Method for continuous and non-invasive determination of effective lung volume and cardiac output

• US 10,085,673 B2
• Filed: 03/21/2013
• Issued: 10/02/2018
• Est. Priority Date: 03/21/2012
• Status: Active Grant

• Current Assignee: Maquet Critical Care AB (Getinge AB)
• Original Assignee: Maquet Critical Care AB (Getinge AB)
• Inventors: Emtell, Par, Hallback, Magnus
• Primary Examiner(s): Cheng, Jacqueline
• Assistant Examiner(s): PORTILLO, JAIRO H
• Application Number:
  US13/848,304
• Publication Number:
  US 20130253359A1
• Time in Patent Office: 2,021 Days
• Field of Search: 600532
• CPC Class Codes: A61B 5/029 Measuring or recording blood output from the heart, e.g. minute volume A61B8/065 takes precedence
• CPC Class Codes: A61B 5/082 Evaluation by breath analysis, e.g. determination of the chemical composition of exhaled breath A61B5/083, A61B5/091 take precedence
• CPC Class Codes: A61B 5/0836 Measuring rate of CO2 production
• CPC Class Codes: A61B 5/087 Measuring breath flow
• CPC Class Codes: A61B 5/72 Signal processing specially adapted for physiological signals or for diagnostic purposes character recognition, recognising digital ink, document-oriented image-based pattern recognition G06V30/00; recognition or understanding of postal images G06V30/424
• CPC Class Codes: A61M 16/0051 with alarm devices
• 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 2016/0036 in the breathing tube and used in both inspiratory and expiratory phase
• CPC Class Codes: A61M 2230/432 partial CO2 pressure (P-CO2)
• CPC Class Codes: G16H 50/50 for simulation or modelling of medical disorders

Abstract

In a method for continuous and non-invasive determination of the effective lung volume, the cardiac output, and/or the carbon dioxide content of venous blood of a subject during a sequence of respiratory cycles, the inspiratory and expiratory flow, and the carbon dioxide content of at least the expiration gas are measured. In each respiratory cycle, a first parameter related to the subject'"'"'s fraction of alveolar carbon dioxide, a second parameter related to the carbon dioxide content of the subject'"'"'s arterial blood, and a third parameter related to the subject'"'"'s carbon dioxide elimination are determined based on the measured inspiratory flow, expiratory flow and carbon dioxide content. The effective lung volume, the cardiac output, and/or the carbon dioxide content of venous blood of the subject is determined based on the correlation of the first, second and third parameters.

Claims

1. A non-invasive method for simultaneously determining at least two physiological parameters related, respectively, to the effective lung volume and the cardiac output of a subject, the method comprising the steps of, during a sequence of respiratory cycles:

changing ventilation of a subject provided by a breathing apparatus, wherein the change of ventilation is performed by a control unit of the breathing apparatus and wherein the change in ventilation causes a substantial change in carbon dioxide content in expiration gas exhaled by the subject during the sequence of respiratory cycles;

after changing ventilation, measuring at least an expiratory flow of expiration gas exhaled by the subject, and measuring the carbon dioxide content of at least the expiration gas, wherein the expiratory flow of the expiration gas is measured by at least one flow sensor of a monitoring device, and the carbon dioxide content is measured by at least one gas analyzer of the monitoring device;

determining, for each respiratory cycle in the sequence of respiratory cycles, a first parameter related to the fraction of alveolar carbon dioxide of the subject, a second parameter related to the carbon dioxide content of the arterial blood of the subject, and a third parameter related to carbon dioxide elimination of the subject, wherein the determination of each of the first parameter, the second parameter, and the third parameter is performed by the control unit of the breathing apparatus and is based on the measured expiratory flow and the measured carbon dioxide content;

for each respiratory cycle in the sequence of respiratory cycles, the control unit inserts the determined values of the first, second and third parameters into a capnodynamic equation so as to form an overdetermined system of equations, wherein the simultaneous determination of the at least two physiological parameters is performed by the control unit, and the simultaneous determination of the at least two physiological parameters involves finding an approximate solution to the overdetermined system of equations; and

continuously monitoring the at least two physiological parameters simultaneously determined by the control unit, wherein the control unit is a component of the monitoring device.

