System and method for providing blood pressure safe zone indication during autoregulation monitoring

• US 10,499,818 B2
• Filed: 10/18/2016
• Issued: 12/10/2019
• Est. Priority Date: 10/19/2015
• Status: Active Grant

• Current Assignee: Covidien LP (Medtronic Plc)
• Original Assignee: Covidien LP (Medtronic Plc)
• Inventors: Addison, Paul Stanley, Watson, James N., Montgomery, Dean
• Primary Examiner(s): Messersmith, Eric J
• Application Number:
  US15/296,150
• Publication Number:
  US 20170105631A1
• Time in Patent Office: 1,148 Days
• CPC Class Codes: A61B 5/0059 using light, e.g. diagnosis by transillumination, diascopy, fluorescence A61B5/0093, A61B5/1455, A61B5/02416 and A61B5/0261 take precedence
• CPC Class Codes: A61B 5/02028 Determining haemodynamic parameters not otherwise provided for, e.g. cardiac contractility or left ventricular ejection fraction
• CPC Class Codes: A61B 5/0205 Simultaneously evaluating both cardiovascular conditions and different types of body conditions, e.g. heart and respiratory condition
• CPC Class Codes: A61B 5/021 Measuring pressure in heart or blood vessels A61B5/0205 takes precedence
• CPC Class Codes: A61B 5/026 Measuring blood flow A61B3/1233, A61B3/1241 take precedence
• CPC Class Codes: A61B 5/0261 using optical means, e.g. infrared light
• CPC Class Codes: A61B 5/031 Intracranial pressure
• CPC Class Codes: A61B 5/14546 for measuring analytes not otherwise provided for, e.g. ions, cytochromes
• CPC Class Codes: A61B 5/14553 specially adapted for cerebral tissue
• CPC Class Codes: A61B 5/4064 Evaluating the brain A61B5/031, A61B5/369, A61B5/14553 take precedence
• CPC Class Codes: A61B 5/7246 using correlation, e.g. template matching or determination of similarity
• CPC Class Codes: A61B 5/742 using visual displays A61B5/339 takes precedence
• CPC Class Codes: A61B 5/7425 Displaying combinations of multiple images regardless of image source, e.g. displaying a reference anatomical image with a live image geometric transforms for image registration G06T3/14; enhancement using image fusion G06T5/50; algorithms for registration of images G06T7/30
• CPC Class Codes: A61B 5/743 Displaying an image simultaneously with additional graphical information, e.g. symbols, charts, function plots
• CPC Class Codes: G16H 40/63 for local operation
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems
• CPC Class Codes: G16H 50/30 for calculating health indices; for individual health risk assessment

Abstract

A method for monitoring autoregulation includes, using a processor, using a processor to execute one or more routines on a memory. The one or more routines include receiving one or more physiological signals from a patient, determining a correlation-based measure indicative of the patient'"'"'s autoregulation based on the one or more physiological signals, and generating an autoregulation profile of the patient based on autoregulation index values of the correlation-based measure. The autoregulation profile includes the autoregulation index values sorted into bins corresponding to different blood pressure ranges. The one or more routines also include designating a blood pressure range encompassing one or more of the bins as a blood pressure safe zone indicative of intact regulation and providing a signal to a display to display the autoregulation profile and a first indicator of the blood pressure safe zone.

Claims

1. A monitor for monitoring autoregulation, the monitor comprising:

a display;

a memory encoding one or more processor-executable instructions; and

one or more processors configured to access and execute the one or more instructions encoded by the memory, wherein the instructions, when executed, cause the one or more processors to;

receive one or more physiological signals from a patient;

determine a correlation-based measure indicative of an autoregulation of the patient based on the one or more physiological signals;

generate an autoregulation profile of the patient based on autoregulation index values of the correlation-based measure, wherein the autoregulation profile comprises the autoregulation index values sorted into bins corresponding to different blood pressure ranges;

designate a blood pressure range encompassing one or more of the bins as a blood pressure safe zone indicative of intact autoregulation;

provide a first signal to the display to display the autoregulation profile and a first indicator of the blood pressure safe zone; and

provide a second signal to the display to display a second indicator of a target blood pressure within the blood pressure safe zone for the patient.

2. The monitor of claim 1, wherein the correlation-based measure is one of a cerebral oximetry index, a hemoglobin volume index, or a mean velocity index.

3. The monitor of claim 1, wherein the one or more instructions, when executed, cause the one or more processors to:

receive patient specific inputs, the patient specific input being physical characteristics of the patient,

wherein the instructions to designate the blood pressure range encompassing one or more of the bins as the blood pressure safe zone indicative of intact autoregulation comprise instructions to designate the blood pressure range encompassing one or more of the bins as an initial blood pressure safe zone indicative of intact autoregulation utilizing at least historical population data based on the patient specific inputs, and

wherein the instructions to provide the first signal to the display comprise instructions to provide a signal to display an indicator of the initial blood pressure safe zone.

4. The monitor of claim 3, wherein the instructions to designate the blood pressure range encompassing one or more of the bins as the initial blood pressure safe zone indicative of intact autoregulation comprise instructions to designate the blood pressure range as the initial blood pressure safe zone utilizing both the historical population data based on the patient specific inputs and initially measured baselines of physiological parameters of the patient.

5. The monitor of claim 3, wherein the one or more instructions, when executed, cause the one or more processors to:

determine if there is sufficient data within the autoregulation profile to designate a patient-specific blood pressure safe zone;

in response to determining that there is sufficient data, subsequently designate the blood pressure range encompassing one or more of the bins as a subsequent patient specific blood pressure safe zone indicative of intact autoregulation utilizing the autoregulation index values and corresponding blood pressure levels; and

provide a third signal to the display to display an indicator of the subsequent patient specific blood pressure safe zone.

