METHODS AND APPARATUS FOR DETECTING AND TREATING RESPIRATORY INSUFFICIENCY

• US 20100275921A1
• Filed: 03/31/2010
• Published: 11/04/2010
• Est. Priority Date: 04/29/2009
• Status: Active Grant

• Current Assignee: ResMed Pty Ltd. (ResMed Incorporated)
• Original Assignee: Resmed Limited (ResMed Incorporated)
• Inventors: Richards, Glenn, Bassin, David John, Schindhelm, Klaus Henry
• Granted Patent: US 9,827,388 B2
• Time in Patent Office: Days
• US Class Current: 128/204.23
• CPC Class Codes: A61B 5/08 Detecting, measuring or recording devices for evaluating the respiratory organs A61B5/0205 takes precedence
• CPC Class Codes: A61B 5/7264 Classification of physiological signals or data, e.g. using neural networks, statistical classifiers, expert systems or fuzzy systems neural networks per se G06N3/00; expert systems per se G06N5/00
• CPC Class Codes: A61B 5/7275 Determining trends in physiological measurement data; Predicting development of a medical condition based on physiological measurements, e.g. determining a risk factor
• CPC Class Codes: A61M 16/0006 with means for creating vibrations in patients' airways
• CPC Class Codes: A61M 16/0051 with alarm devices
• CPC Class Codes: A61M 16/0069 the speed thereof being controlled by respiratory parameters, e.g. by inhalation
• CPC Class Codes: A61M 16/026 specially adapted for predicting, e.g. for determining an information representative of a flow limitation during a ventilation cycle by using a root square technique or a regression analysis
• CPC Class Codes: A61M 2016/0027 pressure meter
• CPC Class Codes: A61M 2016/0036 in the breathing tube and used in both inspiratory and expiratory phase
• CPC Class Codes: A61M 2205/3375 Acoustical, e.g. ultrasonic, measuring means
• CPC Class Codes: A61M 2205/3569 sublocal, e.g. between console and disposable
• CPC Class Codes: A61M 2205/3592 using telemetric means, e.g. radio or optical transmission
• CPC Class Codes: A61M 2205/502 User interfaces, e.g. screens or keyboards
• CPC Class Codes: A61M 2230/04 Heartbeat characteristics, e.g. ECG, blood pressure modulation
• CPC Class Codes: A61M 2230/205 partial oxygen pressure (P-O2)
• CPC Class Codes: A61M 2230/42 Rate
• CPC Class Codes: A61M 2230/46 Resistance or compliance of the lungs
• 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 50/30 : for calculating health indices; for individual health risk assessment

Abstract

Devices and systems provide methods of detecting a severity change in respiratory insufficiency (RI) or chronic obstructive pulmonary disease (COPD) condition of a patient. In an example embodiment, a detection monitoring device determines one or more severity change indicators based on a measure of supplied pressure or other representative measure determined by the device. The supplied pressure may optionally be determined during pressure treatment that satisfies a target ventilation. The supplied pressure or representative data may be compared to one or more thresholds that are selected to represent a change in the condition of the RI or COPD patient such as an exacerbation of a prior condition. Results of the comparisons may trigger one or more warnings or messages to notify a patient or physician of a pending change to the patient'"'"'s RI or COPD condition so that the patient may more immediately seek medical attention to treat the condition.

Claims

1. A device for monitoring a patient to evaluate a respiratory insufficiency condition of the patient comprising:

a transducer to generate a signal representative of the pressure delivered by a flow generator; and

a processor, coupled with the sensor, the processor configured to control an evaluation of a severity change indicator based on a measure of pressure derived from the signal representative of pressure, the indicator representing information about a change in severity of a respiratory insufficiency condition of the patient.

2. The device of claim 1 further comprising a flow generator configured to generate a flow of breathable gas at a pressure above atmospheric pressure to a patient interface, wherein the processor is configured to control the flow generator.

3. The device of claim 2 wherein the flow generator is configured to generate the flow of breathable gas at a pressure above atmospheric pressure to maintain a target measure of ventilation, and wherein measure of pressure comprises a measure of pressure generated by the flow generator in order to maintain the target ventilation.

4. The device of claim 3 wherein the target ventilation is a minute ventilation and the measure of pressure is an average pressure.

5. The device of claim 3 wherein the target ventilation is an estimate of alveolar ventilation.

6. The device of claim 3 wherein the evaluation of the severity change indicator comprises a threshold comparison of the measure of pressure.

7. The device of claim 6 wherein the threshold comparison involves the measure of pressure and a prior measure of pressure used to maintain a target ventilation during a prior treatment session with the device.

8. The device of claim 6 wherein the threshold comparison represents an indication of a repeated rise in the measure of pressure over a period of days.

