Prospect. Vol 12, No. 2, July -. December 2014, p.

57-64

Designing a system of self-care medical oxygen noninvasive monitoring

based on fuzzy logic

Health care system of self-regulation of oxygen by non-invasive

monitoring, using fuzzy logic

Adalberto Castro Ospino one, Carlos Robles Algarín two, Duran Alejandro Pabón 3

one MSc in Control Engineering, Research Professor of Electrical Engineering, University of Costa CUC, Research Group on Energy Optimization GIOPEN,
Barranquilla, Colombia. two MSc in Control Engineering, Research Professor of Electronic Engineering,
Cooperative University of Colombia, Professor Associate Professor, University of Magdalena, Research Group Electronic Systems and Renewable Energies SEER.
Santa marta colombia. 3 MSc in Control Engineering, Professor of Engineering Associate Professor
Electronics, University of Magdalena. Santa marta colombia.
Email: aospino8@cuc.edu.co Received:

06.12.14, 01.07.14 Accepted

Cited as: A. Ospino, C.Robles, A.Duran, "Health care system of self-regulation of oxygen by non-invasive
monitoring, using fuzzy logic", Prospect, Vol 12, No. 2, 57-64, 2014 .

SUMMARY

This article scientific research and technological development, the design of a control system autoregulation oxygen occurs by fuzzy logic,
which allows deliver to a patient an amount of the exact ta inspired oxygen fraction FIO two taking into account the levels of oxygen saturation.
For this purpose, the mathematical modeling of the hemoglobin dissociation curve was made from data obtained by linking oximetry oxygen
saturation O two and the oxygen pressure PAO two. Subsequently, modeling a proportional valve for medical applications was done, which
receives a current signal obtained from the mixture of air and oxygen. Finally the fuzzy controller Sugeno type with an inlet, an outlet for the
valve opening and eleven fuzzy rules defined from the interview with experts designed. Thus an investigation of possible types supported in a
field design and one documentary was made. The results demonstrated the effectiveness of fuzzy controller to maintain the valve in an exact
level FIO two composed of the mixture of air and oxygen.

Keywords: Diffuse logic; Autoregulation oxygen; Inspired oxygen fraction; Oxygen saturation; Oxygen pressure.

ABSTRACT

This research presents the design of an oxygen self-regulation control system based on fuzzy logic, Which Allows delivering an exact quantity
of the fraction of inspired oxygen FIO two to the patient based on the oxygen saturation levels. For This, it was performed the math modeling of
hemoglobin dissociation curve from data Obtained by oximetry oxygen saturation Relating O two Oxygen pressure and PAO two. Then, a
proportional valve for medical appli- cations was modeled; You receive a current signal esta Obtained from the air-oxygen blend. Finally, it
was designed a fuzzy controller from the Sugeno type With one input, one output for the valve and eleven fuzzy rules specified from the
interview with medical specialists. A research was done feasible type, supported on a field design and a documentary one. Results shown the
effectiveness of the fuzzy controller to keep the valve to an exact level of FIO two Consisting of an air-oxygen blend.

Key words: Fuzzy logic; Oxygen self-regulation; Fraction of inspired oxygen; Oxygen saturation; Oxygen pressure.

