a sensor 850 through an instrument cable 814 and a sensor cable 812. An information element 860 is included in the sensor cable 812.
The physiological monitor 810 interfaces with the instrument cable 814 using a connector 819, which mates with a connector 831 of the instrument cable 814. The instrument cable 814 mates in turn with the sensor cable 812 through a connector 835 on the instrument cable 814 and a corresponding connector 837 on the sensor cable 812. The sensor cable 812 in turn connects to a sensor 850 through a connector 833 and a corresponding connector 851 on the sensor 850. In alternative embodiments, the sensor cable 812 may be a splitter cable.
In the embodiment shown, the information element 860 is located in the connector 837. Other placements for the information element 860 are also possible. For example, the information element 860 could be located anywhere in the sensor 850 or in the sensor cable 812, including in a sensor cable section 832 or the connector 833. In addition, the information element 860 could also be located in the instrument cable 814 instead, or two or more information elements 860 could be used, one or more in each cable 812, 814 (see, e.g., FIG. 8).
The information element 860 can include any one or more of a wide variety of information elements. In an embodiment, the information element 860 is a non-volatile information element, such as, for example, an erasable programmable read-only memory (“EPROM”). “EPROM” as used herein includes its broad ordinary meaning known to one of skill in the art, including those devices commonly referred to as “EEPROM “EPROM,” as well as any types of electronic devices capable of retaining their contents even when no power is applied and/or those types of devices that are reprogrammable. In an embodiment, the information element is an impedance value associated with the sensor, such as, for example, a resistive value, an impedance value, an inductive value, and/or a capacitive value or a combination of the foregoing. In addition, the cable's information element could be provided through an active circuit such as a transistor network, memory chip, flash device, or other identification device, including multi-contact single wire information elements or other devices, such as those commercially available from Dallas Semiconductor or the like. Moreover, the information element may be random access memory (RAM), read-only memory (ROM), or a combination of the same.
In an embodiment, the physiological monitor 810 communicates with the information element 860 via a serial transmission line 840. In one embodiment, the serial transmission line 840 is a multi-drop bus, although in alternative embodiments, the serial transmission line 840 is a 1-wire bus, a SCSI bus, or another form of bus. Once the physiological monitor 810 determines that it is connected to the sensor cable 812, it sends and receives signals to and from the information element 860 to access cable management information and/or patient context information. Alternatively, the physiological monitor 810 does not access the information element 860 until requested to do so by a user (e.g., a clinician). In addition, the physiological monitor 810 may also automatically access the information element 860 or access the information element 860 in response to a user request.
Cable management information that may be stored on the information element 860 may include information on cable usage, sensor usage, and/or monitor usage. Cable usage data may include, for example, information on the time the cable has been in use, enabling the physiological monitor 810 to determine when the sensor cable 812 is near the end of its life. Sensor usage data may include, for example, information on what sensors have been attached to the sensor cable 812, for how long, and the like. Similarly, monitor usage data may include, for example, information on what monitors have been attached to the sensor cable 812, for how long, and the like. More detailed examples of cable management information are described below, with respect to FIG. 9.
Patient context information that may be stored on the information element 860 may include patient identification data and patient flow data. In one example embodiment, patient identification data includes at least the patient's name and one or more identification numbers. Patient flow data may include, for example, details regarding the departments the patient has stayed in, the length of time therein, and devices connected to the patient. More detailed examples of patient context information may also be found below, with respect to FIG. 9.
Advantageously, in certain embodiments, the physiological monitor 810 uses the cable management information in various embodiments to determine when to replace a cable in order to prevent cable failure. The physiological monitor 810 may also use the information element 860 to track sensor 850 and physiological monitor 810 use. Some implementations of the physiological monitor 810 enable the physiological monitor 810 to transmit some or all of the cable management information to a central nurses' station or to a clinician's end user device, such as is described in further detail below, with respect to FIG. 9. In some implementations, the physiological monitor 810 or a central nurses' station sends an alarm to the end user device that alerts the user to impending cable failure. For example, a clinician might receive an alarm notification on a personal digital assistant (PDA), pager, or the like, which enables the clinician to replace the cable before it fails. Patient context information, including identification information, may also be provided along with the alarm to help the clinician identify the cable with the patient.
Moreover, the physiological monitor 810 may transmit some or all of the cable management information and/or patient context information to a central server (see, e.g., FIG. 10). Inventory software on the central server can use this information to preemptively order new cables when cable inventory is low or at other times.
Different sensors 850 and physiological monitors 810 may be attached to the same sensor cable 812. Thus, the cable management information may also include a list of which sensors 850 and physiological monitors 810 have been attached to the cable 812, how long they were attached, and the like. The physiological monitor 810 may also provide this information to the central server to keep track of or journal this information. The cable management information is therefore used in some embodiments to derive patient monitoring metrics, which may be analyzed to monitor or improve hospital operations. A hospital may use these metrics, for example, to determine when to replace cables or to determine whether personnel are using the cables improperly or are damaging the cables through improper use.
The patient context information in some embodiments also enables the sensor cable 812 to be identified with a particular patient. As the sensor cable 812 of some embodiments may be transported with the patient when the patient is moved about the hospital, when the sensor cable 812 is attached to different monitors 850, the data stored in the information element 860 may be transferred to the new monitor 850. Thus, during the patient's stay at the hospital or at discharge, the information element 860 of certain embodiments has patient flow data that a hospital can use to monitor or improve operations. The flow data of multiple patients may be used, for instance, to determine the number of patients staying in a particular department at a given time and the equipment used during those patients' stay. Knowing this information, the hospital can adjust equipment inventories and staff assignments to more efficiently allocate hospital resources among the various departments.
FIG. 8B illustrates another embodiment of a monitoring system 800B. The monitoring system 800B preferably includes all the features of the monitoring system 800A and additionally includes an information element 862 in the instrument cable 814 and an information element 864 in the sensor 850. The information elements 862, 864 may have the same or different characteristics of the information element 860, including the same or different memory type, capacity, latency, or throughput.
In an embodiment, the serial transmission line 840 connects the physiological monitor 810 to the information element 860 in the sensor cable 812 as above. However, the serial transmission line 840 also connects to the information elements 862, 864. The physiological monitor 810 may therefore access the information elements 860, 862, 864 while running generally few transmission lines 840.
The information elements 862, 864 may have all or a portion of the functionality of the information element 860. In one embodiment, the same data is stored in each of the information elements 860, 862, 864, thereby providing data redundancy. Additionally, in such embodiments the instrument cable 814 may stay with the patient as the patient moves from one department to another, in place of or in addition to the sensor cable 812. Moreover, in one embodiment only the instrument cable 814 or the sensor assembly 850 has an information element 862 or 864, and the sensor cable 812 does not have an information element 860.
The placement of the information elements 862, 864 can be in any of a variety of locations. For example, the information element 862 may be located in either one or the connectors 831, 835 or in the instrument cable section 834. Likewise, the information element 864 of the sensor 850 may be located in the connector 851 or in another part of the sensor 850.
Although not shown, the sensor cable 812 and/or the instrument cable 814 may have multiple information elements in some embodiments. When multiple information elements are used, certain data may be stored on some information elements, and other data may be stored on others. For instance, cable management information may be stored on a separate information element from patient context information, and physiological information may be stored on yet another information element.
FIG. 8C illustrates an embodiment of a circuit 800C for facilitating communication between a monitor and one or more information elements 890. The circuit 800C may be included in any of the cable or sensor assemblies described above, including in a splitter cable, a non-splitter cable, an instrument cable, a sensor cable, a sensor assembly, combinations of the same, and the like. In addition, the circuit 800C may be used in conjunction with the circuits 500B and 500C in a single cable, e.g., on the same circuit board, or in combination with multiple cables and/or sensor assemblies.
Advantageously, in certain embodiments, the circuit 800C provides electrical decoupling for communications lines 877, 879, 882, and 883, which provide communications between a monitor and one or more information elements. In addition, the circuit 800C may provide sensor connection status to a monitor via a sensor detect circuit 872.
A decoupling circuit 540d shown includes digital decoupling logic to electrically decouple one or more information elements and one or more sensors from the monitor. The decoupling circuit 540d includes transformers on a chip and associated logic that perform digital decoupling. In one embodiment, the decoupling circuit 540d is a ADuM130x series chip from Analog Devices. In other embodiments, optocouplers and/or other transformers are used.
Communications lines 882, 883 allow the monitor to transmit and receive data to and from one or more information elements 890. The line 882 is a monitor transmit line 882, and the line 883 is a monitor receive line 883. Each of these lines 882, 883 is electrically decoupled from the communications line 877 by the decoupling circuit 540d. The communication lines 877, 879 may be electrically coupled with the one or more information elements 890.
In an embodiment, the communications line 877 is a bus, such as a 1-wire bus. The communications line 877 may be used to both transmit and receive data to and from the monitor. The communications line 879 may be used to receive data from the monitor. A MOSFET switch 876 or the like is in communication with the depicted communications line 879, which selectively transmits signals to the one or more information elements 890.
