Computer-Aided Diagnosis for Endotracheal Intubation Confirmation using Video-image Classification

Dror Lederman

2017

Abstract

In this paper, a Computer-Aided Diagnosis (CAD) system for endotracheal tube position confirmation, and detection of errors in intubation positioning is presented. Endotracheal intubation is a complex procedure which requires high skills and the use of secondary confirmation devices to ensure correct positioning of the tube. Our novel confirmation approach is based on video images classification and specifically on identification of specific anatomical landmarks, including esophagus, upper trachea and main bifurcation of the trachea into the two primary bronchi (“carina”), as indicators of correct or incorrect tube insertion and positioning. Classification of the images is performed using a neural network classifier. The performance of the proposed approach was evaluated using a dataset of cow-intubation videos and a dataset of human-intubation videos. Each one of the video images was manually (visually) classified by a medical expert into one of three categories: upper tracheal intubation, correct (carina) intubation and esophageal intubation. The image classification algorithm was applied off-line using a leave-one-case-out method. The results show that the system correctly classified 1567 out of 1600 (97.9%) of the cow intubations images, and 349 out of the 358 human intubations images (97.5%).

References

  1. Bhende, S. M., and Thompson, A. E., 1995. Evaluation of an end-tidal CO2 detector during pediatric cardiopulmonary resuscitation. Pediat., 95(3), 395-399.
  2. Brunel, W., Coleman, D. L., and Schwartz, D. E., 1989. Assessment of routine chest reoentgenograms and the physical examination to confirm endotracheal tube position. Chest, 96, 1043-1045.
  3. Gravenstein, J. S., Jaffe, M. B., and Paulus, D. A., 2004. Capnograhpy clinical aspects: Cambridge University Press.
  4. Haralick, R. M., Shanmugam, M., and Dinstein, I., 1973. Textural features for image classification. IEEE Trans. on Systems, Man, and Cybernatics, SMC-3(6), 610-621.
  5. Howells, T. H., 1985. Oesophageal misplacement of a tracheal tube. Anaesthesia, 40, 398-389.
  6. Jacobs, L. M., Berrizbeitia, L. D., Bernnett, B., and Madigan, C., 1983. Endotracheal intubation in the prehospital phase of emergency medical care. JAMA, 250(2175-2177).
  7. Jemmet, M. E., Kendal, K. M., and Fourre, M. W., 2003. Unrecognized misplacement of endotracheal tubes in a mixed urban to rural emergency medical services setting. Acad. Emerg. Med., 10, 961-965.
  8. Jones, J. H., Murphy, M. P., and Dickson, R. L., 2004. Emergency physician-verified out-of-hospital intubation: miss rates by paramedics. Acad. Emerg. Med., 11, 707-709.
  9. Katz, S. H., and Falk, J. L., 2001. Misplaced endotracheal tubes by paramedics in an urban emergency medical services system. Ann. Emerg. Med., 37, 32-37.
  10. Klepper, I. D., Webb, R. K., Walt, J. V. D., Ludbrooks, G. L., and Cockings, J., 1993. The sthethoscope: Application and limintation- an analysis of 2000 incidents reports. Anaesth. Intens. Care, 21(5), 575-578.
  11. Lederman, D., 2006. An energy ratio test for one lung intubation detection. Paper presented at the 18th Biennial International EURASIP conference, Brno, Czech Republic.
  12. Lederman, D., 2011. Endotracheal intubation confirmation based on video image classification using a parallel GMMs framework- a preliminary evaluation. Annals of Biomed. Eng., 39(1), 508-513.
  13. Li, J., 2001. Capnography alone is imperfect for endotracheal tube placement confirmation during emergency intubation. J. Emerg. Med., 20(3), 223-229.
  14. Linko, K., Paloheimo, M., and Tammisto, T., 1983. Capnograhphy for detection of accidental oesophageal intubation. Acta Anaesthesiol. Scand., 27, 199-202.
  15. Nolan, J. P., Deakin, C. D., and Soar, J., 2005. European resuscitation council guidelines for resuscitation. Resuscitation, 67(1), S39-S86.
  16. O'connor, C. J., Mansy, H., Balk, R. A., Tuman, K. J., and Sandler, R. H., 2005. Identification of endotracheal tube malpopsitions using computerized analysis of breath sounds via electronic stethoscopes. Anesth. Analg., 101(3), 735-739.