57
Designing a system of self-care medical oxygen noninvasive monitoring based on fuzzy logic
1. INTRODUCTION
In hospital centers it is common that preterm infants receive assistance
piratoria response and supplemental oxygen, which in many occasions
can cause hypoxemia that may be determined tectate through
continuous measurements of blood saturation oxygen by pulse oximetry
(SpO two) and treated with manual adjustments fraction rado inspire oxygen
(FiO two), to maintain oxygen saturation (SO two)
within a given target range. Monitoring SO two
and manual adjustment of the FIO two must be performed by trained
personnel, which is a labor and time response vary widely depending on
the responsibilities and staff motivation invoked profited [1, 2].
In several studies it has been used pulse oximetry and different types of
drivers that have permitted adjust the FIO two, especially in neonatology,
due to the risks suffering preterm infants by changes in oxygenation [3,
4]. In adults, ros Prime- studies oxygenation control systems have been
conducted in patients with military trauma and in patients with chronic
obstructive pulmonary disease therapies ca requiring oxygen for long
periods of time [5, 6 ].
Recent studies have shown that in newborn premature na- acids,
excessive and prolonged use of oxy- gen has been associated with
long-term complications involving the eyes, lungs and central nervous
system [7, 2]. Moreover, insufficient oxygenation has also been
associated with detrimental effects in the brain, lung problems and
permeability Duc to arteriosus [8, 5].
According to a study in the Imbanaco Medical Center in Cali, about 25%
of premature newborns ros are diagnosed with some kind of pathology
response piratoria so often require Canica Me- ventilation or
supplemental oxygen. The study shows that approximately 25% of
patients who survive respiratory problems remain oxygen dependent [9].
For an adult patient under stable conditions, oxygen saturation (SO two) must
remain between 88% and 95%; while for the case of re-born hundred
range should be between 85% and 93% [10]. Therefore, monitoring of
oxygen saturation and continuous and precise control of the inspired
oxygen fraction (FiO two) that patients requiring oxygen therapy is
administered, are critical factors that require prompt attention because it
can cause permanent damage to the blood vessels in
58
the retina, which is one of the main causes of child Guera EC [11].
Currently the dosage of oxygen in the pa- tients in hospitals is done
manually, which means that health personnel should always be aware of
the measure oxygen saturation displayed on the pulse oximeter in order
to verify if said para- meter is in the proper range for the patient [12].
In this context, this paper the design of a system of self oxygen occurs,
by fuzzy logic, which is capable of controlling the oxygen delivery of
accurate and timely manner to avoid deficiency or excess of oxygen
delivered to a patient . For this purpose Matlab / Simulink is used as a
simulation tool and validation of models implemented for oxygen control
system for the air control system and mathematical modeling of the
dissociation curve of hemoglobin.
2. METHODOLOGY
This research is methodologically considered as a feasible project that is
supported by a dise- ño field and one documentary because required
data collection directly from reality, ADE over the review and analysis of
documentary sources [13]. To achieve the correct achievement of the
objectives, work has been divided into phases according to the
methodology of decomposition of work, basing the constitution and
develop- ment of activities in project management, which is the discipline
that allows organize and manage resources so that it can meet the
objectives within time, scope and cost defined. In that senti- do, then the
whole process of design, modeling, and simulation was carried out for
the oxygen self-regulatory system is detailed.
2.1 Modeling hemoglobin dissociation curve
To simulate the process of hemoglobin dissociation curve, Saveringhaus,
a study of the various models proposed in the literature to model these
processes and found that there is a relevant mathematical model for this
research was conducted. Throughout the literature reviewed and curves
are- are you darizadas, obtaining a reference to generate a mathematical
model that represents the behavior of hemoglobin dissociation curves
[14]. Given this context, it was decided to work with a set of real data
showing the relationship between
 Prospect. Vol 12, No. 2, July -. December 2014, p. 57-64

oxygen saturation and oxygen pressure (PaO two),

the privileges which acquired from different patients TRA VES oximetry
technique. See Table 1 [15].
Figure 1. Adjusting the mathematical function.
Table 1. Relationship between oxygen saturation two and PaO two. Figure 1. Setting the mathematical function.
Table 1. Relationship Between O two saturation and PaO two.

O2 saturation PaO2 in mmHg

100% 677

98.4% 100

95% 80

90% 59

80% 48

73% 40

60% 30

fifty% 26

40% 2. 3

35% twenty-one

30% 18

Source: Ospino, A. 2013. [15]

Source: Ospino, A. 2013. [15]

With the acquired data, we proceeded to use the toolbox Matlab curve
fitting, Curve Fitting Toolbox, which provides graphical tools and In the process for mixing air and oxygen to produce FiO two mixing air and
command-line functions to adjust curves and surfaces to data. After oxygen were used. Thus the calculation of the FiO two It is performed by the
creating an adjustment you can be applied a variety of methods of following equation:
post-processing for drawing, interpolation, extrapolation and estimation of
confidence intervals of in-.

