SYSTEM AND METHOD FOR ANALYZING A PATIENT STATUS FOR RESPIRATORY INSUFFICIENCY FOR USE IN AUTOMATED PATIENT CARE

• US 20070203422A1
• Filed: 03/26/2007
• Published: 08/30/2007
• Est. Priority Date: 11/16/1999
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Bardy, Gust
• Granted Patent: US 7,959,574 B2
• Time in Patent Office: Days
• US Class Current: 600/529
• CPC Class Codes: A61B 2505/03 Intensive care
• CPC Class Codes: A61B 5/0031 Implanted circuitry
• CPC Class Codes: A61B 5/02055 Simultaneously evaluating both cardiovascular condition and temperature
• CPC Class Codes: A61B 5/0215 by means inserted into the body catheters A61M25/00
• CPC Class Codes: A61B 5/024 Detecting, measuring or recording pulse rate or heart rate A61B5/0205, A61B5/021 take precedence
• CPC Class Codes: A61B 5/0535 Impedance plethysmography for measuring blood flow A61B5/0295
• CPC Class Codes: A61B 5/0816 Measuring devices for examining respiratory frequency measuring frequency of electric signals G01R23/00
• CPC Class Codes: A61B 5/1112 Global tracking of patients, e.g. by using GPS
• CPC Class Codes: A61B 5/1116 Determining posture transitions
• CPC Class Codes: A61B 5/145 Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissuemeasuring of blood pressure or blood flow A61B5/02; non-radiation detecting or locating of foreign bodies in blood A61B5/06
• CPC Class Codes: A61B 5/14532 for measuring glucose, e.g. by tissue impedance measurement
• CPC Class Codes: A61B 5/14539 for measuring pH
• CPC Class Codes: A61B 5/14546 for measuring analytes not otherwise provided for, e.g. ions, cytochromes
• CPC Class Codes: A61B 5/349 Detecting specific parameters of the electrocardiograph cycle
• CPC Class Codes: A61N 1/3624 occurring in the atrium, i.e. atrial tachycardia
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 15/00 ICT specially adapted for medical reports, e.g. generation or transmission thereof
• CPC Class Codes: G16H 20/30 relating to physical therapies or activities, e.g. physiotherapy, acupressure or exercising
• CPC Class Codes: G16H 20/40 relating to mechanical, radiation or invasive therapies, e.g. surgery, laser therapy, dialysis or acupuncture
• CPC Class Codes: G16H 40/67 for remote operation
• CPC Class Codes: G16H 50/20 : for computer-aided diagnosis, e.g. based on medical expert systems
• CPC Class Codes: G16H 50/70 : for mining of medical data, e.g. analysing previous cases of other patients
• CPC Class Codes: G16H 70/60 : relating to pathologies
• CPC Class Codes: Y10S 128/92 : Computer assisted medical diagnostics
• CPC Class Codes: Y10S 128/923 : by comparison of patient data to other data

Abstract

A system and method for analyzing a patient status for respiratory insufficiency for use in automated patient care. A set of one or more physiological measures relating to patient information recorded on a substantially continuous basis or derived therefrom are received. The physiological measures set is stored into a patient care record for an individual patient into a database. One or more of the physiological measures in the physiological measures set are analyzed relative to one or more other physiological measures to determine a pathophysiology indicating an absence, an onset, a progression, a regression, and a status quo of respiratory insufficiency.

Claims

1. A system for analyzing a patient status for respiratory insufficiency for use in automated patient care, comprising:

a server system receiving a set of one or more physiological measures relating to patient information recorded on a substantially continuous basis or derived therefrom;

a database module storing the physiological measures set into a patient care record for an individual patient into a database; and

an analyzer analyzing one or more of the physiological measures in the physiological measures set relative to one or more other physiological measures to determine a pathophysiology indicating an absence, an onset, a progression, a regression, and a status quo of respiratory insufficiency.

2. A system according to claim 1, further comprising:

the analyzer analyzing the physiological measures in the physiological measures set relative to the other physiological measures to determine a pathophysiology indicating an absence, an onset, a progression, a regression, and a status quo of diseases other than respiratory insufficiency.

3. A system according to claim 1, further comprising:

the server system receiving a set of one or more quality of life measures relating to patient information recorded on a substantially continuous basis or derived therefrom;

the database module storing the quality of life measures set into the patient care record for the individual patient into the database; and

the analyzer analyzing the quality of life measures in the physiological measures set relative to the other quality of life measures to determine a pathophysiology indicating an absence, an onset, a progression, a regression, and a status quo of respiratory insufficiency.