The monitor receive line 883 is in communication with a power validation circuit 878, which determines whether the feedback power VFB described above with respect to FIG. 5C is high enough. If the feedback power VFB is too low, the data received from the information elements 890 may not be used because the data may be corrupt.
In the depicted embodiment, the power validation circuit 878 includes a comparator 889 that compares the feedback power VFB with a reference voltage. If the feedback power VFB is equal to or higher than the reference voltage, the comparator 889 might output a high voltage. This high voltage can be selectively overridden by a MOSFET switch 887 in response to communications received from the information elements 890. If the feedback power VFB is lower than the reference voltage, the comparator 889 might output a low voltage. The low voltage can override the MOSFET switch 887 such that communications from the information elements 890 are not sent to the monitor.
In the depicted embodiment, sensor connection status is provided to the monitor via the sensor detect circuit 872. The sensor detect circuit 872 includes a sensor detect line 875 in communication with a pull-up resistor 873. When a sensor 885 is not connected to the line 875, the line 875 may be pulled high. This high voltage may be inverted by a MOSFET switch 874 to provide a low signal to the monitor via sensor connect line 881. The switch 874 may be omitted in some embodiments.
In response to a sensor 885 being connected to the sensor detect line 875, a shorted line 886 (or low resistance line) in the sensor 885 can cause the line 875 to be pulled low. This low value can be inverted by the switch 874 to provide a high signal to the monitor. This signal can indicate that the sensor 885 is connected. Conversely, if the sensor 885 is disconnected, the line 875 may again be pulled high, resulting in a low output of the switch 874. As a result, the monitor may receive a rapid or near-immediate indication that the sensor 885 has been disconnected.
The sensor detect circuit 872 also includes passive elements in the depicted embodiment, such as a capacitor 891, to smooth or debounce contact oscillations from the sensor 885. Thus, the sensor detect circuit 872 can also be considered a debounce circuit. In other embodiments, the sensor detect circuit 872 can be replaced with other forms of debounce circuitry.
Advantageously, in certain embodiments, the sensor detect circuit 872 can be used instead of polling the one or more information elements 890 frequently to determine if the sensor 885 is connected. Alternatively, the polling cycle of the one or more information elements 890 may be reduced. Reducing or eliminating the polling cycle can reduce power consumption by the circuit 800C.
The sensor detect circuit 872 may be used to detect the connection of cables, such as a splitter cable, as well as or instead of detecting sensor connections. In some embodiments, a sensor detect line 875 may be provided for each sensor in a multi-sensor system, each cable, or the like. Moreover, the sensor detect circuit 872 may also be used with cables that do not have a decoupling circuit.
FIG. 9 illustrates a block diagram of example forms of data that can be stored on an information element. In the depicted embodiment, patient context information 920, cable management information 930, and physiological information 940 are shown. The patient context information can include patient identification data 922 and patient flow data 924. Cable management information 930 can include cable usage data 932, sensor usage data 934, and instrument usage data 936. However, while the data is depicted in FIG. 9 as comprising discrete categories, data from one category may be included within another. Data from one or more categories also may not be included, or alternatively, additional data categories than that shown may be included.
Turning to more specific examples, in one embodiment patient identification data 922 can include a patient's name, a patient's unique hospital identification number, type of patient or body tissue, information about the patient's age, sex, medications, and medical history, and other information that can be useful for the accuracy of alarm settings and sensitivities and the like. In addition, the patient identification data 922 may also include an SpO2 fingerprint, determined by a pulse oximeter. In one such embodiment, the SpO2 fingerprint is determined by calculating a ratio of an infrared detected wavelength and a red detected wavelength. The SpO2 fingerprint can be used to detect if a sensor or cable is being improperly reused.
Patient flow data 924 can include a record of departments the patient has visited, length of stay (LOS) in those departments, overall LOS in the hospital, admittance date and time, discharge date and time, time stamps for events occurring in the hospital, and the like. Some or all of this information, in conjunction with the patient identification data, can constitute a patient flow profile.
Cable usage data may include buyer or manufacturer information, cable type, serial number of the cable, date of purchase, time in use, and cable life monitoring functions (CLM), including near expiration percentage, update period, expiration limit, and an index of functions. In addition, the cable usage data 932 may include numerous read write parameters, such as the number of times the cable is connected to a monitoring system, the number of times the cable has been successfully calibrated, the total elapsed time connected to a monitor system, the number of times the cable has been connected to one or more sensors, the total time used to process patient vital parameters, the cumulative current, voltage, or power applied to the cable, the cumulative temperature of the cable, and the expiration status of the cable.
In an embodiment, the number of times the cable is placed on or removed from a patient is monitored and an indication is stored in the memory. The number of times a sensor connected to the cable is placed on or removed from a patient can be monitored by monitoring the number of probe off conditions sensed, or it can be monitored by placing a separate monitoring device on the cable or sensor to determine when a sensor clip is depressed, opened, removed, replaced, attached, or the like.
In an embodiment, the average operating temperature of the cable is monitored and an indication stored. This can be done, for example, through the use of bulk mass or through directly monitoring the temperature of the cable or the temperature of the cable's connectors. In an embodiment, the number of different monitors connected to the cable is tracked and an indication is stored in memory. In an embodiment, the number of times the cable is calibrated is monitored, and an indication is stored in memory. In an embodiment, the number of patients that use a cable is monitored and an indication is stored. This can be done by, for example, by storing sensed or manually entered information about the patient and comparing the information to new information obtained when the cable is powered up, disconnected and/or reconnected, or at other significant events or periodically to determine if the cable is connected to the same patient or a new patient. In an embodiment, a user is requested to enter information about the patient that is then stored in memory and used to determine the useful cable life. In an embodiment, a user is requested to enter information about cleaning and sterilization of the cable, and an indication is stored in the memory. Although described with respect to measuring certain parameters in certain ways, various other electrical or mechanical measurements can be used to determine any useful parameter in measuring the useful life of a cable.
Sensor usage data 934 can include some or all of the same information as the cable usage data but applied to sensors attached to the cable, and may also include information on the type or operation of the sensor, type or identification of a sensor buyer, sensor manufacturer information, sensor characteristics including the number of wavelengths capable of being emitted, emitter specifications, emitter drive requirements, demodulation data, calculation mode data, calibration data, software such as scripts, executable code, or the like, sensor electronic elements, sensor life data indicating whether some or all sensor components have expired and should be replaced, encryption information, monitor or algorithm upgrade instructions or data, or the like. In an embodiment, the sensor usage data 934 can also include emitter wavelength correction data.
Sensor usage data 934 can also include the number of emitting devices, the number of emission wavelengths, data relating to emission centroids, data relating to a change in emission characteristics based on varying temperature, history of the sensor temperature, current, or voltage, emitter specifications, emitter drive requirements, demodulation data, calculation mode data, the parameters it is intended to measure (e.g., HbCO, HbMet, etc.) calibration data, software such as scripts, executable code, or the like, sensor electronic elements, whether it is a disposable, reusable, or multi-site partially reusable, partially disposable sensor, whether it is an adhesive or non-adhesive sensor, whether it is reflectance or transmittance sensor, whether it is a finger, hand, foot, forehead, or ear sensor, whether it is a stereo sensor or a two-headed sensor, sensor life data indicating whether some or all sensor components have expired and should be replaced, encryption information, keys, indexes to keys or has functions, or the like monitor or algorithm upgrade instructions or data, and some or all of parameter equations.
Instrument usage data 936 can include buyer or manufacturer information, information on the type of monitors that the cable has connected to, number of monitors the cable has connected to, duration of cable connections to the monitors, duration of use of the monitor, trend history, alarm history, sensor life, an identification number for a specific monitor, and the like. In addition, the instrument usage data 936 may include all or a portion of all the cable and sensor usage data described above.
The physiological information 940 may include any of the physiological parameters described above, obtained from the sensors or monitors attached to the information element 960. In one implementation, the information element 960 enables the physiological information 940 to be transferred between physiological monitors. As a result, a historical view of the patient's physiological parameters may be provided to different monitors throughout the hospital. Thus, clinicians in different departments can observe the patient's physiological information obtained in a previous department, enabling clinicians to provide a higher quality of care.
FIG. 10 illustrates an embodiment of a physiological monitoring system 1000 which may be used in a hospital, nursing home, or other location where medical services are administered (collectively “hospital”). Certain aspects of the physiological monitoring system 1000 are described in more detail in U.S. patent application Ser. No. 11/633,656, titled “Physiological Alarm Notification System,” filed Dec. 4, 2006, which is hereby incorporated by reference in its entirety.
The physiological monitoring system 1000 of certain embodiments includes patient monitoring devices 1002. The patient monitoring devices 1002 of various embodiments include sensors 1050, one or more physiological monitors 1010, cables 1030 attaching the sensors 1050 to the monitors 1010, and a network interface module 1006 connected to one or more physiological monitors 1010. Each patient monitoring device 1002 in some embodiments is part of a network 1020 of patient monitoring devices 1002. As such, the patient monitoring devices 1002 in these embodiments can communicate physiological information and alarms over a hospital wireless network (WLAN) 1026 or the Internet 1050 to clinicians carrying end user devices 1028, 1052.
