Respiratory therapy control based on cardiac cycle

• US 20050109339A1
• Filed: 09/15/2004
• Published: 05/26/2005
• Est. Priority Date: 09/18/2003
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Stahmann, Jeffrey E., Hartley, Jesse W., Lee, Kent, Ni, Quan
• Granted Patent: US 7,967,756 B2
• Time in Patent Office: Days
• US Class Current: 128/204.180
• CPC Class Codes: A61N 1/3601 of respiratory organs
• CPC Class Codes: A61N 1/36514 controlled by a physiological quantity other than heart potential, e.g. blood pressure controlled by two or more physical parameters A61N1/36585
• CPC Class Codes: A61N 1/36542 controlled by body motion, e.g. acceleration
• CPC Class Codes: A61N 1/36578 controlled by mechanical motion of the heart wall, e.g. measured by an accelerometer or microphone

Abstract

Methods and systems involve adjusting respiratory therapy based on cardiac cycle phase. A parameter indicative of cardiac cycle is sensed and the respiratory therapy is adjusted based on cardiac cycle phase. Modulation of respiratory therapy pressure reinforces the pumping action of the heart and results in increased cardiac output with decreased expenditure of myocardial energy output.

Claims

1. A method for delivering airway pressure to a patient, comprising:

determining cardiac cycle phase; and

controlling the airway pressure based on the cardiac cycle phase, wherein controlling the airway pressure is performed at least in part implantably.

2. The method of claim 1, wherein determining the cardiac cycle phase comprises detecting the delivery of a cardiac pacing pulse.

3. The method of claim 1, wherein determining the cardiac cycle phase comprises sensing a parameter indicative of cardiac cycle phase.

4. The method of claim 3, wherein sensing the parameter comprises sensing oxygen saturation.

5. The method of claim 4, wherein sensing the parameter comprises sensing blood pressure.

6. The method of claim 4, wherein sensing the parameter comprises sensing cardiac electrical activity.

7. The method of claim 4, wherein sensing the parameter comprises sensing a parameter associated with cardiac motion.

8. The method of claim 7, wherein sensing the parameter associated with cardiac motion comprises sensing transthoracic impedance.

9. The method of claim 7, wherein sensing the parameter associated with cardiac motion comprises sensing heart sounds.

10. The method of claim 1, wherein implantably controlling the airway pressure comprises matching intrathoracic pressure with cardiac cycle phase.

11. The method of claim 1, wherein implantably controlling the airway pressure comprises:

delivering a first airway pressure during a first cardiac cycle phase; and

delivering a second airway pressure during a second cardiac cycle phase.

12. The method of claim 1, wherein implantably controlling the airway pressure comprises:

modulating airway pressure above a baseline pressure during cardiac systole; and

modulating airway pressure below a baseline pressure during cardiac diastole.

13. The method of claim 1, wherein:

determining the cardiac cycle phase comprises anticipating the cardiac cycle phase; and

implantably controlling the airway pressure comprises controlling the airway pressure based on the anticipated cardiac cycle phase.

14. The method of claim 13, wherein anticipating the cardiac cycle comprises anticipating the cardiac cycle based on recent cardiac cycle history.

15. The method of claim 1, wherein implantably controlling the airway pressure comprises implantably controlling airway pressure to improve at least one of ventricular preload or ventricular afterload.

16. The method of claim 1, wherein implantably controlling the airway pressure comprises implantably controlling the airway pressure to enhance cardiac pumping action.

17. A therapy control system, comprising:

a detector system configured to determine cardiac cycle phase; and

a control unit coupled to the detector system and configured to control airway pressure based on the cardiac cycle phase, wherein the control unit includes at least one implantable component.

18. The system of claim 17, wherein the detector system comprises a sensor configured to sense a parameter associated with cardiac cycle phase.

19. The system of claim 17, further comprising an external respiratory therapy unit configured to deliver an external respiratory therapy to a patient, wherein the implantable control unit is configured to control the delivery of the external respiratory therapy based on the cardiac cycle phase.

20. The system of claim 17, wherein the implantable control unit is configured to match intrathoracic pressure with cardiac cycle.

21. The system of claim 17, wherein the implantable control unit is configured to deliver a first airway pressure during a first cardiac cycle phase and to deliver a second airway pressure during a second cardiac cycle phase.

22. The system of claim 17, wherein the implantable control unit is configured to modulate airway pressure above a baseline pressure during cardiac systole and to modulate airway pressure below a baseline pressure during cardiac diastole.

