Ventilator-Initiated Prompt Regarding Auto-PEEP Detection During Pressure Ventilation

• US 20120000470A1
• Filed: 06/30/2010
• Published: 01/05/2012
• Est. Priority Date: 06/30/2010
• Status: Active Grant

• Current Assignee: Covidien LP (Medtronic Plc)
• Original Assignee: Nellcor Puritan Bennett LLC (Medtronic Plc)
• Inventors: Milne, Gary, Hensley, Kirk, Doyle, Peter R., Kimm, Gardner
• Granted Patent: US 8,607,791 B2
• Time in Patent Office: Days
• US Class Current: 128/205.23
• CPC Class Codes: A61B 5/08 Detecting, measuring or recording devices for evaluating the respiratory organs A61B5/0205 takes precedence
• CPC Class Codes: A61M 16/0051 with alarm devices
• 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 16/0833 T- or Y-type connectors, e.g. Y-piece
• CPC Class Codes: A61M 2016/0021 with a proportional output signal, e.g. from a thermistor
• 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 2205/502 User interfaces, e.g. screens or keyboards
• 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 2210/1014 Diaphragm
• CPC Class Codes: A61M 2230/20 Blood composition characteristics
• CPC Class Codes: A61M 2230/43 Composition of exhalation
• CPC Class Codes: A61M 2230/46 Resistance or compliance of the lungs
• CPC Class Codes: G16H 40/63 for local operation
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems

Abstract

This disclosure describes systems and methods for monitoring and evaluating ventilatory parameters, analyzing ventilatory data associated with those parameters, and providing useful notifications and/or recommendations to clinicians. 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 various types of pressure ventilation. 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 pressure ventilation, 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 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, wherein the patient is a triggering patient.

3. The method of claim 1, wherein the patient is a non-triggering patient.

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 when EEF is positive for a predetermined number of breaths.

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

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

comparing the time required to reach FRC with T_E; and

determining that Auto-PEEP is implicated 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 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 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 when the T_E is less than a predetermined number of pulmonary time constants.

9. A ventilatory system for issuing a smart prompt when Auto-PEEP is implicated during pressure ventilation, 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;

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, wherein the appropriate recommendation message comprises a primary recommendation message and a secondary recommendation message.

13. The ventilatory system of claim 12, wherein the patient is a triggering patient, and wherein the primary recommendation message comprises one or more of:

a suggestion to decrease inspiratory time (T_I);

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

a suggestion to investigate reasons for an elevated patient respiratory drive.

14. The ventilatory system of claim 12, wherein the patient is a non-triggering patient, and wherein the primary recommendation message comprises one or more of:

a suggestion to decrease respiratory rate (RR);

a suggestion to decrease inspiratory time (T_I); and

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

15. The ventilatory system of claim 12, wherein the ventilator detects that flow is about zero during inspiration, and wherein the ventilator determines a time, t, from detection of about zero flow until set inspiratory time (T_I) ends, the primary recommendation message comprising one or more of:

a suggestion to decrease T_I by up to t such that expiratory time (T_E) may be increased while maintaining tidal volume (V_T); and

a suggestion to decrease T_I by more than t such that T_E may be increased, wherein when T_I is decreased by more than t, the primary recommendation further comprises;

a suggestion to increase inspiratory pressure (IP) to maintain V_T.

16. The ventilatory system of claim 12, wherein the secondary recommendation message includes one or more suggestions for providing adequate expiratory time (T_E) comprising a suggestion to decrease inspiratory pressure in order to decrease delivered tidal volume (V_T) so that T_E may be adequate to completely exhale delivered V_T.

17. 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; 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, wherein the detected condition is Auto-PEEP.

18. The graphical user interface of claim 17, wherein the at least one smart prompt element further comprises at least one of a notification message and one or more recommendation messages, wherein the notification message comprises an alert associated with a detected implication of Auto-PEEP, and wherein the one or more recommendation messages comprise one or more suggestions for mitigating Auto-PEEP.

19. The graphical user interface of claim 18, wherein the patient is a triggering patient, and wherein the one or more recommendation messages comprise one or more of:

a suggestion to decrease inspiratory time (T_I);

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

a suggestion to investigate reasons for an elevated patient respiratory drive; and

a suggestion to decrease inspiratory pressure in order to decrease delivered tidal volume (V_T) so that T_E may be adequate to completely exhale delivered V_T.

20. The graphical user interface of claim 18, wherein the patient is a non-triggering patient, and wherein the one or more recommendation messages comprise one or more of:

a suggestion to decrease respiratory rate (RR);

a suggestion to decrease inspiratory time (T_I);

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

a suggestion to decrease inspiratory pressure in order to decrease delivered tidal volume (V_T) so that T_E may be adequate to completely exhale delivered V_T.