Methods and systems for triggering with unknown base flow

• US 10,029,057 B2
• Filed: 08/27/2014
• Issued: 07/24/2018
• Est. Priority Date: 03/30/2012
• Status: Active Grant

• Current Assignee: Covidien LP (Medtronic Plc)
• Original Assignee: Covidien LP (Medtronic Plc)
• Inventors: Jafari, Mehdi M., Jimenez, Rhomere S., Aviano, Jeffrey K.
• Primary Examiner(s): Anderson, Gregory
• Assistant Examiner(s): Paciorek, Jonathan
• Application Number:
  US14/470,330
• Publication Number:
  US 20140360497A1
• Time in Patent Office: 1,427 Days
• CPC Class Codes: A61M 16/0003 Accessories therefor, e.g. sensors, vibrators, negative pressure
• CPC Class Codes: A61M 16/0063 Compressors
• CPC Class Codes: A61M 16/026 specially adapted for predicting, e.g. for determining an information representative of a flow limitation during a ventilation cycle by using a root square technique or a regression analysis
• CPC Class Codes: A61M 16/0833 T- or Y-type connectors, e.g. Y-piece
• CPC Class Codes: A61M 16/204 used for inhalation control
• CPC Class Codes: A61M 16/205 used for exhalation control
• CPC Class Codes: A61M 2016/0021 with a proportional output signal, e.g. from a thermistor
• CPC Class Codes: A61M 2016/0036 in the breathing tube and used in both inspiratory and expiratory phase
• CPC Class Codes: A61M 2016/0039 in the inspiratory circuit
• CPC Class Codes: A61M 2016/0042 in the expiratory circuit
• CPC Class Codes: A61M 2205/16 with back-up system in case of failure
• CPC Class Codes: A61M 2205/505 Touch-screens; Virtual keyboard or keypads; Virtual buttons; Soft keys; Mouse touches
• CPC Class Codes: A61M 2205/70 with testing or calibration facilities

Abstract

This disclosure describes systems and methods for providing novel back-up ventilation that allows the patient to trigger or initiate the delivery of breath. Further, this disclosure describes systems and methods for triggering ventilation when base flow is unknown or undeterminable by the ventilator.

Claims

1. A method for ventilating a patient with a ventilator, comprising:

delivering a fixed base flow;

determining a stable portion of exhalation;

monitoring an exhalation flow during the stable portion of exhalation and in an absence of a determinable inspiratory flow;

estimating a base flow based on the exhalation flow monitored during the stable portion of exhalation;

determining that a flow derivation based on the estimated base flow is greater than an inspiratory trigger threshold during the stable portion of exhalation; and

triggering inspiration based on the determining that the flow derivation is greater than the inspiratory trigger threshold.

2. The method of claim 1, wherein the inspiration flow is undeterminable because of at least one of the following malfunctions:

a malfunction of an inspiratory flow sensor;

a malfunction that prevents utilization of the inspiratory flow sensor

an inspiratory module malfunction; and

a malfunction that deactivates at least one of a data measurement subsystem and a data acquisition subsystem.

3. The method of claim 1, wherein the inspiration flow is undeterminable because of an absence of an inspiratory flow sensor.

4. The method of claim 1, wherein the stable portion of exhalation is a time during exhalation when a slope of patient exhalation flow is about zero.

5. The method of claim 1, wherein the stable portion of exhalation occurs when

(Max(P_e)−

Min(P_e))<

1.5 cm H₂O) and (Max(Q_e)−

Min(Q_e))<

1.5 LPM) for each computation cycle,

wherein Max(P_e) is a maximum exhalation pressure, Min(P_e) is a minimum exhalation pressure, Max(Q_e) is a maximum exhalation flow, and Min(Q_e) is a minimum exhalation flow.

6. The method of claim 1, wherein the inspiratory trigger threshold is a change in flow rate.

7. The method of claim 1, wherein a net negative change in lung volume is converted into flow rate for comparison to the inspiratory trigger threshold.