23. The system of claim 17, wherein:

the detector system is configured to anticipate the cardiac cycle phase; and

the implantable control unit is configured to control the airway pressure based on the anticipated cardiac cycle phase.

24. The system of claim 23, wherein the detector system is configured to store cardiac cycle history and to anticipate the cardiac cycle phase based on the cardiac cycle history.

25. The system of claim 17, wherein the implantable control unit is configured to control the airway pressure comprises to improve at least one of ventricular preload or ventricular afterload.

26. A method, comprising:

delivering cardiac pacing pulses to a patient; and

controlling a patient'"'"'s airway pressure based on the delivery of the cardiac pacing pulses.

27. The method of claim 26, wherein controlling the patient'"'"'s airway pressure is performed at least in part implantably.

28. The method of claim 26, wherein controlling the patient'"'"'s airway pressure based on the delivery of the cardiac pacing pulses comprises:

determining cardiac cycle phase based on the delivery of the cardiac pacing pulses; and

controlling the patient'"'"'s airway pressure based on the cardiac cycle phase.

29. The method of claim 26, wherein at least one of delivering the cardiac pacing pulses and controlling a patient'"'"'s airway pressure are performed to treat or prevent heart failure.

30. The method of claim 26, wherein at least one of delivering the cardiac pacing pulses and controlling a patient'"'"'s airway pressure are performed to treat or prevent disordered breathing.

31. The method of claim 26, wherein controlling the patient'"'"'s airway pressure based on the delivery of the cardiac pacing pulses comprises enhancing at least one of ventricular preload and ventricular afterload using the controlled airway pressure.

32. The method of claim 26, wherein delivering the cardiac pacing pulses comprises delivering the cardiac pacing pulses to treat bradycardia.

33. The method of claim 26, wherein delivering the cardiac pacing pulses comprises delivering the cardiac pacing pulses to treat tachycardia.

34. The method of claim 26, wherein delivering the cardiac pacing pulses comprises delivering the cardiac pacing pulses to treat cardiac mechanical dysynchrony.

35. A medical system, comprising:

a pulse generator configured to deliver cardiac pacing pulses to a patient'"'"'s heart; and

a control unit coupled to the pulse generator, the control unit configured to control airway pressure delivered to the patient based on the delivery of the cardiac pacing pulses.

36. The medical system of claim 35, wherein the control unit comprises at least on implantable component.

37. The medical system of claim 35, wherein the control unit determines cardiac cycle phase based on the cardiac pacing pulses and controls the airway pressure based on the cardiac cycle phase.

38. The medical system of claim 35, further comprising an external respiratory therapy device, coupled to the control unit, and configured to deliver the controlled airway pressure to the patient.

39. A method of delivering therapy to a patient, comprising:

delivering an external respiratory therapy to a patient to treat disordered breathing;

determining cardiac cycle phase; and

controlling delivery of the external respiratory therapy based on the cardiac cycle phase.

40. The method of claim 39, wherein determining the cardiac cycle phase comprises detecting the delivery of a cardiac pacing pulse.

41. The method of claim 39, wherein determining the cardiac cycle phase comprises sensing a parameter indicative of cardiac cycle phase.

42. The method of claim 41, wherein sensing the parameter indicative of cardiac cycle phase comprises sensing blood oxygen saturation.

43. The method of claim 41, wherein sensing the parameter indicative of cardiac cycle phase comprises sensing blood pressure.

44. The method of claim 41, wherein sensing the parameter indicative of cardiac cycle phase comprises sensing cardiac electrical activity.

45. The method of claim 41, wherein sensing the parameter indicative of cardiac cycle phase comprises sensing thoracic motion.

46. The method of claim 41, wherein sensing the parameter indicative of cardiac cycle phase comprises sensing airway pressure modulation.

47. The method of claim 41, wherein sensing the parameter indicative of cardiac cycle phase comprises sensing heart sounds.

48. The method of claim 39, wherein controlling the airway pressure based on cardiac cycle phase comprises:

delivering a first airway pressure during a first portion of a cardiac cycle; and

delivering a second airway pressure during a second portion of the cardiac cycle.

49. The method of claim 39, wherein controlling the airway pressure comprises:

modulating airway pressure above a baseline pressure during cardiac systole; and

modulating airway pressure below a baseline pressure during cardiac diastole.