The network interface module 1002 of certain embodiments transmits physiological information on demand or in the event of an alarm to the end-user devices 1028, 1052 and/or transmits the alarm to a central nurses' station. Alternatively, the network interface module 1002 transmits information and alarms to a server 1036. The server 1036 is a computing device, such as an appliance server housed in a data closet or a workstation located at a central nurses' station. The server 1036 passes the information or alarms to the end user devices 1028, 1052 or to the central nurse's station. The alarms may be triggered when certain physiological parameters exceed safe thresholds, thereby enabling clinicians to respond rapidly to possible life-threatening situations. Situations giving rise to an alarm might include, for example, decreased heart rate, respiratory rate, low SpO2 levels, or any other physiological parameter in an abnormal range.
The network interface module 1002 in one embodiment also performs cable management by generating an alarm when one of the cables 1030 is nearing the end of its life. The network interface module 1002 determines whether the cable's 1030 life is close to expiring by, for example, analyzing some or all of the data described above with respect to FIG. 9. In one embodiment, if the network interface module 1002 determines that the cable life is close to expiration, the network interface module 1002 provides an expiration message as an alarm.
In one embodiment, the server 1036 receives this expiration message. The server 1036 then checks an inventory stored in a database 1038 to see if a replacement cable is available. If there is no replacement cable in the inventory, the server may forward the message to a supplier 1070 over the Internet 1050 (or through a WAN, leased line or the like). In an embodiment, the server 1036 transmits an email message to a supplier 1070 that indicates the cable location, cable condition, and/or other cable usage data. The supplier 1070 in one embodiment is a cable seller. Upon receiving the message, the supplier 1070 may automatically ship a new cable to the hospital. Consequently, cable 1030 inventories are able to be maintained with minimal or no user intervention in this implementation, and cables 1030 may be replaced preemptively, before cable failure.
In additional embodiments, the network interface module 1006 may monitor sensor utilization, such as the number of sensors used during the patient's stay, the types of sensors, and the length of time in use before replacement. Such data can be used by the hospital to preemptively plan restocking and set department par inventory levels. In addition, a supplier can use this data to restock the hospital or implement a just in time inventory control program. Moreover, such information can be used by the supplier to improve overall cable reliability and for the hospital to better plan and manage consumables.
The network interface module 1006 of various implementations also performs context management. In one embodiment, context management includes associating context information with physiological information to form a contextual data package. As described above, context information may include patient identification data and patient flow data. In addition, context information may include context information related to usage of the network interface module 1006 and context information related to the network. For example, this additional context information may include an identification number of the network interface module 1006, time stamps for events occurring in the physiological monitoring system 1000, environmental conditions such as changes to the state of the network and usage statistics of the network interface module 1006, and identification information corresponding to the network (e.g., whether the network connection is WiFi or Ethernet).
The network interface module 1006 receives context information in one embodiment by a nurse entering the information in the network interface module 1006 or from the server 1036. The network interface module 1006 transmits or communicates the contextual data package to clinicians during an alarm, upon clinician request, or on a scheduled basis. In addition, the network interface module 1006 may transmit a continuous stream of context information to clinicians.
The server 1036 receives contextual data packages from a plurality of network interface modules 1006 and stores the contextual data package in a storage device 1038. In certain embodiments, this storage device 1038 therefore archives long-term patient data. This patient data may be maintained even after the patient is discharged. Thus, context information may be stored for later analysis to, for example, develop patient care metrics and improve hospital operations. The patient data could be deleted after the care metrics are developed to protect patient privacy.
Although the functions of cable management and context management have been described as being performed by the network interface module 1006, in certain embodiments, some or all of these functions are instead performed by the physiological monitor 1010. In addition, the physiological monitor 1010 and the network interface module 1006 may both perform cable management and/or context management functions.
FIG. 11 illustrates an embodiment of a usage tracking method 1100 for tracking the life of a medical cable. In one implementation, the usage tracking method 1100 is performed by the network interface module and/or one of the physiological monitors described above. More generally, the usage tracking method 1100 may be implemented by a machine having one or more processors. Advantageously, in certain embodiments, the usage tracking method 1100 facilitates replacing a cable prior to failure of that cable.
The usage tracking method 1100 begins by obtaining sensor parameters from a sensor at block 1102. At block 1104, cable usage information stored in an information element is tracked. The cable usage information can be tracked by at the same time or substantially the same time as obtaining sensor parameters from the sensor. Alternatively, the cable usage information may be tracked by determining cable usage at the start or end of monitoring (e.g., obtaining sensor parameters), or periodically throughout monitoring. In addition, the cable usage information may be tracked even if the block 1102 were not performed, e.g., when the monitor is not currently obtaining parameters from the sensor.
At decision block 1106, it is determined whether the cable's life is close to expiring (or whether the cable has in fact expired). This determination may be made using the data described above with respect to FIG. 9. In addition, the this determination may be made using sensor life functions applied analogously to the life of the cable.
If it is determined that the cable life is close to expiration (or has expired), an expiration message is provided at block 1108. In one embodiment, this message is provided as an alarm on the monitor or at a central nurses' station. The message may also be provided to a clinician's end user device, which may be located in the hospital or at a remote location. Moreover, the message may be provided to a server, which forwards the message to a supplier, which ships a new cable. In an embodiment, the message is an email that indicates the cable location, cable condition, and/or other cable usage data. If, however, it is determined that the cable life is not close to expiration (or is not expired), the usage tracking method 1100 loops back to block 1102 to continue monitoring. In effect, the usage tracking method 1100 may continue monitoring and/or tracking cable usage information until the cable is close to expiration or has expired.
FIG. 12 illustrates an embodiment of a cable inventory method 1200 for controlling cable inventory. The cable inventory method 1200 may be performed by a server, such as the server 1038 described above. More generally, the cable inventory method 1200 may be implemented by a machine having one or more processors. In one embodiment, the method 1200 is performed in response to the method 1100 providing an expiration message at step 1108.
At block 1202, an expiration message is received from a monitor, indicating that a cable is close to expiration or has expired. At block 1204, an inventory is checked for a replacement cable. This inventory may be a hospital inventory, a record of which may be maintained in a hospital database or the like.
If it is determined at decision block 1206 that there is no replacement cable in the inventory, a new cable is ordered automatically to order a at block 1208. In an embodiment, this block 1208 is performed by electronically contacting a supplier to order the cable, for example, by sending a request over a network such as the Internet. Consequently, in certain embodiments, the cable inventory method 1200 enables the cable to be replaced preemptively, before cable failure. If, however, there is a replacement cable in inventory, the cable inventory method 1200 ends. However, in alternative embodiments, the cable inventory method 1200 orders a replacement cable regardless of the inventory, such that a predetermined level of cable inventory is maintained.
In additional embodiments, the cable inventory method 1200 may monitor sensor utilization, such as the number of sensors used during the patient's stay, the types of sensors, and the length of time in use before replacement. Such data can be used by the hospital to preemptively plan restocking and set department par inventory levels. In addition, a supplier can use this data to restock the hospital or implement a just-in-time program. Moreover, such information can be used by the supplier to improve overall cable reliability, and for the hospital to better plan and manage consumables.
FIG. 13 illustrates an example context management method 1300 for managing patient context. In an embodiment, the context management method 1300 is performed by a physiological monitor, such as any of the monitors described above. More generally, certain blocks of the context management method 1300 may be implemented by a machine having one or more processors. The context management method 1300, in certain embodiments, advantageously enables a patient to be assigned a cable with a unique identifier upon the first connection of the cable to the patient or to a monitor.
At block 1300, a cable is connected to a monitor, for example, by a clinician such as a nurse. Thereafter, a temporary patient ID is assigned to the cable at block 1304. The temporary ID may be automatically assigned when power is provided to the information element in the cable, or a prompt may be provided to a clinician, who then assigns the ID. In addition, the temporary ID may also be previous stored on the cable. The temporary patient ID enables the cable to be identified as uniquely relating to the patient, prior to the patient's identification information being provided to the cable. The temporary patient ID may be stored in the information element of the cable.
At block 1306, patient flow data is stored in the information element. The patient flow data may include flow data described above with respect to FIG. 9. For example, the patient flow data may include information regarding connected devices, a department ID associated with the cable, and time spent by the cable in a department. By storing patient flow data, the context management method 1300 can enable the flow of the patient may be monitored upon connection of the cable to a monitor. Thus, even if the nurse neglects to identify the cable with the patient, the cable can have data indicating when it is being used on the same or a different patient.
At decision block 1308 it is determined whether a real patient ID has been provided. If so, then the temporary ID is replaced with the real patient ID at block 1310. The real patient ID may include any of the patient identification information described above, with respect to FIG. 13. If, however, it is determined that a real patient ID has not been provided, the context management method 1300 loops back to block 1306 to continue storing patient flow data in the information element.
