SYSTEM AND METHOD FOR CLOSED-LOOP PATIENT-ADAPTIVE HEMODYNAMIC MANAGEMENT

• US 20120179093A1
• Filed: 01/12/2012
• Published: 07/12/2012
• Est. Priority Date: 01/12/2011
• Status: Active Grant

• Current Assignee: Regents of the University of California (University of California)
• Original Assignee: Regents of the University of California (University of California)
• Inventors: Rinehart, Joseph B., Cannesson, Maxime
• Granted Patent: US 9,022,974 B2
• Time in Patent Office: Days
• US Class Current: 604/66
• CPC Class Codes: A61B 5/021 Measuring pressure in heart or blood vessels A61B5/0205 takes precedence
• CPC Class Codes: A61B 5/0245 by using sensing means generating electric signals, i.e. ECG signals
• CPC Class Codes: A61B 5/029 Measuring or recording blood output from the heart, e.g. minute volume A61B8/065 takes precedence
• CPC Class Codes: A61B 5/0295 using plethysmography, i.e. measuring the variations in the volume of a body part as modified by the circulation of blood therethrough, e.g. impedance plethysmography
• CPC Class Codes: A61B 5/14542 for measuring blood gases A61B5/14551 takes precedence
• CPC Class Codes: A61B 5/4833 Assessment of subject's compliance to treatment
• CPC Class Codes: A61B 5/7203 for noise prevention, reduction or removal
• CPC Class Codes: A61M 2202/0208 Oxygen
• CPC Class Codes: A61M 2205/502 User interfaces, e.g. screens or keyboards
• CPC Class Codes: A61M 2205/52 with memories providing a history of measured variating parameters of apparatus or patient
• CPC Class Codes: A61M 2230/00 Measuring parameters of the user
• CPC Class Codes: A61M 2230/04 Heartbeat characteristics, e.g. ECG, blood pressure modulation
• CPC Class Codes: A61M 5/142 Pressure infusion, e.g. using pumps
• CPC Class Codes: A61M 5/16877 Adjusting flow; Devices for setting a flow rate
• CPC Class Codes: A61M 5/1723 using feedback of body parameters, e.g. blood-sugar, pressure measurement of body parameters A61B5/00
• CPC Class Codes: G16H 20/17 delivered via infusion or injection

Abstract

A system and method for patient-adaptive hemodynamic management is described. One embodiment includes a system for hemodynamic management including transfusion, volume resuscitation with intravenous fluids, and medications, utilizing monitored hemodynamic parameters including the described dynamic predictors of fluid responsiveness, and including an intelligent algorithm capable of adaptation of the function of the device to specific patients.

Claims

1. An intelligent pump apparatus for delivering fluid to a patient, the apparatus comprising:

an infusion pump device; and

a controller in electrical communication with the infusion pump device, the controller determining a predicted change in a physiologic parameter of the patient in response to administration of a fluid bolus to the patient and providing a pump control signal to the infusion pump device in response to the predicted change.

2. The intelligent pump apparatus of claim 1 further including an interface port for receiving input information comprising measurement values relating to one or more physiologic processes of the patient, the controller determining the predicted change based at least in part on the measurement values.

3. The intelligent pump apparatus of claim 1 wherein the physiologic parameter comprises a cardiac output of the patient.

4. The intelligent pump apparatus of claim 1 wherein the physiologic parameter comprises a stroke volume of the patient.

5. The intelligent pump apparatus of claim 1 wherein the one or more physiologic processes include at least one of heart rate, cardiac stroke volume, blood pressure and arterial pressure.

6. The intelligent pump apparatus of claim 1 wherein the controller is further configured to determine the predicted change based upon information relating to an expected change in the physiologic parameter in a patient population in response to infusion of the fluid bolus in patients included in the patient population.

7. The intelligent pump apparatus of claim 1 wherein the controller is further configured to determine the predicted change based at least in part upon results of prior administration of a different fluid bolus to the patient.

8. The intelligent pump apparatus of claim 2 wherein the controller is further configured to filter the measurement values.

9. The intelligent pump apparatus of claim 8 wherein the controller is further configured to perform the filtering by comparing ones of the measurement values to other of the measurement values.

10. The intelligent pump apparatus of claim 2 wherein the controller is further configured to identify artifacts among the measurement values by determining, based upon the measurement values, relative changes in one or more physiologic parameters of the patient.

11. The intelligent pump apparatus of claim 6 wherein the controller is further configured to receive information relating to a medical condition of the patient and determine the patient population based at least upon the medical condition.

12. The intelligent pump apparatus of claim 11 wherein the medical condition is included within state information associated with the patient, the controller being further configured to determine the patient population by selecting the patient population from among plural patient populations based at least upon the state information.

13. The intelligent pump apparatus of claim 12 wherein the controller is further configured to determine the expected change in the physiologic parameter based upon information included within a population reference table associated with the patient population.

14. The intelligent pump apparatus of claim 1 further including a memory, the controller being configured to create a bolus log entry within the memory corresponding to the administration of the fluid bolus to the patient wherein the bolus log entry includes an indication of an effect of the fluid bolus on the physiologic parameter of the patient.

15. The intelligent pump apparatus of claim 1 further including a memory containing a bolus log, the controller being configured to create, in the bolus log, a bolus log entry corresponding to the administration of the fluid bolus to the patient and determine an effect of the administration of the fluid bolus on a hemodynamic state of the patient wherein the bolus log entry includes log information relating to the effect.