4. A system according to claim 1, further comprising:

the server system receiving a set of one or more baseline physiological measures relating to patient information recorded during an initial time period or derived therefrom;

the database module storing the baseline physiological measures set into the patient care record for the individual patient into the database; and

the analyzer analyzing the physiological measures in the physiological measures set relative to the baseline physiological measures to determine a pathophysiology indicating an absence, an onset, a progression, a regression, and a status quo of respiratory insufficiency.

5. A system according to claim 4, wherein the pathophysiology to indicate the progression trending into one of a state of diagnosed respiratory insufficiency and a state of likely respiratory insufficiency is selected from a group comprising:

a respiratory rate that has increased over 1.0 SD from a mean respiratory rate in the baseline physiological measures;

a heart rate that has increased over 1.0 SD from a mean heart rate in the baseline physiological measures;

transthoracid impedance that has increased over 1.0 SD from a mean transthoracic impedance in the baseline physiological measures;

ventilatory tidal volume that has increased over 1.0 SD from a tidal volume score in the baseline physiological measures;

an arterial oxygen score that has decreased over 1.0 SD from an arterial oxygen score in the baseline physiological measures;

an arterial carbon dioxide score that has decreased over 1.0 SD from an arterial carbon dioxide score in the baseline physiological measures;

a patient activity score that has decreased over 1.0 SD from a mean patient activity score in the baseline physiological measures;

a temperature that has increased over 1.0 SD from a mean temperature in the baseline physiological measures;

short-lived spikes in the patient activity score that have occurred over time periods under 5 minutes compared to the baseline physiological measures;

short-lived spikes in a pulmonary arterial pressure score that have occurred over time periods under 5 minutes compared to the baseline physiological measures;

exercise tolerance quality of life measures that have decreased over 1.0 SD from a mean exercise tolerance in the baseline physiological measures;

respiratory distress quality of life measures that have deteriorated by more than 1.0 SD from mean respiratory distress quality of life measures in the baseline physiological measures;

short-lived spikes in right ventricular pressure that have occurred over time periods under 5 minutes compared to the baseline physiological measures;

short-lived spikes in the transthoracic impedance that have occurred over time periods under 5 minutes compared to the baseline physiological measures; and

atrial fibrillation and a sequence of rhythm changes relative to the atrial fibrillation.

6. A system according to claim 5, wherein the pathophysiology to indicate the progression is inverted as the pathophysiology to indicate the regression trending from one of a state of diagnosed respiratory insufficiency and a state of likely respiratory insufficiency.

7. A system according to claim 1, wherein the pathophysiology to indicate the progression into a state of diagnosed respiratory insufficiency is selected from a group comprising:

an absolute limit of arterial oxygen less than 85 mm Hg; and

an absolute limit of arterial carbon dioxide falling below 25 mm Hg in an absence of marked exercise as indicated by hyperventilation; and

an absolute limit of arterial carbon dioxide greater than 50 mm Hg as indicated by hypoventilation.

8. A system according to claim 1, further comprising:

a comparison module retrieving the other physiological measures from measures sets for at least one of an individual patient, a peer group, and a overall patient population.

9. A system according to claim 1, further comprising:

a set of stickiness indicators for the patient information, each stickiness indicator corresponding to a temporal limit related to a program of patient diagnosis or treatment;

a comparison module comparing a time span occurring between changes in patient status for each physiological measure to the stickiness indicator; and

a programming module determining a revised program of patient diagnosis or treatment responsive to the changes in patient status occurring subsequent to a time span exceeding the stickiness indicator.

10. A method for analyzing a patient status for respiratory insufficiency for use in automated patient care, comprising:

receiving a set of one or more physiological measures relating to patient information recorded on a substantially continuous basis or derived therefrom;

storing the physiological measures set into a patient care record for an individual patient into a database; and

analyzing one or more of the physiological measures in the physiological measures set relative to one or more other physiological measures to determine a pathophysiology indicating an absence, an onset, a progression, a regression, and a status quo of respiratory insufficiency.

11. A method according to claim 10, further comprising:

analyzing the physiological measures in the physiological measures set relative to the other physiological measures to determine a pathophysiology indicating an absence, an onset, a progression, a regression, and a status quo of diseases other than respiratory insufficiency.