FIG. 14 illustrates another example context management method 1400 for managing patient context. In an embodiment, the context management method 1400 is performed by one or more monitors, such as any of the monitors described above. More generally, certain blocks of the context management method 1400 may be implemented by a machine having one or more processors.
At block 1402, a cable is connected to a monitor. In one embodiment, this block is performed by a clinician, such as a nurse. Patient flow data is then stored in an information element at block 1404. The patient flow data may include the flow data described above with respect to FIG. 9.
At decision block 1406, it is determined whether the cable has been connected to a new monitor. If it has, patient flow data is transferred from the cable to the new monitor at block 1408. In an embodiment, the new monitor determines whether the cable has been connected to the new monitor. Alternatively, the cable makes this determination. Transferring the patient flow data to the new monitor provides, in certain embodiments, the advantage of enabling the monitor to know where the patient has been in the hospital and for how long. If a new monitor has not been connected, the context management method 1400 ends.
FIG. 15 illustrates an embodiment of a sensor system 1500 including a sensor assembly 1501 and a monitor cable 1511 suitable for use with any of the physiological monitors and cables described herein. The sensor assembly 1501 includes a sensor 1515, a cable assembly 1517, and a connector 1505. The sensor 1515, in one embodiment, includes a sensor subassembly 1502 and an attachment subassembly 1504. The cable assembly 1517 of one embodiment includes a sensor 1507 and a patient anchor 1503. A sensor connector subassembly 1505 is connected to the sensor cable 1507.
The sensor connector subassembly 1505 can be removably attached to an instrument cable 1511 via an instrument cable connector 1509. The instrument cable 1511 can be attached to a cable hub 1520, which includes a port 1521 for receiving a connector 1512 of the instrument cable 1511 and a second port 1523 for receiving another cable. The hub 1520 is an example of the splitter cable described above, and as such, can include decoupling circuitry (see FIGS. 17A and 17B). In certain embodiments, the second port 1523 can receive a cable connected to an optical sensor or other sensor. In addition, the cable hub 1520 could include additional ports in other embodiments for receiving additional cables. The hub includes a cable 1522 which terminates in a connector 1524 adapted to connect to a physiological monitor (not shown).
The sensor connector subassembly 1505 and connector 1509 can be configured to allow the sensor connector 1505 to be straightforwardly and efficiently joined with and detached from the connector 1509. Embodiments of connectors having connection mechanisms that can be used for the connectors 1505, 1509 are described in U.S. patent application Ser. No. 12/248,856 (hereinafter referred to as “the '856 Application”), filed on Oct. 9, 2008, which is incorporated in its entirety by reference herein. For example, the sensor connector 1505 could include a mating feature (not shown) which mates with a corresponding feature (not shown) on the connector 1509. The mating feature can include a protrusion which engages in a snap fit with a recess on the connector 1509. In certain embodiments, the sensor connector 1505 can be detached via one hand operation, for example. Examples of connection mechanisms can be found specifically in paragraphs [0042], [0050], [0051], [0061]-[0068] and [0079], and with respect to FIGS. 8A-F, 13A-E, 19A-F, 23A-D and 24A-C of the '856 Application, for example.
The sensor connector subassembly 1505 and connector 1509 can reduce the amount of unshielded area in and generally provide enhanced shielding of the electrical connection between the sensor and monitor in certain embodiments. Examples of such shielding mechanisms are disclosed in the '856 Application in paragraphs [0043]-[0053], [0060] and with respect to FIGS. 9A-C, 11A-E, 13A-E, 14A-B, 15A-C, and 16A-E, for example.
In an embodiment, the acoustic sensor assembly 1501 includes a sensing element, such as, for example, a piezoelectric device or other acoustic sensing device. The sensing element can generate a voltage that is responsive to vibrations generated by the patient, and the sensor can include circuitry to transmit the voltage generated by the sensing element to a processor for processing. In an embodiment, the acoustic sensor assembly 1501 includes circuitry for detecting and transmitting information related to biological sounds to a physiological monitor. These biological sounds can include heart, breathing, and/or digestive system sounds, in addition to many other physiological phenomena. The acoustic sensor 1515 in certain embodiments is a biological sound sensor, such as the sensors described herein. In some embodiments, the biological sound sensor is one of the sensors such as those described in the '883 Application. In other embodiments, the acoustic sensor 1515 is a biological sound sensor such as those described in U.S. Pat. No. 6,661,161, which is incorporated by reference herein in its entirety. Other embodiments include other suitable acoustic sensors.
The attachment sub-assembly 1504 includes first and second elongate portions 1506, 1508. The first and second elongate portions 1506, 1508 can include patient adhesive (e.g., in some embodiments, tape, glue, a suction device, etc.). The adhesive on the elongate portions 1506, 1508 can be used to secure the sensor subassembly 1502 to a patient's skin. One or more elongate members 1510 included in the first and/or second elongate portions 1506, 1508 can beneficially bias the sensor subassembly 1502 in tension against the patient's skin and reduce stress on the connection between the patient adhesive and the skin. A removable backing can be provided with the patient adhesive to protect the adhesive surface prior to affixing to a patient's skin.
The sensor cable 1507 can be electrically coupled to the sensor subassembly 1502 via a printed circuit board (“PCB”) (not shown) in the sensor subassembly 1502. Through this contact, electrical signals are communicated from the multi-parameter sensor subassembly to the physiological monitor through the sensor cable 1507 and the cable 1511.
In various embodiments, not all of the components illustrated in FIG. 15 are included in the sensor system 1500. For example, in various embodiments, one or more of the patient anchor 1503 and the attachment subassembly 1504 are not included. In one embodiment, for example, a bandage or tape is used instead of the attachment subassembly 1504 to attach the sensor subassembly 1502 to the measurement site. Moreover, such bandages or tapes can be a variety of different shapes including generally elongate, circular and oval, for example. In addition, the cable hub 1520 need not be included in certain embodiments. For example, multiple cables from different sensors could connect to a monitor directly without using the cable hub 1520.
Additional information relating to acoustic sensors compatible with embodiments described herein, including other embodiments of interfaces with the physiological monitor, are included in U.S. patent application Ser. No. 12/044,883, filed Mar. 7, 2008, entitled “Systems and Methods for Determining a Physiological Condition Using an Acoustic Monitor,” (hereinafter referred to as “the '883 Application”), the disclosure of which is hereby incorporated by reference in its entirety. An example of an acoustic sensor that can be used with the embodiments described herein is disclosed in U.S. patent application Ser. No. 12/643,939, filed herewith, titled “Acoustic Sensor Assembly,” the disclosure of which is hereby incorporated by reference in its entirety.
FIG. 16 illustrates a front elevation view of an embodiment of a coextruded cable 1600. The coextruded cable 1600 can be used as a cable or cable section in place of any of the cables mentioned herein. The coextruded cable 1600 can advantageously reduce noise due to a triboelectric effect.
Noise can adversely affect acoustic signals detected by any of the acoustic sensors described herein by corrupting a waveform detected by an acoustic or other sensor. Once source of noise is triboelectric noise, which can be present when a cable is squeezed, bringing conductors in the cable closer together. The closer the conductors are, the greater a capacitance can form between the conductors and/or between the conductors and shielding. This capacitance can be a source of triboelectric noise.
The example coextruded cable 1600 shown includes features that can reduce the amount of triboelectric noise generated by squeezing, rubbing, or other touching of the cable 1600. The cable 1600 includes an outer jacket 1610, which encompasses an outer shielding layer 1612. The outer shielding layer 1612 can reduce ambient noise from reaching conductors 1620 that extend through the cable 1600. Insulation 1622 surrounds each conductor 1620.
For ease of illustration, the coextruded cable 1600 is shown having two conductors 1620. However, the features of the coextruded cable 1600 can be extended to more than two conductors in certain embodiments. For example, more than two conductors can be surrounded by the insulation 1622, or each of two or more conductors can be individually surrounded by insulation. Further, a group of acoustic sensor-related conductors can be surrounded by insulation, and a group of optical sensor-related conductors can be surrounded by separate insulation.
Although not shown, the insulation 1622 can be shielded as well. Thus, in one embodiment, some or all acoustic sensor-related conductors can be shielded by a separate, inner shielding layer (see FIG. 17B) from the outer shielding layer 1612. Similarly, some or all optical sensor-related conductors can be shielding by a separate, inner shielding layer from the outer shielding layer 1612. One or both of the acoustic and optical sensor-related sets of conductors can include their own inner layer of shielding to reduce crosstalk between the acoustic and optical sensor-related conductors. Reducing crosstalk can be particularly beneficial for reducing noise on a communications line or lines in the cable 1600 (such as the serial transmission line 840 of FIGS. 8A, 8B).