2. The method according to claim 1, wherein the step of determining said at least one physiological parameter comprises simultaneous determination of a physiological parameter related to the effective lung volume of the subject, a physiological parameter related to the cardiac output of the subject, and a physiological parameter related the carbon dioxide content of venous blood of the subject, the simultaneous determination of the physiological parameters being performed by the control unit of the breathing apparatus by finding the approximate solution to the overdetermined system of equations.

3. The method according to claim 1, wherein the capnodynamic equation describes a relationship between parameters relating to effective lung volume, cardiac output, carbon dioxide content of venous blood, fraction of alveolar carbon dioxide, carbon dioxide content of arterial blood and carbon dioxide elimination of a subject, so as to form the overdetermined system of equations.

4. The method according to claim 3, wherein said capnodynamic equation is:

V·

Δ

F_ACO₂=Δ

t·

Q·

(CvCO₂−

CaCO₂)−

VTCO₂

where V is the effective lung volume during the respiratory cycle, Δ

F_ACO₂ is the change in volume fraction of alveolar carbon dioxide during the respiratory cycle, Δ

t is the duration in time of the respiratory cycle, Q is the effective pulmonary capillary blood flow during the respiratory cycle, CvCO₂ is the carbon dioxide content of venous blood during the respiratory cycle, CaCO₂ is the carbon dioxide content of arterial blood during the respiratory cycle, and VTCO₂ is the tidal volume elimination of carbon dioxide during the respiratory cycle.

5. The method according to claim 1, wherein the at least one physiological parameter is determined on a breath-by-breath basis by, for each respiratory cycle, replacing the values of the first, second and third parameters obtained during the oldest respiratory cycle in the sequence of respiratory cycles with the values obtained during the most recent respiratory cycle.

6. The method according to claim 1, wherein the step in which the at least a physiological parameter related to the effective lung volume of the subject is determined further comprises the steps of:

measuring also an inspiratory flow of inspiration gas inhaled by the subject,

calculating a difference in volume of inspired and expired gas in each respiratory cycle from the measured inspiratory and expiratory flows; and

determining an updated value of a current effective lung volume of the subject based on the determined physiological parameter and said differences.

7. The method according to claim 1, further comprising the steps of obtaining, prior to determination of the at least one physiological parameter, a priori information comprising at least one value of at least one of said physiological parameters using another method for determination of at least one of said physiological parameters, and using said a priori information in the determination of the at least one physiological parameter.

8. The method according to claim 1, further comprising the steps of determining an error in the determination of the at least one physiological parameter based on the correlation of the first, second and third parameters in the sequence of respiratory cycles, and generating an alarm signal if the error indicates that the correlation is weak.

9. The method according to claim 1, wherein the breathing apparatus is a ventilator or an anesthesia machine.

10. The method according to claim 1, wherein the substantial change in the carbon dioxide content in expiration gas exhaled by the subject is at least 0.5%.

11. A non-transitory, computer-readable data storage medium encoded with programming instructions for non-invasive determination of at least one physiological parameter related to the effective lung volume, the cardiac output, and/or the carbon dioxide content of venous blood of a subject, said storage medium being loaded into a processor of a breathing apparatus that also comprises at least one flow sensor of a monitoring device for measuring at least an expiratory flow of expiration gas exhaled by the subject, at least one gas analyzer of the monitoring device measuring the carbon dioxide content of at least the expiration gas exhaled by the subject, said programming instructions causing said processor to:

change ventilation of a subject provided by the breathing apparatus so as to cause a substantial change in carbon dioxide content in expiration gas exhaled by the subject during a sequence of respiratory cycles;

