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

• US 20120179136A1
• Filed: 01/12/2012
• Published: 07/12/2012
• Est. Priority Date: 01/12/2011
• Status: Abandoned Application

• 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
• Application Number:
  US13/349,168
• Publication Number:
  US 20120179136A1
• 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 facilitating the administration of fluid to a patient, the method comprising:

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

determining, using a processor, 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

generating, using the processor, a fluid administration signal in response to the predicted change.

2. The method of claim 1 wherein the physiologic parameter comprises a cardiac output of the patient.

3. The method of claim 1 wherein the physiologic parameter comprises a stroke volume of the patient.

4. The method 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.

5. The method of claim 1 wherein the predicted change is further 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.

6. The method of claim 1 wherein the predicting is based at least in part upon results of prior administration of a different fluid bolus to the patient.

7. The method of claim 1 wherein the input information comprises measurement values, the method further including filtering the measurement values.

8. The method of claim 7 wherein the filtering includes comparing ones of the measurement values to other of the measurement values.

9. The method of claim 7 further including identifying artifacts among the measurement values by determining, based upon the measurement values, relative changes in one or more physiologic parameters of the patient.

10. The method of claim 5 further including:

receiving information relating to a medical condition of the patient; and

determining the patient population based at least upon the medical condition.

11. The method of claim 10 wherein the medical condition is included within state information associated with the patient, the determining the patient population further including selecting the patient population from among plural patient populations based at least upon the state information.

12. The method of claim 11 further including determining the expected change in the physiologic parameter based upon information included within a population reference table associated with the patient population.

13. The method of claim 1 further including creating a bolus log entry corresponding to the administration of the fluid bolus to the patient, the bolus log entry including an indication of an effect of the fluid bolus on the physiologic parameter of the patient.

14. The method of claim 1 further including:

creating, in a bolus log, a bolus log entry corresponding to the administration of the fluid bolus to the patient; and

determining an effect of the administration of the fluid bolus on a hemodynamic state of the patient, the bolus log entry including log information relating to the effect.

15. The method of claim 14 wherein the determining the predicted change is further 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.

16. The method of claim 1 further including:

generating 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

determining, based upon the log information, an expected change in the physiologic parameter in response to the administration of the fluid bolus to the patient, the predicted change being based at least in part upon the expected change.

17. The method of claim 1 wherein the determining the predicted change further includes:

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

determining a second expected change in the physiologic parameter associated with infusion of the fluid bolus in a patient population in response.

18. The method of claim 17 wherein the determining the predicted change further includes 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.

19. The method 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 fluid administration signal provides an indication that an ongoing fluid administration to the patient should be terminated.

20. The method of claim 1 wherein the predicted change in the physiologic parameter is indeterminate and wherein the fluid administration signal provides an indication that an ongoing fluid administration to the patient should be maintained.

21. The method of claim 1 wherein the predicted change in the physiologic parameter comprises an improvement and wherein the fluid administration signal provides an indication that the fluid bolus should be administered to the patient.

22. The method of claim 1 further including automatically generating a pump control signal in response to the fluid administration signal, the pump control signal being provided to at least one fluid pump.

23. The method of claim 1 further including:

generating, on a user interface, an indication of an intervention command corresponding to the fluid administration signal;

receiving user input corresponding to acceptance of the intervention command; and

generating, in response to the user input, a pump control signal wherein the pump control signal is provided to at least one fluid pump.

24. The method of claim 22 further including:

receiving pump status information indicative of a status of the at least one fluid pump; and

determining whether the pump status information is consistent with an expected status related to the fluid administration signal.

25. The method of claim 1 further including providing the fluid administration signal to a user interface configured to display one or more recommendations for care of the patient in response to the fluid administration signal.

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

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

28. 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.

29. A computer-implemented method for facilitating control of fluid administration;

the method comprising;

receiving 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;

determining, using a processor and 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

adjusting administration of fluid to the patient based upon the predicted change.

30. The method of claim 29 wherein the determining is further based upon input information relating to one or more physiologic processes of the patient.

31. The method of claim 29 further including determining, using the processor, the initial change based upon measured values of one or more physiologic processes of the patient.

32. The method of claim 29 wherein the physiologic parameter comprises a cardiac output of the patient.

33. The method of claim 29 wherein the physiologic parameter comprises a stroke volume of the patient.

34. The method of claim 30 wherein the one or more physiologic processes include at least one of heart rate, cardiac stroke volume, blood pressure and arterial pressure.

35. The method of claim 30 wherein the predicted change is further based upon information relating to an expected change in the physiologic parameter in a patient population in response to infusion of a fluid bolus in patients included in the patient population.

36. The method of claim 30 wherein the input information comprises measurements of the one or more physiologic processes.

37. The method of claim 30 wherein the input information relates to variation in at least one of the one or more physiologic processes.

38. The method of claim 30 wherein the input information comprises at least one of pulse pressure variation, stroke volume variation, plethysmograph waveform variability, and EKG waveform variability.

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

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;

selecting, using a processor and based upon the indication, an oxygen-carrying fluid from among multiple fluids capable of being infused into the patient; and

signaling, using the processor, selection of the oxygen-carrying fluid for infusion into the patient.