Filling or substantially filling the space between the insulation 1622 and the shielding layer 1612 is a coextruded material 1630. The coextruded material 1630 can be conductive PVC or the like that reduces space between the conductors 1620, so that the cable 1600 does not compress the conductors 1622 together as easily. The cable 1600 can still be flexible or relatively flexible, however. Because the cable 1600 may compress less than other cables, less triboelectric noise may be generated. In addition, the conductive property of the conductive material 1630 can dissipate charge that builds up from the triboelectric capacitance occurring between the conductors 1620 and/or between the conductors 1620 and the shielding 1612. This dissipative property of the material 1630 can further reduce noise.
Moreover, in certain embodiments, the outer jacket 1610 of the cable 1600 can be coated or can be composed of a glossy material that has a reduced coefficient of friction. Accordingly, materials that rub, brush against, or otherwise contact the outer jacket 1610 can slide smoothly off, thereby further reducing triboelectric noise.
Many other configurations of the cable 1600 are possible. For example, in one embodiment, the cable 1600 can include a flexible or “flex” circuit having conductive traces disposed on a substrate. Acoustic and/or optical sensor-related conductors can be disposed in the flex circuit (or in separate flex circuits). Further, the decoupling circuitry described above can also be included in the flex circuit or circuits. The flex circuit can be used as a sensor cable (see above), an instrument cable (see above), as a hub cable (see below), portions of the same, or any combination of the same. Some examples of flex circuits that can be employed with any of the sensors, circuits, and cables described herein are described in U.S. Pat. No. 6,986,764, filed May 2, 2002, titled “Flex Circuit Shielded Optical Sensor,” and U.S. Pat. No. 7,377,794, filed Mar. 1, 2006, titled “Multiple Wavelength Sensor Interconnect,” the disclosures of which are both hereby incorporated by reference in their entirety.
FIG. 17A illustrates example internal components of an example hub 1720 or splitter cable. The hub 1720 shown is an example implementation of the hub 1520 of FIG. 15 and can be used in place of any of the splitter cables described herein. Advantageously, in certain embodiments, the hub 1720 includes localized shielding 1742 to reduce the effects of electromagnetic noise on one or more physiological signals.
The hub 1720 includes connectors 1710, 1712 that connect to sensor or patient cables (see, e.g., FIG. 15). For purposes of illustration, the connector 1710 can be connected to an optical sensor via a cable, and the connector 1712 can be connected to an acoustic sensor via a cable. Other physiological sensors can be connected via cables to the connectors 1710, 1712.
The connectors 1710, 1712 can be soldered to a printed circuit board (PCB) 1730 housed within the hub 1720. The PCB 1730 includes front-end signal conditioning circuitry 1740, 1750, which can filter and condition optical signals and acoustic signals, respectively. The optical signal conditioning circuitry 1740 is disposed on a first area 1731 of the PCB 1730, and the acoustic signal conditioning circuitry 1750 is disposed on a second area 1732 of the PCB 1730. An electrical decoupling region 1733, which may be a nonconductive portion of the PCB 1730, separates the two areas 1731, 1732 of the PCB 1730 electrically. In other embodiments, the two areas 1731, 1732 are separate PCBs. For example, one of the areas 1731, 1732 can be a daughter board attachable to the other area.
Decoupling circuitry 1756 electrically decouples the two areas 1731, 1732. The decoupling circuitry 1756 can include any of the decoupling features described above. For example, the decoupling circuitry 1756 can include a transformer 1754 for decoupling power signals and an optocoupler 1752 for decoupling physiological signals. The decoupling circuitry 1756 is shown coupled to the acoustic signal conditioning circuitry 1750 in the depicted embodiment. In other embodiments, the decoupling circuitry 1756 is coupled with the optical signal conditioning circuitry 1740. Decoupling circuitry can also be applied separately to both the optical and acoustic signal conditioning circuitry 1740, 1750.
Due to regulations on winding insulation, to increase power efficiency of the transformer 1754, and possibly other factors, the transformer 1754 can be physically large relative to the size of other components in the hub 1720. As a result, the hub 1720 can be relatively large. The size of the hub 1720 can be reduced in certain embodiments by incorporating the decoupling circuitry in a patient monitor (not shown) attached to the hub 1720. However, if the hub 1720 is used with existing monitors that do not have decoupling circuitry, there may be little or no available space inside the monitor to fit a power-efficient transformer 1754. Thus, including the transformer 1754 in the hub 1720 can be advantageous to avoid making expensive modifications to an existing patient monitor.
A schematic view of a cable 1722 is also shown. The cable 1722 is attached to the hub 1720. The cable 1722 can be permanently attached to the hub 1720 or can be selectively detachable from the hub 1720. The cable 1722 includes various example conductors 1761, 1765, 1767, and 1769 in the depicted embodiment. Certain of the conductors 1761, 1765, 1767, and 1769 can be used for power transmission, signal acquisition, and grounding, among other potential uses.
One of the conductors 1769 is shown as a first ground (G1) and is electrically coupled with the optical signal conditioning circuitry 1740. Another of the conductors 1761 is shown as a second ground (G2) and is electrically coupled with the decoupling circuit 1752 (and, optionally, the decoupling circuit 1754 as well). The first and second grounds 1769, 1761 are therefore separated for optical and acoustic signals, respectively, in the depicted embodiment. Providing separate ground lines for the optical and acoustic signals can beneficially reduce crosstalk between these signals. The ground lines 1769, 1761 can be connected together at the end of the cable 1722 (e.g., in a monitor connector) or in a patient monitor (e.g., on a processing board).
To reduce noise, various components of the hub 1720 (e.g., including the PCB 1730) can be enclosed in an electromagnetic shield. The electromagnetic shield can be tied to ground conductors in the hub 1720, including the conductors 1761, 1769, and ground conductors in the acoustic signal conditioning circuitry 1750. However, doing so can cause the ground lines 1761, 1769 to come in electrical communication with both electrically-decoupled areas 1731, 1732 of the PCB 1730. As a result, patient isolation or decoupling would be broken, causing potentially unsafe conditions.
Advantageously, in certain embodiments, shielding can be provided locally within the hub 1720 instead of over all or substantially all of the components in the hub 1720. For instance, a local shield can enclose or at least partially enclose the acoustic circuitry 1750 and/or connector 1712. Alternatively, a local shield can enclose or at least partially enclose the optical circuitry 1740 and/or connector 1710. Advantageously, in certain embodiments, substantial noise-reduction benefit can be achieved by locally shielding one of the optical and acoustic circuitry 1740, 1750 with a local shield 1742. The local shield 1742 can beneficially shield solder joints of the connector 1710 and/or components 1740 as well. The shield can include a metal box, grate, perforated box, conductive glass, combinations of the same, or the like.
In other embodiments, a first local shield is disposed about the optical circuitry 1740 and a second local shield is disposed about the acoustic circuitry 1750. Each of these shields can be tied to different grounds or common potentials by virtue of the decoupling circuitry 1752, 1754.
Although the hub 1720 is illustrated with respect to optic and acoustic signals, more generally, the hub 1720 can interface with any type of physiological signals. Further, some or all of the features of the hub 1720 can be used in certain applications outside of the medical field where cables are joined together in a single hub. Moreover, the features of the hub 1720 can be extended to more than two sensor cables. Such a hub can optionally include decoupling circuitry for some or all of the sensor cables that interface with the hub.
FIG. 17B depicts internal components of an example hub 1820 similar to the hub 1720 described above with respect to FIG. 17A. The hub 1820 also depicts example internal components of the hub 1520 of FIG. 15. The features of the hub 1820 can combined with any of the embodiments describing splitter cables herein.
The example hub 1820 shown includes connectors 1810 and 1812 for receiving signals from two physiological sensors, such as optical and acoustic sensors. A PCB 1830 is shown that includes, among other components, decoupling circuitry 1856. A local shield 1842 encloses circuitry corresponding to one of the sensors (e.g., the optical sensor-related circuitry). The local shield 1842 can include a metal or at least partially metal enclosure. The local shield 1842 can fully or partially enclose various circuit components. The local shield 1842 can be disposed on top of a PCB 1830 without fully enclosing the PCB 1830 on the bottom of the PCB 1830. Alternatively, the local shielding 1842 can enclose at least a portion of the bottom of the PCB 1830 as well.
A shielded cable portion 1860 extends from the local shield 1842 to become part of a cable 1822, which cable 1822 can be connected to a patient monitor. The shielded cable portion 1860 can include conductors from the circuitry enclosed by the local shield 1842, such as signal, power, and ground wires. The shielded cable portion 1860 also includes a cable shield, such as an outer cable sheath, that at least partially surrounds the conductors. Thus, both the circuitry and cable wiring for a particular sensor can be shielded or at least partially shielded from circuitry and cable wiring for another sensor. The cable shielding can beneficially reduce crosstalk between conductors, including conductors responsible for communications (such as the serial transmission line 840 of FIG. 8A, 8B).
Wires 1870 extending from circuitry corresponding to the other sensor (e.g., the acoustic sensor-related circuitry) are depicted as being unshielded. However, these wires can also be enclosed or at least partially enclosed in a cable shield, like the shielded cable portion 1860. Shielding the wires from both optical and acoustic sensor-related circuitry can further reduce crosstalk between these wires. As described above with respect to FIG. 16, the cable 1822 can further include an outer shielding layer that surrounds the shielded cable portion 1860 and the wires 1870 (or shielded wires 1870).
