Alarm Detection Methods for Physiological Variables

Sandra Ramos, Isabel Silva 1,

M. Eduarda Silva, Teresa Mendonça

Departamento de Matemática Aplicada,

Faculdade de Ciências da Universidade do Porto

1
Departamento de Engenharia Civil,
Faculdade de Engenharia da Universidade do Porto

This research is part of the Ph.D. work of Isabel Silva, financially supported by PRODEP III
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 Summary

Motivation

Purpose

Designing an adaptive reference trajectory

Alarm system for neuromuscular blockade

Walsh-Fourier spectral analysis

Simulations results

Final remarks

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 Motivation

Design of automatic control systems for neuromuscular blockade

Nonlinear dynamical relationship between the muscle relaxant dose and the
induced muscle paralysis

Large variability of the individual responses to the infusion of muscle relaxant

120

100

Individual tuning of
80
the controller
r(t) %

60
according to the
40
characteristics of the
20
patient
0
0 1 2 3 4 5 6 7 8 9 10
time (minutes)

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 Motivation

induce total muscle relaxation in a very short period of time ( < 5’)
Initial bolus
control action starts 10’ after bolus administration

Reference profile

variability of the expected noise clinical

response level requirements

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 Motivation

r (t ) : level of muscle relaxation, normalized between 0 (full paralysis) and 100 (full
muscular activity)

100
Longer effect of
the initial bolus
% r(t)
50
end of infusion

initial overshoot
and oscillatory
behaviour 0
0 50 100 150
t (minutes)

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 Motivation

The reference profile should be time dependent on the effect of the initial bolus

Persistence parameter: P

Instant at which begins

the patient recovery

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 Purpose

Propose and evaluate an adaptive controller incorporating

a varying beginning for automatic control action

an individual reference profile

Alarm system for the control of the neuromuscular blockade

Forecasting techniques

Walsh-Fourier spectral analysis (WFA)

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 Alarm systems for neuromuscular blockade

Predict the neuromuscular blockade upcrossing of a specified critical level, α %

Estimate of the recovery time, P, at an critical neuromuscular blockade level, . Pα

100

80
r^ (t+5) %

60

40

20

α%

0
0 30 60
P
α t (minutes)
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 Alarm systems for neuromuscular blockade

Linear prediction of the neuromuscular blockade response, r ( t )

r̂ (t + m ) = E [r (t + m ) | r (s ) , u (s ) ; s ≤ t ]

r ( t ) is modelled using an ARX ( 4, 4 )

r (t ) = a1r (t − 1) + L + a4 r (t − 4 ) + b0u (t − 1) + L + b3u (t − 4 )

On-line identification of the ARX model parameters Kalman Filter

r̂ (t + 5 ) > α → " alarm" P̂α = t + 5

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 Alarm systems for neuromuscular blockade

100

80

60
r(tt) %

40
r(t)
20
^r(t+5)

0
0 20 40 60 t (minutes)

It is found that the estimated persistence parameter is close to the

observed persistence for all critical value considered

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 Walsh-Fourier Spectral Analysis

Walsh Function: complete, ordered and orthonormed set of rectangular

waves taking the values -1 and 1.

Sequential or Walsh order

W (n , t ), t ∈ [0,1 [, n = 0,1, 2,K
 t : time
 n : sequency (number of switches signs)

Walsh periodogram: x0, x1, ..., xN-1 observations

2
 1 N −1 
( )
IW λ j = ∑ ( )
x (n ) W n , λ j 
 N n =0 
where λ j= j / N, 0 < j < N, is the sequency.
( )

One can plot IW λ j versus λ j to inspect the peaks, that indicate a switch
each λ j time points. The average periods are defined by 1 / λ j
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 Walsh-Fourier Spectral Analysis

Relaxation level at the WFA average periods

High predictive power for the parameters of the controller

Robustness of the parameters prediction in the presence of noise

Pα is highly correlated with r (14.0)

P̂α : Linear regression using as predictors the relaxation levels of WFA average periods

Without noise With noise

P 2.5 P5 P10 P 2.5 P5 P10
r(14.0) 0.87 0.75 0.63 0.72 0.67 0.53
r(28.0) 0.85 0.88 0.87 0.76 0.84 0.84
r(1.6)+r(3.0)+r(7.0)+r(12.0)+r(14.0) 0.89 0.83 0.77 0.77 0.72 0.60
r(1.6)+r(3.0)+r(7.0)+r(12.0)+r(14.0)+r(28.0) 0.92 0.91 0.89 0.83 0.86 0.84
Correlation coefficient

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 Choosing P

Comparision of ARX and WFA predictors of Pα by calculating eα = Pα − P̂α

Pα True value for α = 5%, 10%
P̂α Estimated value

ARX( 4, 4) process

linear regression with W28 = {r (1.6),r (3.0), r (7.0), r (12.0),r (14.0), r (28.0)}

15

10

5
Boxplots of e10 for simulated
10
e

0 responses with P10 > 28.0 minutes

-5

-10
ARX WFA

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 Simulation Results

25
20
r (PID30) Simulation
ref
15 that mimics
r(t) %

10 the clinical
5 Improvement
case
0
0 20 40 60 80 100 120 in the
25 reference
rARX (PID38)
20
ref
tracking
15
r(t) %

10

5
0
Decreasing in
0 20 40 60 80 100 120
the initial
25
rWFA (PID37)
overshoot and
20
ref oscillatory
15
r(t) %

10
behaviour
5
0
0 20 40 60 80 100 120
t (minutes)

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 Final Remarks

Design of an adaptive controller for neuromuscular blockade incorporating an

alarm system

Robust on-line prediction of the beginning of the patient’s recovery from the
initial bolus by

 ARX forecasting

 WFA methodology

 Improvement of the reference pursuit

 Adaptation of the automatic control system to individual requirements

The alarm system can easily be adapted to deal with other related situations,
namely the detection of eventual changes in the dynamics of the system.

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