In the working environment of the toolbox, the da- cough were imported
from the workspace Matlab Curve Fitting Toolbox as illustrated in Figure
1. Thereafter, the regression analysis was used to obtain a Fourier series
which represents the model dissociation curve of hemoglobin tion. See
Equation 1.
For example, if a flow is supplied O two 20 L / min and an air flow of 40 L /
min, a total gas flow of 60 L / min and an actual flow of O two 20 + 8.4 L /
min, which means, by simple division, FiO two 0.47. In Table 2 an air ratio
vs oxygen delivery shown FiO two, that in the case of this project should be
kept in one liter per minute (1 L / min), by virtue that this is the desired
flow to the nasal prongs or low flow systems.

With the following coefficients: a 0 = 51.78; to 1 = 40.15; b 1 = 0.3108; to 2 = 19.28; b 2 = 12.65;

to 3 = 4,656; b 3 = 11.75; to 4 = 0.09893; b 4 = 4,838; w = 0.06206.

To construct new intermediate points which may be the value of FiO two use
of inter- polation, based on the knowledge of a set of points is made. In
Once the equation that fits the behavior of the curve, is calculated how
engineering, it is common to have a num- ber of points obtained from a
much current blood pressure of oxygen as the saturation value being
sample or experiment and build a function that setting. Once the data is
measured in patients [16]. From there begins to operate with the
validated, a system called "Mathematical Model proceeded to imple-
equation that allows us to find a new FiO two
ment in Simulink
needed to stabilize the patient in a normal value.

59
Designing a system of self-care medical oxygen noninvasive monitoring based on fuzzy logic

Severinghaus curve "containing subsystems Severinghaus curve, Oxygen (SO two) and output the value of PaO Current (PaO two).
calculating FIO two and amount of air and O two from the different models
obtained in the investigation. See Figure 2.
In the next subsystem the new value of fraction of inspired oxygen is FiO two
where it has the in- TRADA the value of the current blood pressure and
To construct new intermediate points which may be the value of FiO two use generates as output the FiO two. In the last subsystem output the required
of inter- polation, based on the knowledge of a set of points is made. In amount of flow of air and oxygen that are the values ​read as the set-point
engineering, it is common to have a num- ber of points obtained from a con- trolador is generated.
sample or experiment and build a function that setting. Once the data is
validated, a system called "Mathematical Model Curve Severinghaus"
containing subsystems Severinghaus curve, calculating FIO proceeded
2.2 Modeling of the control valve
to imple- ment in Simulink two and amount of air and O two from the different
models obtained in the investigation. See Figure 2.
The type of valve used for testing Teknocraft belongs to family which are
used in different in- dustries, including the medical field. The technique
used for experimental identification is relative lated to methods based on
the reaction curve of the process, parametric identification, which are
used in open-loop techniques such as identifying system [17].

Figure 2. Modeling the dissociation curve lobina hemog-.

Figure 2. Matlab model of the hemoglobin dissociation curve.

In Figure 3 different reaction curves of the valve open-loop type from a
unit step input are observed. The valve model was implemented at 20 psi
due to pressure regulator implemented in research, which is responsible
for obtaining a constant and uniform pressure to the valve inlet. With said
controller can obtain a flow of 20 L / min, the maximum flux that can
withstand the trans- mitter for correct measurement. This test was
performed with the valve fully open control was achieved obtained have a
4.9V output transmitter indicating that the transmitter circulates a flow of
20 L / min approximately. Thus the function of transfer of the valve is
Source: Ospino, A. 2013. [15] obtained.

Subsystem called "Curve Saveringhaus" Cuentra It is understood the

mathematical function that fits the model, which takes as input the value
of saturation

Table 2. Calculation of FiO two from the mixture of air vs oxygen.

Table 2. FiO two calculation from the mixture of oxygen vs. air.