9. The device of claim 6 wherein the threshold comparison involves a difference between the measure of pressure and a prior measure of pressure used to maintain the target ventilation during a prior treatment session with the device.

10. The device of claim 6 wherein the threshold comparison involves a ratio of the measure of pressure and a prior measure of pressure used to maintain a target ventilation during a prior treatment session with the device.

11. The device of claim 6 wherein the evaluation of the severity change indicator further comprises a further threshold comparison involving a determined respiratory rate and a prior respiratory rate.

12. The device of claim 11 wherein the further threshold comparison represents an indication of a repeated rise in the determined respiratory rate over a period of days.

13. The device of claim 6 wherein the processor is configured to activate a warning based on the severity change indicator.

14. The device of claim 13 wherein the warning comprises an activated light.

15. The device of claim 13 wherein the warning comprises a message.

16. The device of claim 1 wherein the processor is configured to control transmitting of an electronic message including data representing a result of the evaluation of the severity change indicator.

17. The device of claim 3 further comprising a transmitter coupled with the processor, wherein the processor is further configured to control transmitting of a message including data representing the severity change indicator.

18. A system for monitoring a patient to evaluate a respiratory insufficiency condition of the patient comprising:

a pressure means to generate a signal representative of the pressure delivered by a flow generator; and

processing means for controlling an evaluation of a severity change indicator based on a measure of pressure derived from the signal representative of pressure, the indicator representing information about a change in severity of a respiratory insufficiency condition of the patient.

19. The system of claim 18 further comprising means for transmitting a message representing the chronic obstructive pulmonary disease condition change indicator.

20. The system of claim 18 further comprising means for warning a user of the apparatus based on the chronic obstructive pulmonary disease condition change indicator.

21. The system of claim 18 further comprising a flow generator configured to generate a flow of breathable gas at a pressure above atmospheric pressure to a patient interface to satisfy a target ventilation.

22. The system of claim 21 wherein the target ventilation is an estimate of alveolar ventilation.

23. A device for monitoring a patient to evaluate a respiratory insufficiency condition of a patient comprising:

a sensor to generate a signal associated with a pressure therapy treatment of the respiratory system of a patient; and

a processor configured to control an evaluation of a severity change indicator based on a measure from the signal of the sensor, the severity change indicator representing information about a change in severity of a respiratory insufficiency condition of the patient.

24. The device of claim 23 wherein the measure represents the degree of respiratory assistance therapy determined from the signal of the sensor.

25. The device of claim 24 wherein the control of the evaluation of the severity change indicator includes assessing detected data associated with inspiratory flow limitation to rule out upper airway obstruction.

26. The device of claim 23 wherein the control of the evaluation of the severity change indicator includes assessing a measure representing a respiratory rate.

27. The device of claim 23 wherein the control of the evaluation of the severity change indicator includes assessing a measure representing a respiratory duty cycle determined from the signal of the sensor.

28. The device of claim 23 wherein the control of the evaluation of the severity change indicator includes assessing a measure representing an intrinsic positive end expiratory pressure.

29. The device of claim 23 wherein the control of the evaluation of the severity change indicator includes assessing a measure representing an expiratory flow limitation.

30. The device of claim 23 wherein the measure represents a magnitude of a measured flow in a later portion of expiration that is determined from the signal of the sensor and wherein the control of the evaluation further assesses an insignificant change in respiratory rate or ventilation.

31. The device of claim 23 wherein the evaluation of the processor comprises determining a change of one or more earlier measures of the signal compared to one or more subsequent measures of the signal.

32. An apparatus adapted to determine the likelihood of an acute exacerbation occurring in a patient with respiratory insufficiency, comprising:

at least one sensor adapted to measure at least one respiratory parameter of the patient; and

a controller, coupled to the at least one sensor, wherein the controller is configured to evaluate the respiratory parameter measured at an at least one earlier first time with the respiratory parameter measured at a second time to determine when changes in the respiratory parameter are occurring, when a change in the respiratory parameter is determined the level of change and the length of time between the at least one first time and second time are evaluated to determine the likelihood of an acute exacerbation occurring.

33. The apparatus according to claim 32 wherein a larger level of change in the respiratory parameter and a longer length of time indicates a more likely occurrence of an acute exacerbation.

34. The apparatus according to claim 32 wherein the change in the respiratory parameter is an increase over time.

35. The apparatus according to claim 32 wherein the respiratory parameter measured at a second time is evaluated with the respiratory parameter measured at multiple earlier first times to determine a change trend in the respiratory parameter over time.

36. The apparatus according to claim 32 wherein the controller is configured to provide a warning signal based on the determined likelihood of an acute exacerbation occurring.

37. The apparatus according to claim 32 further comprising a flow generator adapted to provide positive pressure support to the patient.