Patient monitor for determining microcirculation state

• US 10,271,748 B2
• Filed: 09/19/2017
• Issued: 04/30/2019
• Est. Priority Date: 05/06/2010
• Status: Active Grant

• Current Assignee: Masimo Corporation
• Sponsoring Entity: Masimo Corporation
• Inventors: Al-Ali, Ammar
• Primary Examiner(s): Winakur, Eric F
• Assistant Examiner(s): Fardanesh, Marjan
• APPLICATION: US 20180055385A1
• Time in USPTO: 588 Days
• Field of Search: None
• CPC Class Codes: A61B 5/02007 : Evaluating blood vessel condition, e.g. elasticity, compliance
• CPC Class Codes: A61B 5/02427 : Details of sensor
• CPC Class Codes: A61B 5/0261 : using optical means, e.g. infra-red light
• CPC Class Codes: A61B 5/14551 : for measuring blood gases
• CPC Class Codes: A61B 5/14552 : Details of sensors specially adapted therefor
• CPC Class Codes: A61B 5/6801 : specially adapted to be attached to or worn on the body surface
• CPC Class Codes: A61B 5/7275 : Determining trends in physiological measurement dataPredicting development of a medical condition based on physiological measurements, e.g. determining a risk factor
• CPC Class Codes: A61B 5/7282 : Event detection, e.g. detecting unique waveforms indicative of a medical condition A61B5/4094, A61B5/4818, A61B5/0452, A61B5/0823 take precedence
• CPC Class Codes: A61B 5/746 : Alarms related to a physiological condition, e.g. details of setting alarm thresholds or avoiding false alarms alarms per se G08B

Abstract

As placement of a physiological monitoring sensor is typically at a sensor site located at an extremity of the body, the state of microcirculation, such as whether vessels are blocked or open, can have a significant effect on the readings at the sensor site. It is therefore desirable to provide a patient monitor and/or physiological monitoring sensor capable of distinguishing the microcirculation state of blood vessels. In some embodiments, the patient monitor and/or sensor provide a warning and/or compensates a measurement based on the microcirculation state. In some embodiments, a microcirculation determination process implementable by the patient monitor and/or sensor is used to determine the state of microcirculation of the patient.

Claims

1. A patient monitor configured to monitor a patient and determine a microcirculation condition of the patient, the patient monitor comprising:

a sensor interface configured to receive a signal from a physiological sensor that is configured to transmit light of at least a first wavelength and a second wavelength into tissue of a patient and to detect the light after it has been attenuated by the tissue, wherein the signal is responsive to the detected light; and

one or more processors configured to;

process the signal to determine at least;

a measure of oxygen saturation of the tissue of the patient, and

an other calculated parameter responsive to a physiological characteristic of the tissue of the patient;

determine a relationship between the measure of oxygen saturation and the other calculated parameter;

compare the determined relationship with at least some of a plurality of previously determined data sets, wherein the previously determined data sets indicate microcirculation conditions associated with different relationships between measures of oxygen saturation and other calculated parameters; and

responsive to determining, based on said comparing, that a microcirculation condition of the patient comprises an at least partially blocked microcirculation condition in at least a portion of blood vessels in the tissue of the patient, perform at least one of;

provide an electronic microcirculation condition indication for review by a caregiver,

cause the physiological sensor to be configured to transmit at least a portion of the light at a different wavelength, or

apply an offset of to at least one of the measure of oxygen saturation or the other calculated parameter to compensate for the at least partially blocked microcirculation condition.

2. The patient monitor of claim 1, wherein the one or more processors are further configured to:

determine that the microcirculation condition is indicative of cyanosis and/or sepsis; and

in response to determining that the microcirculation condition is indicative of cyanosis and/or sepsis, provide the electronic microcirculation indication.

3. The patient monitor of claim 1, wherein the other calculated parameter comprises a measure of perfusion or perfusion index of the tissue of the patient.

4. The patient monitor of claim 3, wherein determining the relationship comprises:

determining a ratio of the measure of oxygen saturation to the measure of perfusion or perfusion index.

5. The patient monitor of claim 4, wherein comparing the determined relationship with at least some of the plurality of previously determined data sets comprises:

comparing the ratio with at least some of the plurality of previously determined data sets.

6. The patient monitor of claim 4, wherein the plurality of previously determined data sets comprise a plurality of lookup curves, and wherein comparing the determined relationship with at least some of the plurality of previously determined data sets further comprises:

generating a trend line based on the ratio and one or more other ratios determined based on further measures of oxygen saturation and perfusion or perfusion index obtained a different times; and

comparing the trend line to at least one lookup curve of the plurality of lookup curves.

7. The patient monitor of claim 1, wherein comparing the determined relationship with at least some of the plurality of previously determined data sets comprises:

determining one of the plurality of previously determined data sets that is most similar to the determined relationship.

8. The patient monitor of claim 1, wherein the oxygen saturation is responsive to differential absorption of hemoglobin derivatives.

9. The patient monitor of claim 1, wherein the at least partially blocked microcirculation condition indicates an at least partial blockage of hemoglobin.

10. The patient monitor of claim 1 further comprising:

a memory storing the plurality of previously determined data sets, wherein;

at least some of the previously determined data sets indicate relationships between measures of oxygen saturation and the other calculated parameter that correspond to an at least partially blocked microcirculation condition, and

at least some of the previously determined data sets indicate relationships between measures of oxygen saturation and the other calculated parameter that correspond to an unblocked microcirculation condition.