Oxygen (L / m) 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 one

Air (L / m) 0 one one one one one one one one one one

0 0 one one one one one one one one one one

0.1 0.21 0.61 0.74 0.80 0.84 0.87 0.89 0.90 0.91 0.92 0.93
0.2 0.21 0.47 0.61 0.68 0.74 0.77 0.80 0.82 0.84 0.86 0.87
0.3 0.21 0.41 0.53 0.61 0.66 0.70 0.74 0.76 0.78 0.80 0.82
0.4 0.21 0.37 0.47 0.55 0.61 0.65 0.68 0.71 0.74 0.76 0.77
0.5 0.21 0.34 0.44 0.51 0.56 0.61 0.64 0.67 0.70 0.72 0.74
0.6 0.21 0.32 0.41 0.47 0.53 0.57 0.61 0.64 0.66 0.68 0.70
0.7 0.21 0.31 0.39 0.45 0.50 0.54 0.57 0.61 0.63 0.65 0.67
0.8 0.21 0.30 0.37 0.43 0.47 0.51 0.55 0.58 0.61 0.63 0.65
0.9 0.21 0.29 0.35 0.41 0.45 0.49 0.53 0.56 0.58 0.61 0.63
one 0.21 0.28 0.34 0.39 0.44 0.47 0.51 0.54 0.56 0.58 0.61

Source: Ospino, A. 2013. [15]

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 Prospect. Vol 12, No. 2, July -. December 2014, p. 57-64

2.4 Design of fuzzy controller

2.3 Transfer function Flow Transmitter
For this investigation elec- tronic transmitter calibrated to work with a
range of 0 to 1 L / min with an output of 4 to 20 mA it was implemented.
See Figure 4. From a point-slope equation trans- mitter function is
obtained. See Equation 5.
fuzzy inference system Sugeno type where the error takes as input,
outputs the openness of the mixer (blender) and 11 rules diffuse [18] was
designed. Inputs are variables defined as the problem and are fuzzified
using for this a series of di- fusos sets. As a Fuzzy Inference System
(FIS) output is defined as a function of the inputs. In this case the
function is a constant value for each linguistic etique- [19] ta.

Input: error: for the input signal was used as re- ference the desired
saturation must be between the ranges initially programmed and the
Figure 3. Response curves of the valve. actual saturation of the patient. The equation for reference is:
Figure 3. Response curve of the valve.

For this input sets have 11 values ​from

- 5 to 5 considering that as agreed with specialists a patient never going
to present a big dif- ference in its desired value and the measured value.
The sets are: when the error is negative, when it is negative, when it is
zero, when positive and when is very positive. In Figure 5 func- tions
membership to the first input of the fuzzy inference system with their
respective ranges shown.

Output: blender movement: are have 11 possible lores for the system
Source: Ospino, A. 2013. [15]
output ranging from -5 to 5. See Figure 6 va-.

Figure 4. Response curve of the transmitter.

Figure 4. Transmitter response curve. fuzzy rules: the system has 11 fuzzy rules which were obtained with the
help of doctors specialists in anesthesiology and by the following
analysis:

• If the error is positive means that the measured saturation is less

than the desired saturation, which indi- cates that the patient needs
a stimulus would be needed oxygen and open the blender.

• If the error is negative means that the measure is greater saturation

saturation, indicating that the patient does not need a stimulus
would be needed oxygen and close the blender.

• If the error is zero, it means that the Me- dida saturation is equal to
the desired, indicating that there is no need to do anything.
Source: Lopez, J. 2014. [9]

61
Designing a system of self-care medical oxygen noninvasive monitoring based on fuzzy logic

Figure 5. Membership functions for input. If (Error is -3) then (output is -3) (1) If (Error is -4) then (output is -4) (1) If
Figure 5. Membership functions for input. (Error is -5) then (output is -5) (1 ) If (Error is 1) then (output is 1) (1) If
(Error is 2) then (output is 2) (1) If (Error is 3) then (output is 3) (1) If
(Error is 4) Then (output is 4) (1) If (Error is 5) then (output is 5) (1)
Finally, with the help of display rules are achieved GRO evaluate the
performance of fuzzy inference system to different variations in the input
variables.

3. RESULTS

In Figure 7, the closed loop system of self-regulation shown FIO two which it
was implemented in Matlab, in which the subsystems for the
mathematical model curve Severinghaus, for the control system for
oxygen and air control system is. To confirm the performance of the
fuzzy controller in the closed loop system, different evi- bas for different
values ​of oxygen saturation (90%, 94%, 97%, 98.4%) with excellent
Source: Ospino, A. 2013. [15] results in accurate delivery of FIO they were performed two from the proper
performance of air controllers and oxygen.
Figure 6. Membership functions for output.
Figure 6. Membership functions for output.

