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

• US 20120179135A1
• 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 8,617,135 B2
• Time in Patent Office: Days
• US Class Current: 604/503
• 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. A computer-implemented method for controlling fluid administration, the method comprising:

receiving input information relating to one or more physiologic processes of a patient;

determining, based at least in part upon the input information, a subgroup of bolus log entries associated with a current state of the patient; and

adjusting, using a processor, administration of fluid to the patient based at least in part upon log data included within the subgroup of bolus log entries.

2. The method of claim 1 wherein the adjusting further includes determining a predicted change in a physiologic parameter of the patient based at least in part upon the log data.

3. The method of claim 2 wherein the physiologic parameter comprises a cardiac output of the patient.

4. The method of claim 2 wherein the physiologic parameter comprises a stroke volume of the patient.

5. The method of claim 2 further including determining, using the processor, the predicted change based upon information relating to results of administration of a first fluid bolus to a patient population.

6. The method of claim 5 wherein the adjusting includes the administration of fluid includes selecting the first fluid bolus for administration to the patient.

7. The method of claim 1 wherein the input information comprises measurements of the one or more physiologic processes.

8. The method of claim 1 wherein the input information relates to variation in at least one of the one or more physiologic processes.

9. The method of claim 1 wherein the input information comprises at least one of pulse pressure variation, stroke volume variation, plethysmograph waveform variability, and EKG waveform variability.

10. 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 the patient,

determine, based at least in part upon the input information, a subgroup of bolus log entries associated with a current state of the patient, and

adjust administration of fluid to the patient based at least in part upon log data included within the subgroup of bolus log entries.

11. 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 the patient, determines a subgroup of bolus log entries associated with a current state of the patient based at least in part upon the input information, and adjusts administration of fluid to the patient based at least in part upon log data included within the subgroup of bolus log entries.

12. A computer-implemented method for facilitating the administration of fluid to a patient, the method comprising:

determining a first effect on a physiologic parameter of the patient associated with administration of a first fluid bolus to the patient;

storing, using a processor, first information relating to the first effect in a first bolus log entry;

determining a second effect on the physiologic parameter of the patient associated with administration of a second fluid bolus to the patient;

storing, using a processor, second information relating to the second effect in a second bolus log entry; and

generating, using the processor, a fluid administration signal based at least in part upon at least one of the first bolus log entry and the second bolus log entry.

13. The method of claim 12 wherein the generating further includes determining a predicted change in the physiologic parameter based upon the first bolus log entry and a predicted response to administration of the first fluid bolus wherein the predicted response is associated with a population group.

14. The method of claim 12 further including receiving input information relating to one or more physiologic processes of the patient, the generating being further based upon the input information.

15. The method of claim 12 wherein the generating further includes determining a predicted change in the physiologic parameter of the patient in response to administration of a fluid bolus to the patient.

16. The method of claim 12 wherein the determining the first effect on the physiologic parameter includes receiving input information comprising measurements of one or more physiologic processes of the patient.

17. The method of claim 12 wherein the determining the first effect on the physiologic parameter includes receiving input information relating to variation in one or more physiologic processes of the patient.

18. The method of claim 12 wherein the determining the first effect on the physiologic parameter includes receiving input information relating to at least one of pulse pressure variation, stroke volume variation, plethysmograph waveform variability, and EKG waveform variability of the patient.

19. A device, comprising:

one or more processors; and

a memory operatively coupled to the one or more processors, the memory storing program code which, when executed by the one or more processors, determines a first effect on a physiologic parameter of the patient associated with administration of a first fluid bolus to the patient, stores first information relating to the first effect in a first bolus log entry within device storage, determines a second effect on the physiologic parameter of the patient associated with administration of a second fluid bolus to the patient, stores second information relating to the second effect in a second bolus log entry within the device storage, and generates a fluid administration signal based upon at least one of the first bolus log entry and the second bolus log entry.

20. An infusion system, comprising:

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

a controller that determines a first effect on a physiologic parameter of the patient associated with administration of a first fluid bolus to the patient, stores first information relating to the first effect in a first bolus log entry within device storage, determines a second effect on the physiologic parameter of the patient associated with administration of a second fluid bolus to the patient, stores second information relating to the second effect in a second bolus log entry within the device storage, and provides a fluid administration signal to the pump apparatus based upon at least one of the first bolus log entry and the second bolus log entry.

21. A computer-implemented method for providing clinical decision support relating to the administration of fluid to a patient, the method comprising:

receiving input information relating to one or more physiologic processes of a patient;

determining, based at least in part upon the input information, a subgroup of bolus log entries associated with a current state of the patient; and

providing, using the processor, a fluid administration recommendation based at least in part upon log data included within the subgroup of bolus log entries.

22. A computer-implemented method for providing clinical decision support relating to the administration of fluid to a patient, the method comprising:

determining a first effect on a physiologic parameter of the patient associated with administration of a first fluid bolus to the patient;

storing, using a processor, first information relating to the first effect in a first bolus log entry;

determining a second effect on the physiologic parameter of the patient associated with administration of a second fluid bolus to the patient;

storing, using a processor, second information relating to the second effect in a second bolus log entry; and

providing, using the processor, a fluid administration recommendation based at least in part upon at least one of the first bolus log entry and the second bolus log entry.

23. A computer-implemented method for providing clinical decision support relating to the administration of fluid to a patient, the method comprising:

receiving bolus log information relating to one or more effects on a state of the patient associated with prior administration of fluid to the patient;

determining, using a processor and based upon the bolus log information, a predicted change in a physiologic parameter of the patient in response to the administration of a fluid bolus to the patient; and

providing, using the processor, a fluid administration recommendation based upon the predicted change.

24. A computer-implemented method for facilitating the administration of fluid to a patient, the method comprising:

receiving bolus log information relating to one or more effects on a state of the patient associated with prior administration of fluid to the patient;

determining, using a processor and based upon the bolus log information, a predicted change in a physiologic parameter of the patient in response to the administration of a fluid bolus to the patient; and

generating, using the processor, a fluid administration signal based upon the predicted change.