FIG. 18 illustrates an embodiment of the sensor assembly 1501 of FIG. 15 applied to a patient. The sensor assembly 1501 includes a sensor subassembly 1502 that can be applied to the patient's neck to detect upper airway acoustic vibrations on the surface of the skin during the respiratory cycle. In one embodiment, the sensor subassembly includes an adhesive layer and an integrated acoustic transducer, and is configured to generate a respiratory signal in response to vibrations detected from the patient's breathing. The sensor assembly can also include an anchor 1503, an attachment subassembly 1504 having first and second elongate portions 1506, 1508, and a sensor cable having a first portion 1805 from the sensor subassembly 1502 to the anchor, and a second portion 1810 from the anchor to an acoustic respiratory monitor (not shown). Using acoustic signal processing, the respiratory signal is separated and processed with the acoustic respiratory monitor to display continuous respiration rate. An example of such acoustic signal processing is disclosed in U.S. Pat. Pub. No. 2007/0282212, filed on Jun. 19, 2007 and titled Non-Invasive Monitoring Of Respiratory Rate, Heart And Apnea, which is incorporated by reference herein in its entirety.
One or more elongate members (not shown) included in the first and/or second elongate portions 1506, 1508 of the sensor assembly 1501 can beneficially bias the sensor assembly in tension against the patient's skin and reduce stress on the connection between the patient adhesive and the skin. The elongate member can be Y-shaped, having a single, elongate member 1507 on the first elongate portion 1506 and a dual, branching elongate member 1509 on the second elongate portion 1508 or vice versa.
In one embodiment, a sensor cable (e.g., cable 1805) is positioned between the branches of the branching elongate member 1509 of the Y-shaped elongate member. The sensor cable can be oriented such that the cable comes out of the sensor assembly towards the back of the patient's head, keeping the cable away from the patient's face.
The anchor 1503 can be attached in the same general vicinity as the sensor subassembly 1502 to secure the first portion of the cable 1805 against the patient. The anchor can maintain a constant tension and/or slack on the first portion of the cable 1805, thereby minimizing movement of the first portion 1805 with respect to the sensor subassembly 1502. Furthermore, the anchor can dampen movement from the second portion of the cable 1810, thereby minimizing movement of the first portion 1805. Minimizing movement of the first portion of the cable allows the sensor assembly to remain largely unnoticeable and more comfortable to the patient. By providing greater patient comfort and making the sensor “patient-friendly”, patient compliance with the monitoring can be increased. In addition, minimizing movement of the cable with respect to the sensor reduces unwanted motion induced noise from being detected by the sensor.
The sensor assembly 1501 provides a signal useful to noninvasively and continuously determines the patient's respiration rate. In one embodiment, respiration rate is the number of breaths per minute (although any breathing rate may be used) and can provide a critical vital sign in assessing the physiological status of hospitalized patients. The sensor assembly can enable earlier detection of respiratory compromise and patient distress, such as, for example, respiratory compromise and distress occurring in post-surgical patients on the general floor of a hospital. Continuous monitoring of respiration rate can be especially important for post-surgical patients receiving patient-controlled analgesia (PCA) for pain management, as sedation can induce respiratory depression and place patients at considerable risk of serious injury or death.
In one embodiment, the sensor assembly 1501 provides clinicians with the ability to automatically and continuously monitor the breathing status of post-surgical patients in general care or post-anesthesia settings, alerting them to the first sign of an abnormal or compromised breathing pattern that can be indicative of airway obstruction or respiratory distress. Visual and/or audible alarms can be activated and/or a notification can be sent to the clinician if an anomaly is detected. Monitoring of patient breathing can improve patient safety and decrease the cost of care in hospitals.
In some embodiments, the sensor assembly 1501 can be used in conjunction with one or more of a pulse oximeter monitor, a remote monitoring and clinician notification system, as well as monitoring technology for other physiological parameters. By monitoring multiple, related physiological parameters (e.g. with a single monitor), for example: 1) blood oxygenation with SpO2, 2) ventilation with an acoustic respiratory member that determines continuous respiration rate as described above, 3) circulation as measured through a pulse oximeter sensor, such as a pulse oximeter sensor capable of reading through motion induced noise, and/or 4) bleeding (e.g. with a noninvasive and continuous hemoglobin monitor), clinicians are able to monitor patients more safely and with more comprehensive detail. In one embodiment, sensors designed to measure such parameters can connect to a cable hub (not shown) attached to a multi-parameter monitor. In one embodiment, the cable hub includes a first port for the acoustic based sensor on one channel and a second port for an optical based sensor (e.g. sensor assembly 150 of FIG. 1) on another channel. Such multi-parameter monitoring can lead to earlier detection of adverse events and increased life-saving intervention.
Advanced physiological monitoring systems that utilize multiple wavelength sensors and multiple parameter monitors that provide enhanced measurement capabilities can be used with the acoustic respiratory monitor and sensor assembly 1501 disclosed above. Such systems monitor various physiological parameters, including, for example, the measurement of carboxyhemoglobin (HbCO), methemoglobin (HbMet) and total hemoglobin (SpHbTM, Hbt or tHb). Physiological monitors and corresponding multiple wavelength optical sensors are described in at least U.S. Pat. Pub. No. 2006/0211924, filed Mar. 1, 2006 and titled Multiple Wavelength Sensor Emitters and U.S. Pat. Pub. No. 2006/0220881, filed Mar. 1, 2006 and titled Noninvasive Multi-Parameter Patient Monitor, both incorporated by reference herein in their entirety.
Some references that have common shorthand designations are referenced through such shorthand designations. For example, as used herein, HbCO designates carboxyhemoglobin, HbMet designates Methemoglobin and SpHbTM designates total hemoglobin. Other shorthand designations such as COHb, MetHb, and tHb or Hbt are also common in the art for these same constituents. These constituents are generally reported in terms of a percentage, often referred to as saturation, relative concentration or fractional saturation. Total hemoglobin is generally reported as a concentration in g/dL, g/L or millimoles (mMol).
FIG. 19 illustrates an embodiment of a patient monitoring system that can implement any of the systems described herein and which can be integrated with an acoustic respiratory monitor, including any of the physiological monitors and sensors disclosed above with respect to FIGS. 1-17. FIG. 19 illustrates a block diagram of an exemplary embodiment of a patient monitoring system 1900. As shown in FIG. 19, the system 1900 includes a patient monitor 1902 including a processing board 1904 and a host instrument 1908. The processing board 1904 communicates with a sensor 1906 to receive one or more intensity signal(s) indicative of one or more parameters of tissue of a patient. The processing board 1904 also communicates with a host instrument 1908 to display determined values calculated using the one or more intensity signals. According to an embodiment, the board 1904 comprises processing circuitry arranged on one or more printed circuit boards capable of installation into the monitor 1902, or capable of being distributed as some or all of one or more OEM components for a wide variety of host instruments monitoring a wide variety of patient information. In an embodiment, the processing board 1902 comprises a sensor interface 1910, a digital signal processor and signal extractor (“DSP” or “processor”) 1912, and an instrument manager 1914. In general, the sensor interface 1910 converts digital control signals into analog drive signals capable of driving sensor emitters, and converts composite analog intensity signal(s) from light sensitive detectors into digital data.
In an embodiment, the sensor interface 1910 manages communication with external computing devices. For example, in an embodiment, a multipurpose sensor port (or input/output port) is capable of connecting to the sensor 1906 or alternatively connecting to a computing device, such as a personal computer, a PDA, additional monitoring equipment or networks, or the like. When connected to the computing device, the processing board 1904 can upload various stored data for, for example, off-line analysis and diagnosis. The stored data can comprise trend data for any one or more of the measured parameter data, plethysmograph waveform data acoustic sound waveform, or the like. Moreover, the processing board 1904 can advantageously download from the computing device various upgrades or executable programs, can perform diagnosis on the hardware or software of the monitor 1902. In addition, the processing board 1904 can advantageously be used to view and examine patient data, including raw data, at or away from a monitoring site, through data uploads/downloads, or network connections, combinations, or the like, such as for customer support purposes including software maintenance, customer technical support, and the like. Upgradable sensor ports are disclosed in copending U.S. application Ser. No. 10/898,680, filed on Jul. 23, 2004, titled “Multipurpose Sensor Port,” incorporated by reference herein.
As shown in FIG. 19, the digital data is output to the DSP 1912. According to an embodiment, the DSP 1912 comprises a processing device based on the Super Harvard ARChitecture (“SHARC”), such as those commercially available from Analog Devices. However, the DSP 1912 can also comprise a wide variety of data and/or signal processors capable of executing programs for determining physiological parameters from input data. In particular, the DSP 1912 can include program instructions capable of receiving multiple channels of data related to one or more intensity signals representative of the absorption (from transmissive or reflective sensor systems) of a plurality of wavelengths of emitted light by body tissue. In an embodiment, the DSP 1912 accepts data related to the absorption of eight (8) wavelengths of light, although the data can be related to the absorption of two (2) to sixteen (16) or more wavelengths.