11. A method of monitoring a patient and non-invasively determining a microcirculation condition of the patient, the method comprising:

receiving, from a non-invasive physiological sensor at a tissue site of a patient, a signal responsive to light of at least at first wavelength and a second wavelength that is transmitted by non-invasive physiological sensor and detected by the non-invasive physiological sensor after attenuation by tissue of the patient;

processing the signal to determine at least;

a measure of oxygen saturation of the tissue of the patient, and

an other calculated parameter responsive to a physiological characteristic of the tissue of the patient;

determining a relationship between the measure of oxygen saturation and the other calculated parameter;

comparing the determined relationship with at least some of a plurality of previously determined and stored relationships between measures of oxygen saturation and other calculated parameters, wherein;

at least some of the previously determined relationships correspond to an at least partially blocked microcirculation condition, and

at least some of the previously determined relationships correspond to an unblocked microcirculation condition; and

responsive to determining, based on said comparing, that a the microcirculation condition of the patient comprises an at least partially blocked microcirculation condition in at least a portion of blood vessels in the tissue of the patient, perform at least one of;

providing an electronic microcirculation condition indication for review by a caregiver,

causing the non-invasive physiological sensor to be configured to transmit at least a portion of the light at a different wavelength, or

applying an offset of to at least one of the measure of oxygen saturation or the other calculated parameter to compensate for the at least partially blocked microcirculation condition.

12. The method of claim 11, wherein the other calculated parameter comprises a measure of perfusion or perfusion index of the tissue of the patient.

13. The method of claim 12, wherein determining the relationship comprises:

determining a ratio of the measure of oxygen saturation to the measure of perfusion or perfusion index.

14. The method of claim 13, wherein comparing the determined relationship with at least some of the plurality of previously determined relationships:

comparing the ratio with at least some of the plurality of previously determined relationships.

15. The method of claim 13, wherein the plurality of previously determine relationships comprise a plurality of lookup curves, and wherein comparing the determined relationship with at least some of the plurality of previously determined relationships comprises:

generating a trend line based on the ratio and one or more other ratios determined based on further measures of oxygen saturation and perfusion or perfusion index obtained a different times; and

comparing the trend line to at least one lookup curve of the plurality of lookup curves.

16. The method of claim 11, wherein comparing the determined relationship with at least some of the plurality of previously determined relationships comprises:

determining one of the plurality of previously determined relationships that is most similar to the determined relationship.

17. The method of claim 11, wherein the oxygen saturation is responsive to differential absorption of hemoglobin derivatives, and wherein the at least partially blocked microcirculation condition indicates an at least partial blockage of hemoglobin.

18. A method of monitoring a patient and non-invasively determining a microcirculation condition of the patient, the method comprising:

receiving, from a non-invasive physiological sensor at a tissue site of a patient, a signal responsive to light of at least at first wavelength and a second wavelength that is transmitted by non-invasive physiological sensor and detected by the non-invasive physiological sensor after attenuation by tissue of the patient;

processing the signal to determine at least;

a first measure of oxygen saturation of the tissue of the patient at a first time,

a first other calculated parameter responsive to a physiological characteristic of the tissue of the patient at the first time,

a second measure of oxygen saturation of the tissue of the patient at a second time different from the first time, and

a second other calculated parameter responsive to a physiological characteristic of the tissue of the patient at the second time;

determining a first relationship between the first measure of oxygen saturation and the first other calculated parameter;

determining a second relationship between the second measure of oxygen saturation and the second other calculated parameter;

comparing the determined first and second relationships with at least some of a plurality of previously determined and stored relationships between measures of oxygen saturation and other calculated parameters, wherein;

at least some of the previously determined relationships correspond to an at least partially blocked microcirculation condition, and

at least some of the previously determined relationships correspond to an unblocked microcirculation condition; and

responsive to determining, based on said comparing, that a microcirculation condition of the patient comprises an at least partially blocked microcirculation condition in at least a portion of blood vessels in the tissue of the patient, perform at least one of;

providing an electronic microcirculation condition indication for review by a caregiver,

causing the non-invasive physiological sensor to be configured to transmit at least a portion of the light at a different wavelength, or

applying an offset of to at least one of the first measure of oxygen saturation, the second measure of oxygen saturation, the first other calculated parameter, or the second other calculated parameter to compensate for the at least partially blocked microcirculation condition.

19. The method of claim 18, wherein:

determining the first and second relationships includes;

averaging the respective first and second measures of oxygen saturation to determine an average measure of oxygen saturation;

averaging the respective first and second other calculated parameters to determine an average other calculated parameter; and

determining a ratio of the average measure of the other calculated parameter to the average measure of oxygen saturation; and

wherein comparing the determined first and second relationships with at least some of the plurality of previously determined and stored relationships includes;

comparing the ratio with at least some of the plurality of previously determined relationships.

20. The method of claim 18,

wherein determining the first and second relationships includes:

determining respective ratios of the respective first and second other calculated parameters to the respective first and second measures of oxygen saturation; and

wherein comparing the determined first and second relationships with at least some of the plurality of previously determined and stored relationships includes;

comparing the ratios to at least one lookup curve of the plurality of previously determined relationships.

21. The method of claim 18, wherein comparing the determined first and second relationships with at least some of the plurality of previously determined relationships comprises:

determining one of the plurality of previously determined relationships that is most similar to at least one of the first or second determined relationships.

22. The method of claim 18, wherein the oxygen saturation is responsive to differential absorption of hemoglobin derivatives, and wherein the at least partially blocked microcirculation condition indicates an at least partial blockage of hemoglobin.