Ventilator monitoring and control

• US 10,426,906 B2
• Filed: 03/18/2010
• Issued: 10/01/2019
• Est. Priority Date: 03/18/2009
• Status: Active Grant

• Current Assignee: Mayo Foundation For Medical Education And Research (Mayo Clinic), Mayo Medical Ventures (Mayo Clinic)
• Original Assignee: Mayo Foundation For Medical Education And Research (Mayo Clinic)
• Inventors: Gajic, Ognjen, Herasevich, Vitaly
• Primary Examiner(s): Stuart, Colin W
• Application Number:
  US13/257,048
• Publication Number:
  US 20120000464A1
• Time in Patent Office: 3,484 Days
• Field of Search: 12820421, 12820024, 12820314, 12820418, 12820423, 12820422
• CPC Class Codes: A61B 5/0036 including treatment, e.g., using an implantable medical device, ablating, ventilating
• CPC Class Codes: A61B 5/03 Detecting, measuring or recording fluid pressure within the body other than blood pressure, e.g. cerebral pressure; Measuring pressure in body tissues or organs A61B5/205 takes precedence
• CPC Class Codes: A61B 5/036 by means introduced into body tracts A61B5/032 and A61B5/035 take precedence
• CPC Class Codes: A61B 5/038 Measuring oral pressure
• CPC Class Codes: A61B 5/08 Detecting, measuring or recording devices for evaluating the respiratory organs A61B5/0205 takes precedence
• CPC Class Codes: A61B 5/0816 Measuring devices for examining respiratory frequency measuring frequency of electric signals G01R23/00
• CPC Class Codes: A61B 5/085 Measuring impedance of respiratory organs or lung elasticity
• CPC Class Codes: A61B 5/087 Measuring breath flow
• CPC Class Codes: A61B 5/091 Measuring volume of inspired or expired gases, e.g. to determine lung capacity
• CPC Class Codes: A61B 5/412 Detecting or monitoring sepsis
• CPC Class Codes: A61M 16/00 Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes stimulating the respiratory movement by mechanical, pneumatic or electrical means, iron lungs combined with gas breathing means A61H31/00
• CPC Class Codes: A61M 16/0051 with alarm devices
• CPC Class Codes: A61M 16/021 operated by electrical means A61M16/202 – A61M16/205 take precedence
• CPC Class Codes: A61M 2205/18 with alarm
• CPC Class Codes: A61M 2205/33 Controlling, regulating or measuring
• CPC Class Codes: A61M 2205/3331 Pressure; Flow
• CPC Class Codes: A61M 2205/3344 Measuring or controlling pressure at the body treatment site
• CPC Class Codes: A61M 2205/3553 remote, e.g. between patient's home and doctor's office
• CPC Class Codes: A61M 2205/3569 sublocal, e.g. between console and disposable
• CPC Class Codes: A61M 2205/3584 using modem, internet or bluetooth
• CPC Class Codes: A61M 2205/3592 : using telemetric means, e.g. radio or optical transmission
• CPC Class Codes: A61M 2230/205 : partial oxygen pressure (P-O2)
• CPC Class Codes: A61M 2230/40 : Respiratory characteristics
• CPC Class Codes: A61M 2230/435 : partial O2 pressure (P-O2)

Abstract

A computer-implemented patient information provisioning method is disclosed. The method includes automatically extracting with a computer system, from records maintained for a patient under care in a healthcare facility, information from a electronic medical record; obtaining with the computer system information about a medical ventilator treating the patient; using the information from the electronic medical record and the information about the medical ventilator to determine whether a potentially dangerous condition exists with respect to the ventilator; and electronically alerting a caregiver if it is determined that a potentially dangerous condition exists.

