Minimally invasive determination of collateral ventilation in lungs

• US 20060264772A1
• Filed: 12/07/2005
• Published: 11/23/2006
• Est. Priority Date: 09/10/2001
• Status: Active Grant

• Current Assignee: Pulmonx Corp.
• Original Assignee: Pulmonx Pulmonx
• Inventors: Soltesz, Peter, Perkins, Rodney C., Aljuri, Nikolai, Surjan, George, Davis, Kirk, Wondka, Anthony
• Granted Patent: US 7,883,471 B2
• Time in Patent Office: Days
• US Class Current: 600/538
• CPC Class Codes: A61B 5/055 involving electronic [EMR] or nuclear [NMR] magnetic resonance, e.g. magnetic resonance imaging
• CPC Class Codes: A61B 5/08 Detecting, measuring or recording devices for evaluating the respiratory organs A61B5/0205 takes precedence
• CPC Class Codes: A61B 5/0813 Measurement of pulmonary parameters by tracers, e.g. radioactive tracers
• 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 5/4851 Prosthesis assessment or monitoring
• CPC Class Codes: A61B 5/6853 with a balloon
• CPC Class Codes: A61B 5/7278 Artificial waveform generation or derivation, e.g. synthesising signals from measured signals A61B5/327 takes precedence
• CPC Class Codes: A61M 16/04 Tracheal tubes catheters in general A61M25/00
• CPC Class Codes: A61M 16/0404 with means for selective or partial lung respiration
• CPC Class Codes: A61M 16/0434 Cuffs
• CPC Class Codes: A61M 2016/0413 with detectors of CO2 in exhaled gases

Abstract

Minimally invasive methods, systems and devices are provided for qualitatively and quantitatively assessing collateral ventilation in the lungs. In particular, collateral ventilation of a target compartment within a lung of a patient is assessed by advancement of a catheter through the tracheobronchial tree to a feeding bronchus of the target compartment. The feeding bronchus is occluded by the catheter and a variety of measurements are taken with the use of the catheter in a manner which is of low risk to the patient. Examples of such measurements include but are not limited to flow rate, volume and pressure. These measurements are used to determine the presence of collateral ventilation and to quantify such collateral ventilation.

Claims

1. A method for diagnosing collateral ventilation between lung compartments in a patient, said method comprising:

isolating a target lung compartment from at least one adjacent lung compartment;

allowing the patient to breathe air free from introduced markers; and

detecting air flow or accumulation from the isolated lung compartment over time.

2. A method as in claim 1, wherein isolating comprises introducing a catheter transtracheally to a main bronchus feeding into the target lung compartment and deploying an occlusion member on the catheter to isolate the target lung compartment.

3. A method as in claim 2, wherein detecting comprises measuring air flow through a lumen in the catheter while the patient exhales, wherein said air entered the isolated compartment via collateral passages while the patient inhaled.

4. A method as in claim 2, wherein detecting comprises accumulating air from the isolated compartment air from the isolated compartment through the catheter over a number of successive breathing cycles, wherein a continuous increase in accumulated air volume indicates collateral flow into the isolated compartment.

50. A method as in claim 2, wherein isolating comprises occluding air flow into the target lung compartment while permitting air flow from the target lung compartment through the catheter to the atmosphere.

51. A method as in claim 50, wherein the catheter comprises a one-way valve which blocks air flow into the target lung compartment and permits air flow from the compartment to the atmosphere.

54. A method as in claim 50, wherein detecting comprises generating at least one measurement of at least one characteristic of the exhaled air from the target lung compartment.

55. A method as in claim 54, wherein the at least once characteristic includes volume.

56. A method as in claim 54, wherein the at least one characteristic includes volumetric flow rate.

57. A method as in claim 54, wherein the at least one characteristic includes pressure.

58. A method as in claim 1, further comprising calculating a value of collateral resistance.

59. A method as in claim 1, further comprising determining a treatment plan based on the level of collateral ventilation.

5. A method for determining the function or malfunction of an endobronchial prosthesis positioned within a lung passageway of a patient, said method comprising:

occluding the lung passageway proximally of the endobronchial prosthesis;

allowing the patient to breathe air without any markers; and

measuring air flow or accumulation from the lung passageway over time wherein said measurement is correlative to the function or malfunction of the endobronchial prosthesis.

6. A system for detecting collateral ventilation into a lung compartment in a patient, said system comprising:

a catheter adapted to be introduced transtracheally to a bronchus leading to a target lung compartment;

an occlusion member on a distal region of the catheter, said occlusion member being adapted to selectively occlude the bronchus; and

a flow measurement sensor on the catheter to detect flow of air from the isolated compartment as the patient exhales.

52. A system as in claim 6, wherein the catheter comprises a one-way valve which blocks air flow into the target lung compartment and permits air flow from the compartment to the atmosphere.

7. A system for detecting collateral ventilation into a lung compartment in a patient, said system comprising:

a catheter adapted to be introduced transtracheally to a bronchus leading to a target lung compartment;

an occlusion member or a distal region of the catheter, said occlusion member being adapted to selectively occlude the bronchus; and

an accumulator connectable to the catheter to accumulate air exhaled from the catheter over time.

8. A system as in claim 7, wherein the accumulator comprises a slack collection bag which has substantially no resistance to filling with air.

53. A system as in claim 7, wherein the catheter comprises a one-way valve which blocks air flow into the target lung compartment and permits air flow from the compartment to the atmosphere.