following the change in ventilation, process a measure of at least an expiratory flow of expiration gas exhaled by the subject, and process a measure of the carbon dioxide content of at least the expiration gas, wherein the expiratory flow of the expiration gas is measured by the at least one flow sensor, and the carbon dioxide content is measured by the at least one gas analyzer;

determine, for each respiratory cycle in the sequence of respiratory cycles, a first parameter related to the fraction of alveolar carbon dioxide of the subject, a second parameter related to the carbon dioxide content of the arterial blood of the subject, and a third parameter related to carbon dioxide elimination of the subject, wherein the determination of each of the first parameter, the second parameter, and the third parameter is based on the measured expiratory flow and the measured carbon dioxide content; and

for each respiratory cycle in the sequence of respiratory cycles, the processor inserts the determined values of the first, second and third parameters into a capnodynamic equation so as to form an overdetermined system of equations, wherein the determination of the at least one physiological parameter is performed by the processor, and the determination of the at least one physiological parameter involves finding an approximate solution to the overdetermined system of equations; and

calculate an error indicative of uncertainty in the determination of the at least one physiological parameter; and

cause an alarm signal to be generated by the monitoring device when the error exceeds a predetermined threshold value; and

provide continuous monitoring of the at least one physiological parameter determined by the processor, wherein the processor is a component of the monitoring device.

12. The non-transitory, computer-readable data storage medium encoded with programming instructions according to claim 11, wherein the breathing apparatus is a ventilator or an anesthesia machine.

13. The non-transitory, computer-readable data storage medium according to claim 11, wherein the programming instructions cause the processor to calculate the error such that the error depends on the correlation between the first, second and third parameters in the respiratory cycles of the sequence of respiratory cycles.

14. A breathing apparatus adapted to provide a non-invasive determination of at least one physiological parameter related to the effective lung volume, the cardiac output, and/or the carbon dioxide content of venous blood of a subject, the breathing apparatus comprising:

a breathing assist apparatus selected from the group consisting of a ventilator and an anesthesia machine; and

a monitoring device, wherein the monitoring device comprises

at least one flow sensor disposed to measure at least an expiratory flow of expiration gas exhaled by the subject, during a sequence of respiratory cycles;

at least one gas analyzer disposed to measure the carbon dioxide content of at least the expiration gas; and

a control unit configured to control ventilation of the subject provided by the breathing assist apparatus and to determine, for each respiratory cycle in the sequence of respiratory cycles following a ventilation change by the control unit that causes a substantial change in the carbon dioxide content in the expiration gas, a first parameter related to the fraction of alveolar carbon dioxide of the subject, a second parameter related to the carbon dioxide content of the arterial blood of the subject, and a third parameter related to carbon dioxide elimination of the subject, wherein the determination of each of the first parameter, the second parameter, and the third parameter is based on the measured expiratory flow provided by the at least one flow sensor and the measured carbon dioxide content provided by the at least one gas analyzer, and the control unit is configured to, for each respiratory cycle in the sequence of respiratory cycles, insert the determined values of the first, second and third parameters into a capnodynamic equation so as to form an overdetermined system of equations, wherein the determination of the at least one physiological parameter by the control unit involves finding an approximate solution to the overdetermined system of equations, and the control unit is configured to provide non-invasive continuous monitoring of the at least one determined physiological parameter during respiratory treatment provided by the breathing assist apparatus.

15. The breathing apparatus according to claim 14, wherein said control unit is configured to operate said breathing apparatus to provide a ventilatory treatment to the subject.

16. The breathing apparatus according to claim 15, wherein the control unit is configured to cause a change in the effective ventilation of the subject to cause the carbon dioxide content of the expiration gas exhaled by the subject to vary in a range of 0.5%-1% during said sequence of respiratory cycles.