Claims

1. A computer-implemented patient information provisioning method, comprising:

identifying, as key words, terms likely to occur in electronic medical records that are determined to indicate presence of acute lung injury or acute respiratory distress syndrome;

automatically extracting with a computer system and the identified terms, from records maintained for a patient under care in a healthcare facility, information from an electronic medical record, and automatically analyzing text of the electronic medical record to determine whether the patient under care has acute lung injury or acute respiratory distress syndrome, wherein the automatically extracting comprises querying written textual descriptions in patient reports for the identified key words that are indicative of acute lung injury or acute respiratory distress syndrome;

obtaining with the computer system, and as a result of identifying in the analyzed text of the electronic medical record key words that are determined to indicate presence of acute lung injury or acute respiratory distress syndrome, information about a medical ventilator currently treating the patient;

adjusting an operational value for the medical ventilator from a normal value that is used for patients who do not have acute lung injury or acute respiratory distress syndrome, based on determining that an improper setting exists for the patient as a combination of (a) the patient'"'"'s electronic medical record having one or more key words that are indicative of acute lung injury or acute respiratory distress syndrome, and (b) the medical ventilator having a current value inconsistent with treatment of someone with acute lung injury or acute respiratory distress syndrome;

determining that a potentially dangerous condition exists for the patient based on a measured value for the medical ventilator being excessive compared to the adjusted operational value;

identifying a contact identifier for a device of a caregiver based on a determination of who is currently assigned responsibility for the patient, and as a result of determining that the potentially dangerous condition exists; and

electronically alerting the caregiver remote from the patient if it is determined that the potentially dangerous condition exists.

2. The method of claim 1, wherein the information from the electronic medical record comprises data from an arterial blood gas analysis.

3. The method of claim 1, further comprising obtaining with the computer system textual information from a medical report for the patient and using the textual information to determine whether a potentially dangerous condition exists with respect to the medical ventilator.

4. The method of claim 1, wherein the information about the medical ventilator comprises information about a measured peak pressure or set tidal volume for the medical ventilator.

5. The method of claim 4, wherein the potentially dangerous condition is determined to exist if the information from the electronic medical record indicates an arterial blood gas level of PaO₂/FIO₂<

300 mmHg, pressure is above 35 mm H₂O or volume is above 8 mL/kg.

6. The method of claim 1, wherein electronically alerting a caregiver comprises providing an electronic messaging service with a description of an alerting condition of the patient, and information identifying the patient.

7. The method of claim 1, further comprising blocking alerting of the caregiver if the caregiver has previously been notified about the patient a predetermined number of times in a predetermined time period.

8. The computer-implemented method of claim 1, further comprising receiving an input from the caregiver to control the medical ventilator.

9. The computer-implemented method of claim 1, wherein the information from the electronic medical record does not indicate a diagnosis of acute lung injury or acute respiratory distress syndrome.

10. The computer-implemented method of claim 1, further comprising suppressing the electronic alerting of the caregiver until the potentially dangerous condition has been determined to have persisted for a particular time period.

11. The computer-implemented method of claim 1, further comprising suppressing the electronic alerting of the caregiver upon determining that prior alerts have been provided to the caregiver.

12. The computer-implemented method of claim 1, wherein a determination about whether a potentially dangerous condition exists is based on a first group of data that is obtained repeatedly at a first frequency, and a second group of data that is obtained at a different, second frequency, wherein the frequencies depend on how frequently the groups of data are expected to change over time.

13. The computer-implemented method of claim 1, wherein a determination about whether a potentially dangerous condition exists comprises making a provisional determination based on a first set of data, and if the provisional determination is positive regarding a potentially dangerous condition existing, making a final determination using a second set of data.

14. The computer-implemented method of claim 1, wherein determining that a potentially dangerous condition exists for the patient further comprises natural language processing of text in the electronic medical record.

15. The computer-implemented method of claim 1, further comprising automatically changing settings of the medical ventilator as a result of determining that a potentially dangerous condition exists for the patient.

16. The computer-implemented method of claim 1, further comprising delaying the electronic alerting of the caregiver based on a determination of prior alerts that have been provided for the patient.

17. The computer-implemented method of claim 1, further comprising determining a particular location of the patient to identify the contact identifier of the caregiver.