6. The monitor of claim 5,

wherein the indicator of the initial blood pressure safe zone comprises a first color, and

wherein the indicator of the subsequent patient specific blood pressure safe zone comprises a second color different from the first color.

7. The monitor of claim 1, wherein the one or more instructions, when executed, cause the one or more processors to:

change a color of the second indicator displayed on the display based on a distance of a current blood pressure of the patient derived from the target blood pressure;

or

change a level of a blip bar displayed on the display based on the distance of the current blood pressure of the patient derived from the target blood pressure.

8. The monitor of claim 1, wherein the one or more instructions, when executed, cause the one or more processors to receive a user input of the target blood pressure.

9. The monitor of claim 1,

wherein the one or more physiological signals comprise a regional oxygen saturation signal and a blood pressure signal,

wherein the instructions to generate the autoregulation profile comprise instructions to generate a curve from the regional oxygen saturation signal and the blood pressure signal, and

wherein the instructions to designate the blood pressure safe zone comprise instructions to:

determine both a lower limit (LLA) and an upper limit (ULA) of autoregulation from the curve; and

determine the target blood pressure based on the curve.

10. The monitor of claim 9, wherein the instructions to determine the target blood pressure comprise instructions to designate a point equidistant between the LLA and ULA as the target blood pressure.

11. The monitor of claim 9, wherein the one or more instructions, when executed, cause the one or more processors to:

determine a first gradient of the curve at a first blood pressure portion of the curve lower than the LLA; and

determine a second gradient of the curve at a second blood pressure portion of the curve higher than the ULA,

wherein the instructions to determine the target blood pressure comprise instructions to determine the target blood pressure based on the first gradient, the second gradient, or a combination thereof.

12. The monitor of claim 9, wherein the instructions to determine the target blood pressure comprise instructions to designate a point of inflection of the curve as the target blood pressure.

13. The monitor of claim 1, wherein the one or more instructions, when executed, cause the one or more processors to provide a third signal to the display or other output device to provide an audible or visual indication that a current blood pressure of the patient is outside the blood pressure safe zone.

14. The monitor of claim 13,

wherein the audible or visual indication comprises a first audible or visual indication that indicates that the current blood pressure is higher than the blood pressure safe zone and a second audible or visual indication that the current blood pressure is lower than the blood pressure safe zone, and

wherein the first audible or visual indication is different from the second audible or visual indication.

15. The monitor of claim 1, wherein the instructions to provide the first signal to the display comprise instructions to cause the display to flash the autoregulation profile and the first indicator of the blood pressure safe zone on and off.

16. The monitor of claim 1, wherein the instructions to provide the first signal to the display comprise instructions to provide the first signal to the display to display a blood pressure history of the patient, wherein the blood pressure history depicts an amount of time blood pressure measurements within the bins are within the blood pressure safe zone.

17. The monitor of claim 16, wherein the first indicator of the blood pressure safe zone overlays a portion of the autoregulation profile corresponding to the blood pressure safe zone.

21. The monitor of claim 1, wherein the one or more instructions, when executed, cause the one or more processors to provide a third signal to the display or another output device to provide a visual or audible indication of a distance the current blood pressure is from the target blood pressure.

18. A method for monitoring autoregulation, the method comprising:

receiving, by one or more processors executing one or more instructions encoded on a memory, one or more physiological signals from a patient;

determining, by the one or more processors, a correlation-based measure indicative of an autoregulation of the patient based on the one or more physiological signals;

generating, by the one or more processors, an autoregulation profile of the patient based on autoregulation index values of the correlation-based measure, wherein the autoregulation profile comprises the autoregulation index values sorted into bins corresponding to different blood pressure ranges;

designating, by the one or more processors, a blood pressure range encompassing one or more of the bins as a blood pressure safe zone indicative of intact autoregulation;

providing, by the one or more processors and to a display, a signal to display the autoregulation profile and a first indicator of the blood pressure safe zone; and

providing, by the one or more processors and to the display, a second signal to display a second indicator of a target blood pressure within the blood pressure safe zone for the patient.

19. A monitor for monitoring autoregulation, the monitor comprising:

a display;

a memory encoding one or more processor-executable instructions; and

one or more processors configured to access and execute the one or more instructions encoded by the memory, wherein the instructions, when executed, cause the one or more processors to;

receive one or more physiological signals from a patient;

determine a correlation-based measure indicative of an autoregulation of the patient based on the one or more physiological signals;

generate an autoregulation profile of the patient based on autoregulation index values of the correlation-based measure, wherein the autoregulation profile comprises the autoregulation index values sorted into bins corresponding to different blood pressure ranges;

determine if there is sufficient data within the autoregulation profile to designate a patient-specific blood pressure safe zone;

in response to determining that there is sufficient data, designate a blood pressure range encompassing one or more of the bins as a patient-specific blood pressure safe zone indicative of intact autoregulation utilizing the autoregulation index values and corresponding blood pressure levels; and

provide a first signal to the display to display the autoregulation profile and a first indicator of the patient-specific blood pressure safe zone.

20. The monitor of claim 19, wherein the one or more instructions, when executed, cause the one or more processors to:

receive patient specific inputs, the patient specific inputs being physical characteristics of the patient;

in response to determining that there is insufficient data, designate the blood pressure range encompassing one or more of the bins as an initial blood pressure safe zone indicative of intact autoregulation utilizing at least historical population data based on the patient specific inputs; and

provide a second signal to the display to display an indicator of the initial blood pressure safe zone.