  17. Owen, R. L., and Cheney, F. W., 1987. Endobronchial Intubation: a Preventable Complication. Anesthesiology, 67, 255-257.
  18. Peterson, A. W., and Jacker, L. M., 1973. Death following inadvertent esophageal intubation: a case report. Anesth. Analg., 52, 398-401.
  19. Pointer, J. E., 1988. Clinical characteristics of paramedics' performance of endotracheal intubation. J. Emerg. Med., 6(505-509).
  20. Silvestri, S., Ralls, G. A., and Krauss, B., 2005. The effectiveness of out-of-hospital use of continuous endtidal carbon dioxide monitoring on the rate of unrecognized misplaced intubation within a regional emergency medical services system. Ann. Emerg. Med., 45, 497-503.
  21. Steward, R. D., Paris, P. M., and Winter, P. M., 1984. Field endotracheal intubation by paramedical personnel: success rates and complications. Chest, 85(341-345).
  22. Tejman-Yarden, S., Lederman, D., Weksler, N., and Gurman, G., 2006. Acoustic monitoring of double lumen ventilated lungs for the detection of selective unilateral lung ventilation. Anesth. Analg., 103, 1489- 1492.
  23. Tejman-Yarden, S., Zlotnik, A., Weizman, L., Tabrikian, J., Cohen, A., Weksler, N., and Gurman, G. M., 2007. Acoustic monitoring of lung sounds for the detection of one-lung intubation. Anesth. Analg., 105(2), 397-404.
  24. Timmermann, A., Russo, S. G., Eich, C., Roessler, M., Braun, U., Rosenblatt, W. H., and Quintel, M., 2007. The out-of-hospital esophageal and endobronchial intubations performed by emergency physicians. Crit. Care and Trauma, 104(3), 619-623.
  25. Vergese, S. T., Hannallah, R. S., Slack, M. C., Cross, R. R., and Patel, K. M., 2004. Auscultation of bilateral breath sounds does not rule out endobronchial intubation in children. Anesth. Analg., 56-58.
  26. Wang, H. E., Cook, L. J., Chang, C. H., Yealy, D. M., and Lave, J. R., 2009. Outcomes after out-of-hospital endotracheal intubation errors. Resuscitation, 80(1), 50-55.
  27. Wang, H. E., Lave, J. R., Sirion, C. A., and Yealy, M., 2006. Paramedic intubation errors: isolated events or symptoms of larger problems? Health Affairs, 25(2), 501-509.
  28. Webb, R. K., Walt, J. H. V. D., Runciman, W. B., Williamson, J. A., Cockings, J., Russel, W. J., and Helps, S., 1993. Which monitor? an analysis of 2000 indicent reports. Anaesth. Intens. Care, 21(5), 529-542.
  29. Weizman, L., Tabrikian, J., and Cohen, A., 2008. Detection of one-lung intubation incidents. Annals of Biomed. Eng., 36(11), 1844-1855.
  30. Wodicka, G. R., DeFrain, P. D., and Kraman, S. S., 1994. Bilateral asymmetry of respiratory acoustic transmission. Med. Biol. Eng. Comp., 32(5), 489-494.
  31. Yap, S. J., Morris, R. W., and Pybus, D. A., 1994. Alterations in endotracheal tube position during general Anesthesia. Anaesth. Crit. Care, 586-588.
  32. Zwillich, C. W., Pierson, D. J., and Creagh, C. E., 1974. Complications of assisted ventilation, a prospective study of 354 consecutive episodes. Am. J. Med., 57, 161-170.
Download


Paper Citation


in Harvard Style

Lederman D. (2017). Computer-Aided Diagnosis for Endotracheal Intubation Confirmation using Video-image Classification . In Proceedings of the 6th International Conference on Pattern Recognition Applications and Methods - Volume 1: ICPRAM, ISBN 978-989-758-222-6, pages 534-540. DOI: 10.5220/0006200505340540


in Bibtex Style

@conference{icpram17,
author={Dror Lederman},
title={Computer-Aided Diagnosis for Endotracheal Intubation Confirmation using Video-image Classification},
booktitle={Proceedings of the 6th International Conference on Pattern Recognition Applications and Methods - Volume 1: ICPRAM,},
year={2017},
pages={534-540},
publisher={SciTePress},
organization={INSTICC},
doi={10.5220/0006200505340540},
isbn={978-989-758-222-6},
}


in EndNote Style

TY - CONF
JO - Proceedings of the 6th International Conference on Pattern Recognition Applications and Methods - Volume 1: ICPRAM,
TI - Computer-Aided Diagnosis for Endotracheal Intubation Confirmation using Video-image Classification
SN - 978-989-758-222-6
AU - Lederman D.
PY - 2017
SP - 534
EP - 540
DO - 10.5220/0006200505340540