The DSP 1912 can also communicate with an SpHb control process 1919, which can include firmware stored in a memory device (not shown). The SpHb control process 1919 can run on the DSP 1912 or a separate DSP. The SpHb control process 1919 can receive SpHb values 1921 and generate a control signal 1922 that is communicated directly or indirectly to a device interface 1930. The device interface 1930 can be part of the host instrument 1908 and can interface with a blood infuser, dialysis machine, or the like. The device interface 1930 can provide a corresponding control signal 1932 to a blood infuser to control an amount of blood infused into a patient or to a dialysis machine to control dialysis treatment.
FIG. 19 also shows the processing board 1904 including the instrument manager 1914. According to an embodiment, the instrument manager 1914 can comprise one or more microcontrollers controlling system management, including, for example, communications of calculated parameter data and the like to the host instrument 1908. The instrument manager 1914 can also act as a watchdog circuit by, for example, monitoring the activity of the DSP 1912 and resetting it when appropriate.
The sensor 1906 can include a reusable clip-type sensor, a disposable adhesive-type sensor, a combination sensor having reusable and disposable components, or the like. Moreover, the sensor 1906 can also comprise mechanical structures, adhesive or other tape structures, VelcroTM wraps or combination structures specialized for the type of patient, type of monitoring, type of monitor, or the like. In an embodiment, the sensor 1906 provides data to the board 1904 and vice versa through, for example, a patient cable. Such communication can be wireless, over public or private networks or computing systems or devices, or the like.
As shown in FIG. 19, the sensor 1906 includes a plurality of emitters 1916 irradiating the body tissue 1918 with differing wavelengths of light, and one or more detectors 1920 capable of detecting the light after attenuation by the tissue 1918. In an embodiment, the emitters 1916 include a matrix of eight (8) emission devices mounted on a flexible substrate, the emission devices capable of emitting eight (8) differing wavelengths of light. In other embodiments, the emitters 1916 can include twelve (12) or sixteen (16) emitters, although other numbers of emitters are contemplated, including two (2) or more emitters. As shown in FIG. 19, the sensor 1906 can include other electrical components such as, for example, an information element 1923 that can be a memory device comprising an EPROM, EEPROM, ROM, RAM, microcontroller, combinations of the same, or the like. In an embodiment, other sensor components can include a temperature determination device (not shown) or other mechanisms for, for example, determining real-time emission wavelengths of the emitters 1916.
The information element 1923 in certain embodiments advantageously stores some or all of a wide variety data and information, including, for example, information on the type or operation of the sensor 1906, type or identification of sensor buyer or distributor or groups of buyer or distributors, sensor manufacturer information, sensor characteristics including the number of emitting devices, the number of emission wavelengths, data relating to emission centroids, data relating to a change in emission characteristics based on varying temperature, history of the sensor temperature, current, or voltage, emitter specifications, emitter drive requirements, demodulation data, calculation mode data, the parameters for which the sensor is capable of supplying sufficient measurement data (e.g., HbCO, HbMet, SpHb, or the like), calibration or parameter coefficient data, software such as scripts, executable code, or the like, sensor electronic elements, whether the sensor is a disposable, reusable, multi-site, partially reusable, partially disposable sensor, whether it is an adhesive or non-adhesive sensor, whether the sensor is a reflectance, transmittance, or transreflectance sensor, whether the sensor is a finger, hand, foot, forehead, or ear sensor, whether the sensor is a stereo sensor or a two-headed sensor, sensor life data indicating whether some or all sensor components have expired and should be replaced, encryption information, keys, indexes to keys or hash functions, or the like, monitor or algorithm upgrade instructions or data, some or all of parameter equations, information about the patient, age, gender, medications, comorbidity, and other information that may be useful for the accuracy or alarm settings and sensitivities, trend history, alarm history, or the like. In certain embodiments, the monitor can advantageously store data on the memory device, including, for example, measured trending data for any number of parameters for any number of patients, or the like, sensor use or expiration calculations, sensor history, or the like.
FIG. 19 also shows the patient monitor 1902 including the host instrument 1908. In an embodiment, the host instrument 1908 communicates with the board 1904 to receive signals indicative of the physiological parameter information calculated by the DSP 1912. The host instrument 1908 preferably includes one or more display devices 1926 capable of displaying indicia representative of the calculated physiological parameters of the tissue 1918 at the measurement site. In an embodiment, the host instrument 1908 can advantageously comprise a handheld housing capable of displaying SpHb and one or more other parameters such as pulse rate, plethysmograph data, perfusion quality such as a perfusion quality index (“PITM”), signal or measurement quality (“SQ”), values of blood constituents in body tissue, including for example, SpO2, HbCO, HbMet, or the like. In other embodiments, the host instrument 1908 is capable of displaying values for one or more of blood glucose, bilirubin, or the like. The host instrument 1908 can be capable of storing or displaying historical or trending data related to one or more of the measured values, combinations of the measured values, plethysmograph data, or the like. The host instrument 1908 also includes an audio indicator 1927 and user input device 1928, such as, for example, a keypad, touch screen, pointing device, voice recognition device, or the like.
In still additional embodiments, the host instrument 1908 includes audio or visual alarms that alert caregivers that one or more physiological parameters are falling below predetermined safe thresholds. The host instrument 1908 can include indications of the confidence a caregiver should have in the displayed data. In a further embodiment, the host instrument 1908 can advantageously include circuitry capable of determining the expiration or overuse of components of the sensor 1906, including, for example, reusable elements, disposable elements, or combinations of the same.
Although the present disclosure discusses a non-invasive continuous measurement of total hemoglobin, the present disclosure is equally applicable to invasive and non-continuous measurements of total hemoglobin.
Moreover, in an embodiment, a physiological measurement system provides a correction between total hemoglobin measurements taken from venous blood and from arterial blood. Venous blood can have a different total hemoglobin level than arterial blood. Often, venous blood has a higher total hemoglobin then arterial blood does. The difference in total hemoglobin between venous and arterial blood can be between about 0.1 and 2.5 g/dl and higher. The difference can change based on the patient and the patient's current condition. The difference can also change over time for the same patient. In an embodiment, a system for measuring total hemoglobin is provided with an adjustment factor based on the whether the system is measuring total hemoglobin from venous blood or arterial blood. In the situation where a measurement device, such as, for example, a pulse oximeter, is used to measure total hemoglobin and measures both a venous component and an arterial component, a correction factor can be applied to the outputted or displayed total hemoglobin levels to account for the difference between in total hemoglobin between venous blood and arterial blood.
In an embodiment, the difference between total hemoglobin measurements between venous and arterial blood is used to provide a more accurate measurement of total hemoglobin. In an embodiment, noninvasive measurements of total hemoglobin are generated based on a model of the patient's tissue. For example, in pulse oximetry, ratios of attenuated light of different wavelengths are used to cancel out constant tissue attenuation factors such as skin and bone. However, both venous and arterial blood affect measurements of total hemoglobin. Using the knowledge that venous and arterial blood may have different total hemoglobin levels can be used in the model to provide for a more accurate measurement of total hemoglobin. For example, if arterial total hemoglobin measurements are desired, the actual measured total hemoglobin amount can be adjusted down to account for the differences in total hemoglobin levels.
In an embodiment, a correction factor option is provided on a device that measures total hemoglobin. The correction factor can be provided to both a noninvasive or invasive total hemoglobin monitor as well as a continuous or non-continuous total hemoglobin monitor. In an embodiment, the correction factor is determined by taking a measurement of total hemoglobin in a vein and a measurement of total hemoglobin in an artery. In an embodiment, the correction factor can be based on empirically obtained data from a large sample of patients to provide a predicted correction factor. In an embodiment, the correction factor option is provided in either software or hardware or both. The correction factor option can be a switch or button on the device to indicate whether a measurement of venous or arterial blood or both is being measured. Similarly, the correction factor can be a software function which provides a similar option to the caregiver.
In an embodiment, a measurement of total hemoglobin for both arterial and venous blood is measured. The measurement can be a graph, trend or instantaneous measurement. In an embodiment, the measurements are compared and a trend illustrating the difference in total hemoglobin for arterial and venous blood can be determined. The comparison measurement can be used to determine a condition of the patient. For example, if the comparison shows a increasing or decreasing divergence in total hemoglobin, the monitor can provide an alarm to a caregiver to alert the caregiver to a condition of the patient.
In an embodiment, the hemoglobin measurement can be calibrated by taking invasive measurements and inputting invasive measurement determinations into the device to adjust the non-invasive measurement.