8. The method of claim 7, wherein the inspiratory trigger threshold is a change of at least 5 LPM.

9. A ventilator system comprising:

a pressure generating system adapted to generate a flow of breathing gas;

wherein the pressure generating system delivers a fixed base flow,

a ventilation tubing system including a patient interface for connecting the pressure generating system to a patient;

at least one sensor operatively coupled to at least one of the pressure generating system, the patient, and the ventilation tubing system, wherein the at least one sensor is capable of generating an output indicative of an exhalation flow;

a base flow estimator module for determining a stable portion of exhalation, monitoring the exhalation flow during the stable portion of exhalation based on the output, and for estimating a base flow based on the exhalation flow monitored during the stable portion of exhalation and in an absence of determinable inspiratory flow; and

a trigger module that determines that a flow derivation based on an estimated base flow is greater than an inspiratory trigger threshold and then triggers inspiration.

10. The ventilator system of claim 9, wherein the stable portion of exhalation occurs when

(Max(P_e)−

Min(P_e))<

1.5 cm H₂O) and (Max(Q_e)−

Min(Q_e))<

1.5 LPM) for each computation cycle, and

wherein Max(P_e) is a maximum exhalation pressure, Min(P_e) is a minimum exhalation pressure, Max(Q_e) is a maximum exhalation flow, and Min(Q_e) is a minimum exhalation flow.

11. The ventilator system of claim 9, further comprising:

a display in communication with at least one of a lung volume module and the trigger module, the display displays at least one of a net negative change in lung volume, the estimated base flow, the exhalation flow, a restricted period, and a trigger threshold.

12. The ventilator system of claim 9, wherein the inspiration flow is undeterminable because of an absence of an inspiratory flow sensor.

13. The ventilator system of claim 9, wherein the inspiration flow is undeterminable because of at least one of the following malfunctions:

a malfunction of an inspiratory flow sensor;

a malfunction that prevents utilization of the inspiratory flow sensor

an inspiratory module malfunction; and

a malfunction that deactivates at least one of a data measurement subsystem and a data acquisition subsystem.

14. The ventilator system of claim 9, wherein the inspiratory trigger threshold is a change in flow rate.

15. The ventilator system of claim 14, wherein a net negative change in lung volume is converted into flow rate for comparison to the inspiratory trigger threshold.

16. The ventilator system of claim 15, wherein the inspiratory trigger threshold is a change of at least 5 LPM.

17. A computer-readable medium having computer-executable instructions for ventilating a patient with a ventilator, the instructions comprising:

deliver a fixed base flow that is undeterminable;

determine a stable portion of exhalation;

monitor an exhalation flow during the stable portion of exhalation;

estimate a base flow based on the exhalation flow monitored during the stable portion of exhalation;

determine that a flow derivation based on the estimated base flow is greater than an inspiratory trigger threshold during the stable portion of exhalation; and

trigger inspiration based on the determining that the flow derivation is greater than the inspiratory trigger threshold.

18. A computer-readable medium having computer-executable instructions for ventilating a patient with a ventilator, the instructions comprising:

deliver a fixed base flow that is undeterminable;

monitor a windowed differential lung volume during exhalation;

determine that the windowed differential lung volume is at about zero after a decreasing trend toward zero; and

trigger inspiration based on the first of at least one of the following events to occur;

a net negative change in lung volume with increasing magnitude is detected that is greater than an inspiratory trigger threshold directly after the step of determining that the windowed differential lung volume is about zero; and

a predetermined amount of time expires.

19. A computer-readable medium having computer-executable instructions for ventilating a patient with a ventilator, instructions comprising:

deliver a fixed base flow that is undeterminable;

determine a stable portion of exhalation;

monitor an exhalation flow during the stable portion of exhalation;

estimate a base flow based on the exhalation flow monitored during the stable portion of exhalation; and

trigger inspiration based on the first of at least one of the following events to occur;

a flow derivation based on the estimated base flow is detected that is greater than an inspiratory trigger threshold during the stable portion of exhalation; and

expiration of a predetermined amount of time.