Ventilator-Initiated Prompt Regarding Auto-PEEP Detection During Volume Ventilation Of Non-Triggering Patient

• US 20110273299A1
• Filed: 05/07/2010
• Published: 11/10/2011
• Est. Priority Date: 05/07/2010
• Status: Active Grant

• Current Assignee: Covidien LP (Medtronic Plc)
• Original Assignee: Nellcor Puritan Bennett LLC (Medtronic Plc)
• Inventors: Milne, Gary, Kimm, Gardner, Hensley, Kirk, Doyle, Peter R.
• Granted Patent: US 8,638,200 B2
• Time in Patent Office: Days
• US Class Current: 340/573.1
• CPC Class Codes: A61B 5/0803 Recording apparatus specially adapted therefor
• 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 5/0871 Peak expiratory flowmeters
• CPC Class Codes: A61B 5/4836 Diagnosis combined with treatment in closed-loop systems or methods A61B5/0036 takes precedence
• CPC Class Codes: A61B 5/743 Displaying an image simultaneously with additional graphical information, e.g. symbols, charts, function plots
• CPC Class Codes: A61B 5/7435 Displaying user selection data, e.g. icons in a graphical user interface
• CPC Class Codes: A61B 5/746 Alarms related to a physiological condition, e.g. details of setting alarm thresholds or avoiding false alarms alarms per se G08B
• CPC Class Codes: A61M 16/0051 with alarm devices
• CPC Class Codes: A61M 16/0057 Pumps therefor
• CPC Class Codes: A61M 16/0063 Compressors
• 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 16/04 Tracheal tubes catheters in general A61M25/00
• CPC Class Codes: A61M 16/0833 T- or Y-type connectors, e.g. Y-piece
• CPC Class Codes: A61M 16/0875 Connecting tubes
• CPC Class Codes: A61M 2016/0021 with a proportional output signal, e.g. from a thermistor
• CPC Class Codes: A61M 2016/0036 in the breathing tube and used in both inspiratory and expiratory phase
• CPC Class Codes: A61M 2205/18 with alarm
• CPC Class Codes: A61M 2205/3375 Acoustical, e.g. ultrasonic, measuring means
• CPC Class Codes: A61M 2205/505 Touch-screens; Virtual keyboard or keypads; Virtual buttons; Soft keys; Mouse touches
• CPC Class Codes: A61M 2205/584 : having a color code
• CPC Class Codes: A61M 2230/43 : Composition of exhalation
• CPC Class Codes: G08B 5/22 : using electric transmission; using electromagnetic transmission

Abstract

This disclosure describes systems and methods for monitoring and evaluating ventilatory parameters, analyzing those parameters and providing useful notifications and recommendations to clinicians. That is, modern ventilators monitor, evaluate, and graphically represent a myriad of ventilatory parameters. However, many clinicians may not easily identify or recognize data patterns and correlations indicative of certain patient conditions, changes in patient condition, and/or effectiveness of ventilatory treatment. Further, clinicians may not readily determine appropriate ventilatory adjustments that may address certain patient conditions and/or the effectiveness of ventilatory treatment. Specifically, clinicians may not readily detect or recognize the presence of Auto-PEEP during volume ventilation of a non-triggering patient. According to embodiments, a ventilator may be configured to monitor and evaluate diverse ventilatory parameters to detect Auto-PEEP and may issue suitable notifications and recommendations to the clinician when Auto-PEEP is implicated. The suitable notifications and recommendations may further be provided in a hierarchical format.

Claims

1. A ventilator-implemented method for detecting Auto-PEEP during volume ventilation of a non-triggering patient, the method comprising:

collecting data associated with ventilatory parameters;

processing the collected ventilatory parameter data, wherein processing the collected ventilatory parameter data includes deriving ventilatory parameter data from the collected ventilatory parameter data;

analyzing the processed ventilatory parameter data, wherein analyzing the processed ventilatory parameter data comprises;

receiving one or more predetermined thresholds associated with the processed ventilatory parameter data; and

detecting whether the processed ventilatory parameter data breaches the one or more predetermined thresholds;

determining that Auto-PEEP is implicated for the non-triggering patient upon detecting that the processed ventilatory data breaches the one or more predetermined thresholds; and

issuing a smart prompt when Auto-PEEP is implicated.

2. The method of claim 1, further comprising:

receiving a patient diagnosis; and

determining that Auto-PEEP is implicated for the non-triggering patient based at least in part on the patient diagnosis.

3. The method of claim 1, further comprising:

identifying one or more ventilatory settings associated with the ventilatory treatment of the non-triggering patient; and

upon determining that Auto-PEEP is implicated for the non-triggering patient, determining an appropriate smart prompt based at least in part on the one or more ventilatory settings.