16. The intelligent pump apparatus of claim 15 wherein the controller is further configured to determine the predicted change based upon other log information obtained from the bolus log, wherein the other log information is associated with prior administration of fluid to the patient.

17. The intelligent pump apparatus of claim 1 further including a memory containing a bolus log, the controller being further configured to generate a bolus log containing log information relating to one or more effects on a hemodynamic state of the patient associated with prior administration of fluid to the patient and determine, based upon the log information, an expected change in the physiologic parameter in response to the administration of the fluid bolus to the patient wherein the predicted change is based at least in part upon the expected change.

18. The intelligent pump apparatus of claim 1 wherein the controller is further configured to determine the predicted change by determining a first expected change in the physiologic parameter based upon bolus log information relating to one or more effects of prior administration of fluid to the patient on a condition of the patient and determine a second expected change in the physiologic parameter associated with infusion of the fluid bolus in a patient population in response.

19. The intelligent pump apparatus of claim 18 wherein the controller is further configured to determine the predicted change by relatively weighting the first expected change and the second expected change in accordance with error values respectively associated with the first expected change and the second expected change.

20. The intelligent pump apparatus of claim 1 wherein the predicted change in the physiologic parameter comprises at least one of a reduction or a lack of change in a cardiac output of the patient and wherein the pump control signal instructs the infusion pump device to terminate an ongoing fluid administration to the patient.

21. The intelligent pump apparatus of claim 1 wherein the predicted change in the physiologic parameter is indeterminate and wherein the pump control signal instructs the infusion pump device to maintain an ongoing fluid administration to the patient.

22. The intelligent pump apparatus of claim 1 wherein the predicted change in the physiologic parameter comprises an improvement and wherein the pump control signal instructs the infusion pump device to administer the fluid bolus to the patient.

23. The intelligent pump apparatus of claim 1 further including a user interface, the controller being configured to generate, on the user interface, an indication of an intervention command and to receive user input corresponding to acceptance of the intervention command wherein the controller is further configured to generate the pump control signal responsive to the user input.

24. The intelligent pump apparatus of claim 1 further including an interface port through which is received pump status information indicative of a status of the infusion pump device, the controller being configured to determine whether the pump status information is consistent with an expected status related to the pump control signal.

25. The intelligent pump apparatus of claim 1 further including a user interface, the controller being configured to cause the user interface to provide one or more recommendations for care of the patient based at least in part upon the predicted change in the physiologic parameter.

26. The intelligent pump apparatus of claim 1 further including a network interface through which is received at least one population reference table containing expected response information relating to expected responses of a patient population to fluid infusions, the controller being configured to determine the predicted change based at least in part upon the expected response information.

27. The intelligent pump apparatus of claim 26 wherein the controller is configured to send, to a network server through the network interface, bolus log information relating to an effect of the administration of the fluid bolus on the physiologic parameter of the patient.

28. A device, comprising:

one or more processors; and

a memory operatively coupled to the one or more processors, the memory storing signals which, when executed by the one or more processors, cause the one or more processors to receive input information relating to one or more physiologic processes of a patient, determine a predicted change in a physiologic parameter of the patient in response to administration of a fluid bolus to the patient wherein the predicted change is based at least in part on the input information, and generate a fluid administration signal in response to the predicted change.

29. An infusion system, comprising:

a pump apparatus configured to control delivery of fluid to a patient; and

a controller that receives input information relating to one or more physiologic processes of a patient, determines a predicted change in a physiologic parameter of the patient in response to administration of a fluid bolus to the patient wherein the predicted change is based at least in part on the input information, and provides a fluid administration signal to the pump apparatus in response to the predicted change.

30. A device, comprising:

one or more processors; and

a memory operatively coupled to the one or more processors, the memory storing signals which, when executed by the one or more processors, cause the one or more processors to receive information relating to an initial change in a physiologic parameter of a patient in response to administration of a first fluid bolus to a patient, determine, based at least in part upon the information, a predicted change in the physiologic parameter in response to an administration of a second bolus, and adjust administration of fluid to the patient based upon the predicted change.

31. An infusion system, comprising:

a pump apparatus configured to control delivery of fluid to a patient; and

a controller that receives information relating to an initial change in a physiologic parameter of a patient in response to administration of a first fluid bolus to a patient, determines, based at least in part upon the information, a predicted change in the physiologic parameter in response to an administration of a second bolus, and adjusts a fluid administration signal provided to the pump apparatus based upon the predicted change.

32. An intelligent pump apparatus for delivering fluid to a patient, the apparatus comprising:

an infusion pump device;

a monitoring interface for receiving, from a monitoring device, an indication of at least one of oxygen delivery to tissues of the patient and oxygen utilization by the patient; and

a controller in electrical communication with the infusion pump device, the controller being configured to select, based upon the indication, an oxygen-carrying fluid from among multiple fluids capable of being infused into the patient and to instruct the infusion pump device to infuse the oxygen-carrying fluid into the patient.

33. The intelligent pump apparatus of claim 32 wherein the controller is further configured to determine a predicted change in a physiologic parameter of the patient in response to administration of a fluid bolus to the patient and to instruct the infusion pump device to infuse another of the multiple fluids into the patient in response to the predicted change.