17. The breathing apparatus according to claim 16, wherein the control unit is configured to change the effective ventilation of the subject to deliver a ventilation pattern with alternating sequences of breaths of increased ventilation and breaths of decreased ventilation to the subject.

18. A non-invasive method for determining at least one physiological parameter related to the effective lung volume, the cardiac output, and/or the carbon dioxide content of venous blood of a subject, the method comprising the steps of, during a sequence of respiratory cycles:

changing ventilation of a subject provided by a breathing apparatus, wherein the change of ventilation is performed by a control unit of the breathing apparatus and wherein the change in ventilation causes a substantial change in carbon dioxide content in expiration gas exhaled by the subject during the sequence of respiratory cycles;

after changing ventilation, measuring at least an expiratory flow of expiration gas exhaled by the subject, and measuring the carbon dioxide content of at least the expiration gas, wherein the expiratory flow of the expiration gas is measured by at least one flow sensor of a monitoring device, and the carbon dioxide content is measured by at least one gas analyzer of the monitoring device;

determining, for each respiratory cycle in the sequence of respiratory cycles, a first parameter related to the fraction of alveolar carbon dioxide of the subject, a second parameter related to the carbon dioxide content of the arterial blood of the subject, and a third parameter related to carbon dioxide elimination of the subject, wherein the determination of each of the first parameter, the second parameter, and the third parameter is performed by the control unit of the breathing apparatus and is based on the measured expiratory flow and the measured carbon dioxide content;

for each respiratory cycle in the sequence of respiratory cycles, the control unit inserts the determined values of the first, second and third parameters into a capnodynamic equation so as to form an overdetermined system of equations, wherein the determination of the at least one physiological parameter is performed by the control unit, and the determination of the at least one physiological parameter involves finding an approximate solution to the overdetermined system of equations; and

calculating an error indicative of uncertainty in the determination of the at least one physiological parameter, wherein the control unit calculates the error and causes an alarm signal to be generated by the monitoring device when the error exceeds a predetermined threshold value, wherein the control unit is a component of the monitoring device and the monitoring device continuously monitors the at least one physiological parameter determined by the control unit.

19. The method according to claim 18, wherein the error is calculated such that the error depends on the correlation between the first, second and third parameters in the respiratory cycles of the sequence of respiratory cycles.

20. A non-transitory, computer-readable data storage medium encoded with programming instructions for non-invasive and simultaneous determination of at least two physiological parameters related, respectively, to the effective lung volume and the cardiac output of a subject, said storage medium being loaded into a processor of a breathing apparatus that also comprises at least one flow sensor of a monitoring device for measuring at least an expiratory flow of expiration gas exhaled by the subject, and at least one gas analyzer of the monitoring device for measuring the carbon dioxide content of at least the expiration gas exhaled by the subject, said programming instructions causing said processor to:

change ventilation of a subject provided by the breathing apparatus so as to cause a substantial change in carbon dioxide content in expiration gas exhaled by the subject during a sequence of respiratory cycles;

following the change in ventilation, process a measure of at least an expiratory flow of expiration gas exhaled by the subject, and process a measure of the carbon dioxide content of at least the expiration gas, wherein the expiratory flow of the expiration gas is measured by the at least one flow sensor, and the carbon dioxide content is measured by the at least one gas analyzer;

determine, for each respiratory cycle in the sequence of respiratory cycles, a first parameter related to the fraction of alveolar carbon dioxide of the subject, a second parameter related to the carbon dioxide content of the arterial blood of the subject, and a third parameter related to carbon dioxide elimination of the subject, wherein the determination of each of the first parameter, the second parameter, and the third parameter is based on the measured expiratory flow and the measured carbon dioxide content; and

for each respiratory cycle in the sequence of respiratory cycles, the processor inserts the determined values of the first, second and third parameters into a capnodynamic equation so as to form an overdetermined system of equations, wherein the simultaneous determination of the at least two physiological parameters is performed by the processor, and the determination of the at least two physiological parameters involves finding an approximate solution to the overdetermined system of equations; and

provide continuous monitoring of the at least two physiological parameters determined by the processor, wherein the processor is a component of the monitoring device.