Figure 7. FIO self-regulatory model two.

Figure 7. Self-regulation model of FIO two.

Source: Ospino, A. 2013. [15]

Source: Ospino, A. 2013. [15]
Using the same analysis for each of the linguistic etique- tas 11 in which
the first input is divided, the rules that define the operation of the sys- ma
fuzzy inference are generated. As shown below: If (Error is 0) then
(output is 0) (1) If (Error is -1) then (output is -1) (1) If (Error is -2) then
(Output is - twenty-one)
Particularly, in Figure 8 The answers air fuzzy controller, the fuzzy
controller and oxygen is FIO two a reference to 94% of O two. The results are
contrasted with a PID controller was switched from Ziegler Nichols
method [20]. It can be seen that although both controllers stabilize at 1 L
/ min, the di- Fuso controller eliminates on-pulse and achieves better
stabilization time, which verifies the validity of the controller performed.

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 Prospect. Vol 12, No. 2, July -. December 2014, p. 57-64

Figure 8. System response to a value of 94% SO two.

Figure 8. System response to 94% of SO two.

Source: Ospino, A. 2013. [15]

Then a patient in critical condition with breathing problems and values
​delivered by drivers described:
Oxygen saturation SO 2 = 94% PaO PaO 2 = 74.73 mmHg FiO 2 = .2765
Valve delivery flow (L / min) to reach a stable ni- vel SO two 98.4%:
0.9169 (Air); 0.0831 (O2)
In Figure 9 it can be seen how the pa- sufficient stabilizes after the fuzzy
controller acting valves being delivered exact FiO2 comprising the
mixture of air and oxygen.
The results are consistent with the presence tados in [21] where a design
of a con- troller diffuse to the oxygen supply in disease patients acute
respiratory ties performed. In this study a non-linear fuzzy controller 49
rules with two entries called "error" and "error rate" and an output
corresponding to the increase in FIO designed two necessary for the mixer.
However, the controller FIO two de- signed in [21] presented best
stabilization times that done in this study, but on im- pulse reaching 4%
with times of 3.88s curly. Similarly, the results obtained in [22] where an
automated controller FIO performed two for maintaining the SO two within a
preset range, they are similar to the results presented in this
investigation; what it is demonstrated the need for con- troll automated
FIO two with the aim of pro- vide patients benefit from clinical and
psychological points of view.

Figure 9. Patient with stable values.

Figure 9. Patients With stable values.

4. CONCLUSIONS

• The simulations obtained open loop definitively demonstrated the

need to incorporate a controller to avoid variations of the flows of
the two gases and disturbances affecting system performance.

• a fuzzy controller which allows the precise level main- ner air and
oxygen according rimiento reque- patient for delivery of inspired
oxygen fraction of the mixture containing the exact levels of the two
gases was done.
Source: Ospino, A. 2013. [15]