4. The method of claim 1, wherein the processed ventilatory parameter data includes expiratory flow data, and wherein analyzing the processed ventilatory parameter data further comprises:

receiving one or more predetermined thresholds associated with end-expiratory flow (EEF);

detecting that EEF is positive when the EEF breaches the one or more predetermined thresholds; and

determining that Auto-PEEP is implicated for the non-triggering patient when EEF is positive for a predetermined number of breaths.

5. The method of claim 1, wherein the processed ventilatory parameter data includes respiratory resistance and respiratory compliance data, further comprising:

calculating a time required to reach functional residual capacity (FRC);

comparing the time required to reach FRC with expiratory time (T_E);

determining that Auto-PEEP is implicated for the non-triggering patient when the time required to reach FRC is greater than T_E.

6. The method of claim 1, wherein the processed ventilatory parameter data includes pressure data, and wherein analyzing the processed ventilatory parameter data further comprises:

receiving a positive end-expiratory pressure (PEEP) setting, wherein the PEEP setting is about 0 cm H₂O or greater;

receiving one or more predetermined thresholds associated with end-expiratory pressure (EEP);

detecting that the EEP breaches the one or more predetermined thresholds when the EEP minus the PEEP setting is greater than the one or more predetermined thresholds; and

determining that Auto-PEEP is implicated for the non-triggering patient when the EEP breaches the one or more predetermined thresholds.

7. The method of claim 1, wherein the processed ventilatory parameter data includes respiratory resistance data, and wherein analyzing the processed ventilatory parameter data further comprises:

receiving one or more predetermined thresholds associated with the respiratory resistance data;

detecting that respiratory resistance has increased when the respiratory resistance data breaches the one or more predetermined thresholds; and

determining that Auto-PEEP is implicated for the non-triggering patient when the respiratory resistance has increased.

8. The method of claim 1, wherein the processed ventilatory parameter data includes a pulmonary time constant and an expiratory time (T_E), and wherein analyzing the processed ventilatory parameter data further comprises:

comparing the pulmonary time constant to the T_E; and

determining that Auto-PEEP is implicated for the non-triggering patient when the T_E is less than three pulmonary time constants.

9. A ventilatory system for issuing a smart prompt when Auto-PEEP is implicated during volume ventilation of a non-triggering patient, comprising:

at least one processor; and

at least one memory, communicatively coupled to the at least one processor and containing instructions that, when executed by the at least one processor, perform a method comprising;

detecting that Auto-PEEP is implicated for the non-triggering patient;

determining an appropriate notification message;

determining an appropriate recommendation message; and

displaying at least one of the appropriate notification message and the appropriate recommendation message.

10. The ventilatory system of claim 9, further comprising:

identifying processed ventilatory parameter data that implicated Auto-PEEP; and

determining the appropriate notification message based at least in part on the processed ventilatory parameter data that implicated Auto-PEEP.

11. The ventilatory system of claim 10, wherein the appropriate notification message comprises an alert that Auto-PEEP is implicated and information regarding the processed ventilatory parameter data that implicated Auto-PEEP.

12. The ventilatory system of claim 9, further comprising:

determining the appropriate recommendation message based at least in part on evaluating the processed ventilatory parameter data that implicated Auto-PEEP.

13. The ventilatory system of claim 9, wherein the appropriate recommendation message comprises a primary recommendation message and a secondary recommendation message.

14. The ventilatory system of claim 13, wherein the primary recommendation message comprises one or more of;

a suggestion to decrease respiratory rate;

a suggestion to increase flow;

a suggestion to adjust ventilatory settings until end-expiratory flow (EEF) approximates zero;

a suggestion to investigate reasons for increased resistance; and

a suggestion to investigate reasons for increased compliance.

15. The ventilatory system of claim 13, wherein the secondary recommendation message includes one or more suggestions for increasing expiratory time (T_E), comprising:

a suggestion to decrease tidal volume (V_T); and

a suggestion to switch to a square flow waveform.

16. The ventilatory system of claim 9, further comprising:

identifying one or more ventilatory settings associated with the ventilatory treatment of the non-triggering patient; and

determining the appropriate recommendation message based at least in part on evaluating the one or more ventilatory settings.

17. The ventilatory system of claim 9, further comprising:

receiving a patient diagnosis; and

determining the appropriate recommendation message based at least in part on evaluating the patient diagnosis.

18. A graphical user interface for displaying one or more smart prompts corresponding to a detected condition, the ventilator configured with a computer having a user interface including the graphical user interface for accepting commands and for displaying information, the graphical user interface comprising:

at least one window associated with the graphical user interface; and

one or more elements within the at least one window comprising at least one smart prompt element for communicating information regarding the detected condition.

19. The graphical user interface of claim 18, wherein the at least one smart prompt element further comprises at least one of a notification message and a recommendation message.

20. The graphical user interface of claim 19, wherein the notification message comprises an alert associated with the detected condition, and wherein the recommendation message comprises one or more suggestions for mitigating the detected condition.