21. A breathing apparatus adapted to provide a non-invasive determination of at least one physiological parameter related to the effective lung volume, the cardiac output, and/or the carbon dioxide content of venous blood of a subject, the breathing apparatus comprising:

a breathing assist apparatus selected from the group consisting of a ventilator and an anesthesia machine; and

a monitoring device, wherein the monitoring device comprises

at least one flow sensor disposed to measure at least an expiratory flow of expiration gas exhaled by the subject, during a sequence of respiratory cycles;

at least one gas analyzer disposed to measure the carbon dioxide content of at least the expiration gas; and

a control unit configured to control ventilation of the subject provided by the breathing assist device and to determine, for each respiratory cycle in the sequence of respiratory cycles following a ventilation change by the control unit that causes a substantial change in the carbon dioxide content in the expiration gas, a first parameter related to the fraction of alveolar carbon dioxide of the subject, a second parameter related to the carbon dioxide content of the arterial blood of the subject, and a third parameter related to carbon dioxide elimination of the subject, wherein the determination of each of the first parameter, the second parameter, and the third parameter is based on the measured expiratory flow provided by the at least one flow sensor and the measured carbon dioxide content provided by the at least one gas analyzer, and the control unit is configured to, for each respiratory cycle in the sequence of respiratory cycles, insert the determined values of the first, second and third parameters into a capnodynamic equation so as to form an overdetermined system of equations, wherein the determination of the at least one physiological parameter by the control unit involves finding an approximate solution to the overdetermined system of equations, the control unit further being configured to calculate an error indicative of uncertainty in the determination of the at least one physiological parameter, and cause an alarm signal to be generated by the monitoring device when the error exceeds a predetermined threshold value.

22. The breathing apparatus according to claim 21, wherein the control unit is configured to provide non-invasive continuous monitoring of the at least one determined physiological parameter during respiratory treatment provided by the breathing assist apparatus.

23. The breathing apparatus according to claim 21, wherein the control unit is configured to calculate the error such that the error depends on the correlation between the first, second and third parameters in the respiratory cycles of the sequence of respiratory cycles.

24. A breathing apparatus adapted to provide non-invasive and simultaneous determination of at least two physiological parameters related, respectively, to the effective lung volume and the cardiac output of a subject, the breathing apparatus comprising:

a breathing assist apparatus selected from the group consisting of a ventilator and an anesthesia machine; and

a monitoring device, wherein the monitoring device comprises

at least one flow sensor disposed to measure at least an expiratory flow of expiration gas exhaled by the subject, during a sequence of respiratory cycles;

at least one gas analyzer disposed to measure the carbon dioxide content of at least the expiration gas; and

a control unit configured to control ventilation of the subject provided by the breathing assist apparatus and to determine, for each respiratory cycle in the sequence of respiratory cycles following a ventilation change by the control unit that causes a substantial change in the carbon dioxide content in the expiration gas, a first parameter related to the fraction of alveolar carbon dioxide of the subject, a second parameter related to the carbon dioxide content of the arterial blood of the subject, and a third parameter related to carbon dioxide elimination of the subject, wherein the determination of each of the first parameter, the second parameter, and the third parameter is based on the measured expiratory flow provided by the at least one flow sensor and the measured carbon dioxide content provided by the at least one gas analyzer, and the control unit is configured to, for each respiratory cycle in the sequence of respiratory cycles, insert the determined values of the first, second and third parameters into a capnodynamic equation so as to form an overdetermined system of equations, wherein the simultaneous determination of the at least two physiological parameters by the control unit involves finding an approximate solution to the overdetermined system of equations, and the control unit is configured to provide non-invasive continuous monitoring of the at least two simultaneously determined physiological parameters during respiratory treatment provided by the breathing assist apparatus.