Real-Time Current Volume Estimation System from an Azure Kinect Camera in Pediatric Intensive Care: Technical Development.

Monitoring respiratory parameters is essential in pediatric intensive care units (PICUs), yet bedside tidal volume (Vt) measurement is rarely performed due to the need for invasive airflow sensors. We present a real-time, non-contact respiratory monitoring system using the Azure Kinect DK (Microsoft, Redmond, WA, USA) depth camera, specifically designed for use in the PICU. The system automatically tracks thoracic volume variations to derive a comprehensive set of ventilator equivalent parameters: tidal volume, respiratory rate, minute ventilation, inspiratory/expiratory times, I:E ratio, and peak flows. Results are displayed via an ergonomic web interface for clinical use. This system introduces several innovations: real-time estimation of a complete set of respiratory parameters, a novel infrared-based region-of-interest detection method using YOLO-OBBs, enabling robust operation regardless of lighting conditions, even in total darkness, making it ideal for continuous monitoring of sleeping patients, and a pixel-wise 3D volume computation method that achieves a mean absolute error under 5% on tidal volume. The system was evaluated on both a healthy adult (compared to spirometry) and a critically ill child (compared to ventilator data). To our knowledge, this is the first study to validate such a contactless respiratory monitoring system on a non-intubated child in the PICU. Further clinical validation is ongoing.