40. The method of claim 39 further including:

determining, using the processor, a predicted change in a physiologic parameter of the patient in response to administration of a fluid bolus to the patient, and

signaling, using the processor, an infusion pump device to infuse another of the multiple fluids into the patient in response to the predicted change.

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

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

determining, using a processor and based on the input information, that a change has occurred in a physiologic parameter of the patient; and

generating, using the processor, a fluid administration signal based at least in part on the change in the physiologic parameter.

42. The method of claim 41 further including:

determining that the change exceeds a predefined amount; and

infusing a test bolus of fluid into the patient in response to the fluid administration signal.

43. The method of claim 41 wherein the physiologic parameter comprises a cardiac output of the patient.

44. The method of claim 41 wherein the physiologic parameter comprises a stroke volume of the patient.

45. The method of claim 41 wherein the one or more physiologic processes include at least one of heart rate, cardiac stroke volume, blood pressure and arterial pressure.

46. The method of claim 41 wherein the input information comprises measurements of the one or more physiologic processes.

47. The method of claim 41 wherein the input information relates to variation in at least one of the one or more physiologic processes.

48. The method of claim 41 wherein the input information comprises at least one of pulse pressure variation, stroke volume variation, plethysmograph waveform variability, and EKG waveform variability.

49. The method of claim 43 wherein the determining includes determining that the cardiac output has decreased by at least a predefined percentage.

50. The method of claim 44 wherein the determining includes determining that the stroke volume has decreased by at least a predefined percentage.

51. The method of claim 41 further including:

determining, using the processor, a predicted change in the 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;

wherein the generating the fluid administration signal is further based at least in part upon the predicted change.

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

determining, using a processor, a predicted change in a physiologic parameter of the patient in response to administration of a fluid bolus to the patient;

determining, using a processor, that an actual change has occurred in the physiologic parameter of the patient; and

generating, using the processor, a fluid administration signal based upon at least one of the predicted change and the actual change.

53. The method of claim 52 further including:

determining that the actual change exceeds a predefined amount; and

infusing a test bolus of fluid into the patient in response to the fluid administration signal.

54. 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 the patient;

determining, using a processor, 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

providing, using the processor and in response to the predicted change, a fluid administration recommendation.

55. The method of claim 54 wherein the physiologic parameter comprises a cardiac output of the patient.

56. The method of claim 54 wherein the physiologic parameter comprises a stroke volume of the patient.

57. The method of claim 54 wherein the one or more physiologic processes include at least one of heart rate, cardiac stroke volume, blood pressure and arterial pressure.

58. The method of claim 54 wherein the predicted change is further 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.

59. The method of claim 54 wherein the predicting is based at least in part upon results of prior administration of a different fluid bolus to the patient.

60. The method of claim 59 further including filtering the measurement values.

61. The method of claim 60 wherein the filtering includes comparing ones of the measurement values to other of the measurement values.

62. The method of claim 54 further including identifying artifacts among the measurement values by determining, based upon the measurement values, relative changes in one or more physiologic parameters of the patient.

63. The method of claim 58 further including:

receiving information relating to a medical condition of the patient; and

determining the patient population based at least upon the medical condition.

64. The method of claim 63 wherein the medical condition is included within state information associated with the patient, the determining the patient population further including selecting the patient population from among plural patient populations based at least upon the state information.

65. The method of claim 58 further including determining the expected change in the physiologic parameter based upon information included within a population reference table associated with the patient population.

66. The method of claim 54 further including creating a bolus log entry corresponding to the administration of the fluid bolus to the patient, the bolus log entry including an indication of an effect of the fluid bolus on the physiologic parameter of the patient.

67. The method of claim 54 further including:

creating, in a bolus log, a bolus log entry corresponding to the administration of the fluid bolus to the patient; and

determining an effect of the administration of the fluid bolus on a hemodynamic state of the patient, the bolus log entry including log information relating to the effect.

68. The method of claim 67 wherein the determining the predicted change is further 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.

69. The method of claim 54 further including:

generating 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

determining, based upon the log information, an expected change in the physiologic parameter in response to the administration of the fluid bolus to the patient, the predicted change being based at least in part upon the expected change.

70. The method of claim 54 wherein the determining the predicted change further includes:

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

determining a second expected change in the physiologic parameter associated with infusion of the fluid bolus in a patient population in response.

71. The method of claim 70 wherein the determining the predicted change further includes 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.

72. The method of claim 54 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 recommendation indicates that an ongoing fluid administration to the patient should be terminated.

73. The method of claim 54 wherein the predicted change in the physiologic parameter is indeterminate and wherein the recommendation indicates that an ongoing fluid administration to the patient should be maintained.

74. The method of claim 54 wherein the predicted change in the physiologic parameter comprises an improvement and wherein the recommendation indicates that the fluid bolus should be administered to the patient.

75. The method of claim 54 further including displaying information relating to the recommendation on a user interface.

76. The method of claim 75 further including receiving user input relating to the recommendation through the user interface.

77. The method of claim 54 wherein the input information comprises measurements of the one or more physiologic processes.

78. The method of claim 54 wherein the input information relates to variation in at least one of the one or more physiologic processes.

79. The method of claim 54 wherein the input information comprises at least one of pulse pressure variation, stroke volume variation, plethysmograph waveform variability, and EKG waveform variability.

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

receiving 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;

determining, using a processor and 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

providing, using the processor and in response to the predicted change, a fluid administration recommendation.