Although described in terms of certain embodiments, other embodiments can also be provided. For example, the monitor 1902 can include one or more monitoring systems monitoring parameters, such as, for example, vital signs, blood pressure, ECG or EKG, respiration, glucose, bilirubin, or the like. Such systems can combine other information with intensity-derived information to influence diagnosis or device operation. Moreover, the monitor 1902 can advantageously include an audio system, preferably comprising a high quality audio processor and high quality speakers to provide for voiced alarms, messaging, or the like. In an embodiment, the monitor 1902 can advantageously include an audio out jack, conventional audio jacks, headphone jacks, or the like, such that any of the display information disclosed herein may be audiblized for a listener. For example, the monitor 1902 can include an audible transducer input (such as a microphone, piezoelectric sensor, or the like) for collecting one or more of heart sounds, lung sounds, trachea sounds, or other body sounds and such sounds may be reproduced through the audio system and output from the monitor 1902. Also, wired or wireless communications (such as Bluetooth or WiFi, including IEEE 801.11a, b, g, n, or the like), mobile communications, combinations of the same, or the like, may be used to transmit the audio output to other audio transducers separate from the monitor 1902.
For example, patterns or changes in the continuous noninvasive monitoring of intensity-derived information can cause the activation of other vital sign measurement devices, such as, for example, blood pressure cuffs.
Those of skill in the art will understand that information and signals can be represented using any of a variety of different technologies and techniques. For example, data, instructions, commands, information, signals, bits, symbols, and chips that can be referenced throughout the above description can be represented by voltages, currents, electromagnetic waves, magnetic fields or particles, optical fields or particles, or any combination thereof.
Conditional language used herein, such as, among others, “can,” “could,” “might,” “may,” “e.g.,” and the like, unless specifically stated otherwise, or otherwise understood within the context as used, is generally intended to convey that certain embodiments include, while other embodiments do not include, certain features, elements and/or states. Thus, such conditional language is not generally intended to imply that features, elements and/or states are in any way required for one or more embodiments or that one or more embodiments necessarily include logic for deciding, with or without author input or prompting, whether these features, elements and/or states are included or are to be performed in any particular embodiment.
Depending on the embodiment, certain acts, events, or functions of any of the methods described herein can be performed in a different sequence, can be added, merged, or left out all together (e.g., not all described acts or events are necessary for the practice of the method). Moreover, in certain embodiments, acts or events can be performed concurrently, e.g., through multi-threaded processing, interrupt processing, or multiple processors or processor cores, rather than sequentially.
Those of skill will further appreciate that the various illustrative logical blocks, modules, circuits, and algorithm steps described in connection with the embodiments disclosed herein may be implemented as electronic hardware, computer software, or combinations of both. To clearly illustrate this interchangeability of hardware and software, various illustrative components, blocks, modules, circuits, and steps have been described above generally in terms of their functionality. Whether such functionality is implemented as hardware or software depends upon the particular application and design constraints imposed on the overall system. Skilled artisans can implement the described functionality in varying ways for each particular application, but such implementation decisions should not be interpreted as causing a departure from the scope of this disclosure.
The various illustrative logical blocks, modules, and circuits described in connection with the embodiments disclosed herein can be implemented or performed with a machine, such as a general purpose processor, a digital signal processor (DSP), an application specific integrated circuit (ASIC), a field programmable gate array (FPGA) or other programmable logic device, discrete gate or transistor logic, discrete hardware components, or any combination thereof designed to perform the functions described herein. A general purpose processor can be a microprocessor, processor, controller, microcontroller, state machine, etc. A processor can also be implemented as a combination of computing devices, e.g., a combination of a DSP and a microprocessor, a plurality of microprocessors, one or more microprocessors in conjunction with a DSP core, or any other such configuration. In addition, the term “processing” is a broad term meant to encompass several meanings including, for example, implementing program code, executing instructions, manipulating signals, filtering, performing arithmetic operations, and the like.
The steps of a method or algorithm described in connection with the embodiments disclosed herein can be embodied directly in hardware, in a software module executed by a processor, or in a combination of the two. A software module can reside in RAM memory, flash memory, ROM memory, EPROM memory, EEPROM memory, registers, hard disk, a removable disk, a CD-ROM, a DVD, or any other form of storage medium known in the art. A computer-readable storage medium is coupled to the processor such that the processor can read information from, and write information to, the storage medium. In the alternative, the storage medium may be integral to the processor. The processor and the storage medium can reside in an ASIC. The ASIC can reside in a user terminal. In the alternative, the processor and the storage medium can reside as discrete components in a user terminal.
The modules can include, but are not limited to, any of the following: software or hardware components such as software object-oriented software components, class components and task components, processes, methods, functions, attributes, procedures, subroutines, segments of program code, drivers, firmware, microcode, circuitry, data, databases, data structures, tables, arrays, and/or variables.
In addition, although certain inventions have been disclosed in the context of certain embodiments, it will be understood by those skilled in the art that the inventions disclosed herein extend beyond the specifically disclosed embodiments to other alternative embodiments and/or uses of the inventions and obvious modifications and equivalents thereof. In particular, while the system and methods have been described in the context of certain embodiments, the skilled artisan will appreciate, in view of the present disclosure, that certain advantages, features and aspects of the acoustic signal processing system, device, and method may be realized in a variety of other applications and software systems. Additionally, it is contemplated that various aspects and features of the inventions disclosed herein can be practiced separately, combined together, or substituted for one another, and that a variety of combination and subcombinations of the features and aspects can be made and still fall within the scope of the inventions disclosed herein. Furthermore, the systems described above need not include all of the modules and functions described in certain embodiments. Thus, it is intended that the scope of the inventions disclosed herein disclosed should not be limited by the particular disclosed embodiments described above, but should be determined only by the claims that follow.

## Claims

1. A cable assembly configured to couple an optical sensor cable and an acoustic sensor cable with a physiological monitor having a port for a single cable rather than both the optical sensor cable and the acoustic sensor cable, the cable assembly comprising:
a hub assembly comprising:
a cable comprising a plurality of conductors;
a monitor connector at one end of the cable, the monitor connector configured to connect to a physiological monitor to receive power from the physiological monitor and to supply signals from physiological sensors to the physiological monitor;
a first sensor connector configured to couple with an optical sensor cable and to receive first physiological signals from the optical sensor cable when the optical sensor cable is coupled with the first sensor connector and attached to a patient, the first physiological signals representing received light attenuated by tissue of the patient; and
a second sensor connector configured to couple with an acoustic sensor cable and to receive second physiological signals from the acoustic sensor cable when the acoustic sensor cable is coupled with the second sensor connector and attached to the patient, the second physiological signals representing acoustic biological sounds of the patient;
first signal conditioning circuitry disposed in electrical communication with the first sensor connector, the first signal conditioning circuitry configured to receive the first physiological signals from the optical sensor cable and to prepare the first physiological signals for transmission to the physiological monitor through the monitor connector;
second signal conditioning circuitry disposed in electrical communication with the second sensor connector, the second signal conditioning circuitry configured to receive the second physiological signals from the acoustic sensor cable and to prepare the second physiological signals for transmission to the physiological monitor through the monitor connector; and
first local shielding disposed about the first signal conditioning circuitry, the first local shielding comprising an at least partially metal enclosure configured to at least partially enclose the first signal conditioning circuitry without enclosing the second signal conditioning circuitry, the first signal conditioning circuitry configured to attenuate noise emitted by the first signal conditioning circuitry and received by the second signal conditioning circuitry so as to facilitate increased accuracy of an acoustic parameter calculation based on the second physiological signals.

2. The cable assembly of claim 1, further comprising decoupling circuitry configured to electrically decouple the first and second signal conditioning circuitries.

3. The cable assembly of claim 2, wherein the first local shielding is connected to a first ground connection of the first signal conditioning circuitry but not to a second ground connection of the second signal conditioning circuitry.

4. The cable assembly of claim 2, wherein the decoupling circuitry comprises a transformer and an optocoupler.

5. The cable assembly of claim 1, further comprising second local shielding disposed about the second signal conditioning circuitry.

6. The cable assembly of claim 1, wherein the shield is connected to a common potential of the first signal conditioning circuitry.

7. The cable assembly of claim 1, wherein the first local shielding is configured to reduce crosstalk noise between the first and second signal conditioning circuitries.

8. The cable assembly of claim 1, wherein the first local shielding is configured to reduce noise received by the second signal conditioning circuitry.

9. The cable assembly of claim 1, further comprising a first shielded cable portion connected to the first signal conditioning circuitry, the first shielded cable portion at least partially surrounding first wires of the first signal conditioning circuitry.

10. The cable assembly of claim 9, further comprising a second shielded cable portion connected to the second signal conditioning circuitry, the second shielded cable portion at least partially surrounding second wires of the second signal conditioning circuitry.

11. The cable assembly of claim 10, wherein the first and second shielding cable portions are part of the cable configured to be connected to a physiological monitor.

12. The cable assembly of claim 10, wherein the second shielded cable portion surrounds at least a portion of a cable connecting the second signal conditioning circuitry to the monitor connector.

13. The cable assembly of claim 9, wherein the first shielded cable portion surrounds at least a portion of a cable connecting the first signal conditioning circuitry to the monitor connector.