18. A computing system, comprising:

a medical ventilator for providing mechanical ventilation to a patient;

one or more processors;

memory; and

one or more programs, wherein the one or more programs are stored in the memory and configured to be executed by the one or more processors, the one or more programs including;

instructions for identifying, as key words, terms likely to occur in electronic medical records that are determined to indicate presence of acute lung injury or acute respiratory distress syndrome;

instructions for automatically extracting, from records maintained for the patient, information from an electronic medical record, and automatically analyzing text of the electronic medical record to determine whether the patient under care has acute lung injury or acute respiratory distress syndrome, wherein the automatically extracting comprises querying written textual descriptions in patient reports for the identified key words that are indicative of acute lung injury or acute respiratory distress syndrome;

instructions for obtaining with the computing system, and as a result of identifying in the analyzed text of the electronic medical record key words that are determined to indicate presence of acute lung injury or acute respiratory distress syndrome, current information about the medical ventilator;

instructions for adjusting an operational value for the medical ventilator from a normal value that is used for patients who do not have acute lung injury or acute respiratory distress syndrome, based on determining that an improper setting exists for the patient as a combination of (a) the patient'"'"'s electronic medical record having one or more key words that are indicative of acute lung injury or acute respiratory distress syndrome, and (b) the medical ventilator having a current value inconsistent with treatment of someone with acute lung injury or acute respiratory distress syndrome;

instructions for determining that a potentially dangerous condition exists for the patient based on a measured value for the medical ventilator being excessive compared to the adjusted operational value;

instructions for identifying a contact identifier for a device of a caregiver based on a determination of who is currently assigned responsibility for a location of the patient in the medical facility; and

instructions for electronically alerting the caregiver remote from the patient if it is determined that the potentially dangerous condition exists.

19. The system of claim 18, wherein the information from the electronic medical record comprises data from an arterial blood gas analysis.

20. The system of claim 18, further comprising instructions for obtaining textual information from a medical report for the patient and using the textual information to determine whether the potentially dangerous condition exists with respect to the medical ventilator.

21. The system of claim 18, wherein the information about the medical ventilator comprises information about a measured peak pressure or set tidal volume for the medical ventilator.

22. The system of claim 21, wherein a potential dangerous condition is determined to exist if the information from the electronic medical record indicates an arterial blood gas level of PaO₂/FIO₂<

300 mmHg, and pressure is above 35 mm H₂O or volume is above 8 mL/kg predicted body weight.

23. The system of claim 18, wherein electronically alerting a caregiver comprises providing an electronic messaging service with a description of an alerting condition of the patient, and information identifying the patient.

24. The system of claim 18, further comprising instructions for blocking alerting of the caregiver if the caregiver has previously been notified about the patient a predetermined number of times in a predetermined time period.

25. A computer-implemented patient information provisioning system, comprising:

one or more mechanical ventilators for treating patients in a healthcare facility;

an interface operating on a computer processor system programmed to identify, as key words, terms likely to occur in electronic medical records that are determined to indicate presence of acute lung injury or acute respiratory distress syndrome, and obtain (a) data about operating parameters of the one or more mechanical ventilators, including information about the location(s) of the one or more mechanical ventilators, (b) information for electronically contacting particular caregivers who correspond to patients served by the one or more mechanical ventilators and are identified for contact based on a determination of what caregiver is currently assigned responsibility for a location in the healthcare facility that currently needs action by a caregiver, and (c) data from a central electronic medical records system operated by the healthcare facility, wherein the patient information provisioning system is programmed to automatically query written textual descriptions by caregivers in electronic medical records of the electronic medical record system to determine whether trigger terms in the records indicate that one or more particular patients under care have acute lung injury or acute respiratory distress syndrome;

an electronic patient evaluator to use the data about the current operating parameters of the one or more mechanical ventilators and the data from the central electronic medical records system to

(1) adjust an operational value for a first mechanical ventilator, of the one or more mechanical ventilators, from a normal value that is used for patients who do not have acute lung injury or respiratory distress syndrome, based on determining that a dangerous condition exists for a first patient as a combination of

(a) the first patient'"'"'s electronic medical record having one or more key words that are indicative of acute lung injury or acute respiratory distress syndrome, and

(b) the first mechanical ventilator having a current value inconsistent with treatment of someone with acute lung injury or acute respiratory distress syndrome;

(2) determine that a potentially dangerous condition exists for the first patient based on a measured value for the first mechanical ventilator being excessive compared to the adjusted operational value; and

(3) identify that the first patient is receiving an inappropriate low tidal volume from the first mechanical ventilator by determining that a measured value for the first mechanical ventilator is excessive compared to the adjusted operational value; and

an alert module to provide, for transmission to one or more caregivers who are remote from the first mechanical ventilator, a notification of the identified dangerous condition.