63
Designing a system of self-care medical oxygen noninvasive monitoring based on fuzzy logic

• Tests conducted allowed evaluating the un- determination [9] JA Lopez, R. Araque, A. Matiz, "Auto-mixer: equipment for the
controller for different values ​of oxygen saturation. The results reduction of risks associated With Inadequate oxygen supply" Engineering
show the efficiency of the controller with excellent convergence
and Research magazine, 34 (1), 60-65, 2014. [10] A. Zin, T. Florencio, F.
times without problems oscillated around the flow ing of the two
ideal gases. Fortes, "Brazilian proposal for guidelines screening and treatment of
Retinopathy of Prematurity" PubMed., 70 (5), 875-883, 2007. [11] R.
Vardhan, Retinopathy of Prematurity. India: Jaypee Brothers Medical
• the effectiveness that have controlled for dynamic fuzzy systems
Dores area of ​medicine because of its flexibility and robustness to Pub, 2006, pp. 10-21. [12] A. corners, Methodology Essential Guide
describe a system based on knowledge and reasoning of an expert Noninvasive Mechanical Ventilation. Colombia: Editorial Pan-American
was demonstrated.
Health, 2010, pp. 1-6. [13] M. Ballestrini, How the research project is
made. Venezuela: Caracas BL Publishing, 2002, pp. 20-45. [14] R.
REFERENCES Araque, A. Matiz, (2004) Design and implementation of a system of
self-regulation of oxygen moni- toring noninvasive pulse oximetry. Grade
[1] MS Urschitz, W. Horn, A. Seyfang, A. Hallenberger,
work, Pontificia Universidad Javeriana, 2004. [15] A. Ospino, (2011)
T. Herberts, S. Mitsch, CF Poets, "Automatic Control of the inspired
oxygen fraction in preterm infants: a rando- mized crossover trial" American health care system self-regulation by non-invasive oxygen monitoring,
Journal of Respiratory and Critical Care Medicine, 170 (10), 1095-1100, based on fuzzy logic. Work Master, Universidad Rafael Belloso Chacin,
2004. [2] JM Arnal, M. Wysocki, D. Novotni, D. Demory, R. Lopez, S. 2013.
Donati, "Safety and efficacy of a fully closed- loop control ventilation (
IntelliVent-ASV) in sedated ICU Patients with acute respiratory failure: a
prospective ran- domized crossover study ", Intensive Care Med., 38 (5),
781-

787, 2012.

[3] FT Tehrani, S. Abbasi, "Evaluation of a computerized system for
mechanical ventilation infants" International Jour- nal of Clinical
Monitoring and Computing., 23 (2), 93-104, 2009. [4] J. A, Johannigman,
R. Branson, D. Lecroy, G. Beck, "Autonomous Control of the inspired
oxygen concentration tion During mechanical ventilation of the critically
injured trauma patient " J Trauma., 66 (2), 386-392, 2009. [5] Rice KL,
Schmidt MF, JS Buan, F. Lebahn, TK Schwarzrock, "AccuO2 oximetry
oxygen driven preserved ving device fixed dose versus oxygen devices in
[16] V. Sarita, K. Katiyar, P. Pradhan, "Analytical study of human
respiratory system", Int. J. of Appl. Math and Mech.,
6 (5), 39-45, 2009.
[17] N. Claure, C. D'Ugard, E. Bancalari, "Automated ad- justment of
inspired oxygen in preterm infants fre- quent With fluctuations in
oxygenation: a pilot clinical trial"
The Journal of Pediatrics, 155 (5), 640-645, 2009. [18] K. Passino, S.
Kurkovich, Fuzzy Control. USA: Addi- are Wesley Longman, 1998, pp.

stable COPD patients", Respiratory Care, 56 (12), 1901-1905, 2011. [6] F.

23-110. [19] J. Timothy, Fuzzy Logic With Engineering Applications.
Lellouche, E. L'Her, "Automated oxygen flow titra- tion to Maintain
constant oxygenation", Respiratory Care,
England: John Wiley & Sons, 2004, pp. 1-114. [20] C. Smith, A. Coripio, Automatic

57 (8), 1254-1262, 2012.
[7] F. Lellouche, PA Bouchard, T. Laubscher, S. Blackburn,
E. L'Her, M. Wysocki, "Prospective randomized controlled study com-
paring conventional ventilation versus a fully closed-loop ventilation
(IntelliVent) post cardiac surgery in ICU patients", Intensive Care Med., , 36
(1), 752, 2010. [8] N. Claure, E. Bancalari, "Automated con- trol closed
loop of inspired oxygen concentration" Respiratory care,
process control.
Mexico: Limusa, 1995, pp. 266-283. [21] MI Adawy, AM-Garhy, FO
Sawafta, "De- sign of Fuzzy Controller for Supplying Oxygen in Sub-
acute Respiratory Illnesses" International Journal of Com- puter Science
Issues (IJCSI) 9 (3), 192-206, 2012. [22] K. Saihi, JC Richard, X. Gonin,
T. Krüger, M. Dojat, J. Brochard, "Feasibility and reliability of an
automated con- troller of inspired oxygen mechani- cal ventilation During
concentration " Critical Care, 18 (1), 1-10, 2014.

58 (1), 151-161, 2013.

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