50. The method of claim 39, wherein:

determining the cardiac cycle phase comprises anticipating the cardiac cycle phase; and

controlling the airway pressure comprises controlling the airway pressure based on the anticipated cardiac cycle phase.

51. The method of claim 50, wherein anticipating the cardiac cycle comprises anticipating the cardiac cycle based on recent cardiac cycle history.

52. The method of claim 39, wherein implantably controlling the airway pressure comprises implantably controlling airway pressure to improve at least one of ventricular preload or ventricular afterload.

53. The method of claim 39, wherein delivering the external respiratory therapy comprises delivering positive airway pressure therapy.

54. The method of claim 39, wherein delivering the external respiratory therapy comprises delivering the external respiratory therapy to treat or prevent heart failure.

55. A medical therapy system, comprising:

a respiratory therapy unit configured to deliver a patient-external respiratory therapy to a patient to treat disordered breathing;

detector circuitry configured to determine cardiac cycle phase; and

a control unit coupled to the detector system and the respiratory therapy unit, the control unit configured to control delivery of the respiratory therapy based on the cardiac cycle phase.

56. The system of claim 55, wherein the respiratory therapy unit comprises a positive airway pressure device.

57. The system of claim 55, wherein at least one of the detector system and the control unit are components of the respiratory therapy unit.

58. The system of claim 55, wherein the detector circuitry comprises a sensor configured to sense a parameter associated with cardiac cycle phase and to determine cardiac cycle phase based on the sensed parameter.

59. The system of claim 58, wherein the sensor comprises a blood oxygen saturation sensor.

60. The system of claim 58, wherein the sensor comprises a blood pressure sensor.

61. The system of claim 58, wherein the sensor comprises a cardiac electrical activity sensor.

62. The system of claim 58, wherein the sensor comprises a thoracic motion sensor.

63. The system of claim 58, wherein the sensor comprises an airway pressure sensor.

64. The system of claim 58, wherein the sensor comprises a heart sound sensor.

65. The system of claim 58, wherein the detector circuitry is configured to detect delivery of cardiac pacing pulses and to determine cardiac cycle phase based on the delivery of the cardiac pacing pulses.

66. The system of claim 58, wherein the control unit is configured to deliver a first airway pressure during cardiac systole and a second airway pressure during cardiac diastole.

67. The system of claim 55, wherein:

the detector circuitry is configured to anticipate the cardiac cycle phase; and

the control unit is configured to control the airway pressure based on the anticipated cardiac cycle phase.

68. The system of claim 55, wherein the patient-external respiratory therapy comprises a therapy to treat or prevent heart failure.

69. A system for controlling delivery of airway pressure to a patient, comprising:

means for determining cardiac cycle phase; and

means for implantably controlling the airway pressure based on the cardiac cycle phase.

70. The system of claim 69, further comprising:

means for sensing a parameter indicative of cardiac cycle phase; and

means for determining the cardiac cycle phase based on the parameter.

71. The system of claim 69, further comprising:

means for detecting the delivery of a cardiac pacing pulse; and

means for determining the cardiac cycle phase based on the delivery of the cardiac pacing pulse.

72. A system, comprising:

means for delivering cardiac pacing pulses to a patient; and

means for controlling a patient'"'"'s airway pressure based on the delivery of the cardiac pacing pulses.

73. The system of claim 72, further comprising:

means for determining cardiac cycle phase based on the delivery of the cardiac pacing pulses; and

means for controlling the patient'"'"'s airway pressure based on the cardiac cycle phase.

74. A system for delivering therapy to a patient, comprising:

means for delivering an external respiratory therapy to a patient to treat disordered breathing;

means for determining cardiac cycle phase; and

means for controlling delivery of an airway pressure of the external respiratory therapy based on the cardiac cycle phase.

75. The system of claim 74, further comprising means for detecting the delivery of a cardiac pacing pulse and means for determining the cardiac cycle phase based on the delivery of the cardiac pacing pulse.

76. The system of claim 74, further comprising:

means for sensing a parameter indicative of cardiac cycle phase; and

means for determining cardiac cycle phase based on the sensed parameter.

77. The system of claim 74, further comprising means delivering a first airway pressure during a first portion of a cardiac cycle and means for delivering a second airway pressure during a second portion of the cardiac cycle.

78. The system of claim 74, further comprising:

means for anticipating the cardiac cycle phase; and

means for controlling the airway pressure based on the anticipated cardiac cycle phase.