9. A method of evaluating a target lung compartment of a patient, the method comprising:

positioning an instrument within a lung passageway leading to the target lung compartment so that the target lung compartment is isolated;

injecting an inert gas into the isolated target lung compartment;

generating at least one measurement of pressure within the target lung segment;

generating at least one measurement of concentration of inert gas within the target lung segment; and

analyzing the at least one target lung compartment with the use of the at least one measurement of pressure and the at least one measurement of concentration of inert gas.

10. A method as in claim 9, wherein analyzing comprises determining a degree of hyperinflation.

11. A method as in claim 10, further comprising determining a treatment plan at least partially based on the determined degree of hyperinflation.

12. A method as in claim 9, wherein analyzing comprises determining a state of compliance.

13. A method as in claim 12, further comprising determining a treatment plan at least partially based on the determined state of compliance.

14. A method as in claim 9, wherein analyzing comprises determining a collateral resistance.

15. A method as in claim 14, further comprising determining a treatment plan based on the determined collateral resistance.

16. A method as in claim 9, wherein generating the at least one measurement of pressure comprises generating a plurality of measurements of pressure over a predetermined time period.

17. A method as in claim 16, wherein the predetermined time period comprises approximately one minute.

18. A method as in claim 9, wherein generating the at least one measurement of concentration of inert gas comprises generating a plurality of measurements of concentration of inert gas over a predetermined time period.

19. A method as in claim 18, wherein the predetermined time period comprises approximately one minute.

20. A method as in claim 9, wherein the inert gas comprises helium.

21. A system for evaluating a target lung compartment comprising:

an instrument positionable within a lung passageway leading to the target lung compartment so that the target lung compartment is isolated, wherein the instrument includes a mechanism for injecting an inert gas to the target lung segment;

at least one sensor which generates measurement data reflecting pressure within the target lung segment; and

at least one sensor which generates measurement data reflecting concentration of an inert gas within the target lung segment.

22. A system as in claim 21, further comprising a processor which performs computations with the use of the measurement data reflecting pressure and the measurement data reflecting concentration of inert gas.

23. A system as in claim 22, wherein the computations include calculating a degree of hyperinflation of the target lung compartment.

24. A system as in claim 22, wherein the computations include calculating a state of compliance of the target lung compartment.

25. A system as in claim 22, wherein the computations include calculating collateral resistance of the target lung compartment.

26. A system as in claim 21, wherein the measurement data reflecting pressure comprises generating a plurality of measurements of pressure over a predetermined time period.

27. A system as in claim 26, wherein the predetermined time period comprises approximately one minute.

28. A system as in claim 21, wherein the measurement data reflecting concentration of inert gas comprises generating a plurality of measurements of concentration of inert gas over a predetermined time period.

29. A system as in claim 28, wherein the predetermined time period comprises approximately one minute.

30. A system as in claim 21, wherein the inert gas comprises helium.

31. A treatment guide to determine a course of treatment for a lung compartment of a patient, the guide comprising:

a plurality of hyperinflation values, each hyperinflation value representing a degree of hyperinflation of the lung compartment, and/or a plurality of compliance values, each compliance value representing a degree of compliance of the lung compartment; and

a plurality of treatment options, wherein each treatment option is correlated to a hyperinflation value and/or a compliance value.

32. A treatment guide as in claim 31, wherein the guide comprises a computer program.

33. A treatment guide as in claim 32, wherein the computer program includes at least one mathematical computation to generate the plurality of hyperinflation values and/or the plurality of compliance values.

34. A treatment guide as in claim 33, wherein the mathematical computation utilizes pressure and concentration of inert gas values.

35. A method of evaluating collateral ventilation of a target lung compartment of a patient, the method comprising:

positioning an instrument within a lung passageway leading to the target lung compartment so that the target lung compartment is isolated;

allowing the patient to inhale air;

generating at least one measurement of at least one characteristic of the inhaled air within or exiting the target lung compartment with the use of the instrument; and

determining a level of collateral ventilation into the target lung compartment based on the at least one measurement.

36. A method as in claim 35, wherein the at least one characteristic includes volumetric flow rate.

37. A method as in claim 35, wherein the at least one characteristic includes pressure.

38. A method as in claim 35, wherein determining a level of collateral ventilation includes calculating a value of collateral resistance.

39. A method as in claim 35, further comprising determining a treatment plan based on the level of collateral ventilation

40. A method of evaluating a patient for treatment of a target lung compartment, the method comprising:

generating at least one measurement associated with the target lung compartment while the patient is breathing air;

calculating a level of collateral ventilation into the target lung compartment based on the at least one measurement; and

treating the patient based on the calculated level of collateral ventilation.

41. A method as in claim 40, wherein treating the patient comprises aspirating the target lung compartment.

42. A method as in claim 40, wherein treating the patient comprises occluding a lung passageway feeding the target lung compartment.

43. A method as in claim 42, wherein occluding comprises positioning an occlusal stent within the lung passageway.

44. A method as in claim 40, wherein calculating comprises calculating a value of collateral resistance based on the at least one measurement.

45. A treatment guide to determine a course of treatment for a lung compartment of a patient, the guide comprising:

a plurality of collateral resistance values, each value representing degree of collateral ventilation of the lung compartment; and

a plurality of treatment options, wherein each treatment option is correlated to a collateral resistance value.

46. A treatment guide as in claim 45, wherein the guide comprises a computer program.

47. A treatment guide as in claim 46, wherein the computer program includes at least one mathematical computation to generate the plurality of collateral resistance values.

48. A treatment guide as in claim 47, wherein the mathematical computation utilizes pressure and volumetric flow rate values.

49. A treatment guide as in claim 46, wherein the guide includes a visual display showing a curve representing a relationship between the collateral resistance values and a combination of the pressure and volumetric flow rates.