12. A method according to claim 10, further comprising:

receiving a set of one or more quality of life measures relating to patient information recorded on a substantially continuous basis or derived therefrom;

storing the quality of life measures set into the patient care record for the individual patient into the database; and

analyzing the quality of life measures in the physiological measures set relative to the other quality of life measures to determine a pathophysiology indicating an absence, an onset, a progression, a regression, and a status quo of respiratory insufficiency.

13. A method according to claim 10, further comprising:

receiving a set of one or more baseline physiological measures relating to patient information recorded during an initial time period or derived therefrom;

storing the baseline physiological measures set into the patient care record for the individual patient into the database; and

analyzing the physiological measures in the physiological measures set relative to the baseline physiological measures to determine a pathophysiology indicating an absence, an onset, a progression, a regression, and a status quo of respiratory insufficiency.

14. A method according to claim 13, wherein the pathophysiology to indicate the progression trending into one of a state of diagnose respiratory insufficiency and a state of likely respiratory insufficiency is selected from a group comprising:

a respiratory rate that has increased over 1.0 SD from a mean respiratory rate in the baseline physiological measures;

a heart rate that has increased over 1.0 SD from a mean heart rate in the baseline physiological measures;

transthoracic impedance that has increased over 1.0 SD from a mean transthoracic impedance in the baseline physiological measures;

ventilatory tidal volume that has increased over 1.0 SD from a tidal volume score in the baseline physiological measures;

an arterial oxygen score that has decreased over 1.0 SD from an arterial oxygen score in the baseline physiological measures;

an arterial carbon dioxide score that has decreased over 1.0 SD from an arterial carbon dioxide score in the baseline physiological measures;

a patient activity score that has decreased over 1.0 SD from a mean patient activity score in the baseline physioloical measures;

a temperature that has increased over 1.0 SD from a mean temperature in the baseline physiological measures;

short-lived spikes in the patient activity score that have occurred over time periods under 5 minutes compared to the baseline physiological measures;

short-lived spikes in a pulmonary arterial pressure score that have occurred over time periods under 5 minutes compared to the baseline physiological measures;

exercise tolerance quality of life measures that have decreased over 1.0 SD from a mean exercise tolerance in the baseline physiological measures;

respiratory distress quality of life measures that have deteriorated by more than 1.0 SD from mean respiratory distress quality of life measures in the baseline physiological measures;

short-lived spikes in right ventricular pressure that have occurred over time periods under 5 minutes compared to the baseline physiological measures;

short-lived spikes in the transthoracic impedance that have occurred over time periods under 5 minutes compared to the baseline physiological measures; and

atrial fibrillation and a sequence of rhythm changes relative to the atrial fibrillation.

15. A method according to claim 14, further comprising:

inverting the pathophysiology to indicate the progression as the pathophysiology to indicate the regression trending from one of a state of diagnosed respiratory insufficiency and a state of likely respiratory insufficiency.

16. A method according to claim 10, wherein the pathophysiology to indicate the progression into a state of diagnosed respiratory insufficiency is selected from a group comprising:

and absolute limit of arterial oxygen less than 85 mm Hg; and

an absolute limit of arterial carbon dioxide falling below 25 mm Hg in an absence of marked exercise as indicated by hyperventilation; and

an absolute limit of arterial carbon dioxide greater than 50 mm Hg as indicated by hypoventilation.

17. A method according to claim 10, further comprising:

retrieving the other physiological measures from measures sets for at least one of an individual patient, a peer group, and a overall patient population.

18. A method according to claim 10, further comprising:

defining a set of stickiness indicators for the patient information, each stickiness indicator corresponding to a temporal limit related to a program of patient diagnosis or treatment;

comparing a time span occurring between changes in patient status for each physiological measure to the stickiness indicator; and

determining a revised program of patient diagnosis or treatment responsive to the changes in patient status occurring subsequent to a time span exceeding the stickiness indicator.

19. A computer-readable storage medium for a device holding code for performing the method according to claim 10.

20. An apparatus for analyzing a patient status for respiratory insufficiency for use in automated patient care, comprising:

means for receiving a set of one or more physiological measures relating to patient information recorded on a substantially continuous basis or derived therefrom;

means for storing the physiological measures set into a patient care record for an individual patient into a database; and

means for analyzing one or more of the physiological measures in the physiological measures set relative to one or more other physiological measures to determine a pathophysiology indicating an absence, an onset, a progression, a regression, and a status quo of respiratory insufficiency.