VENTILATOR-INITIATED PROMPT OR SETTING REGARDING DETECTION OF ASYNCHRONY DURING VENTILATION

• US 20150090258A1
• Filed: 09/30/2014
• Published: 04/02/2015
• Est. Priority Date: 10/01/2013
• Status: Abandoned Application

• Current Assignee: Covidien LP (Medtronic Plc)
• Original Assignee: Covidien LP (Medtronic Plc)
• Inventors: Milne, Gary, Doyle, Peter R., Kimm, Gardner
• Application Number:
  US14/501,406
• Publication Number:
  US 20150090258A1
• Time in Patent Office: Days
• US Class Current: 128/202.22
• CPC Class Codes: A61M 16/0051 with alarm devices
• CPC Class Codes: A61M 16/0069 the speed thereof being controlled by respiratory parameters, e.g. by inhalation
• 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 2016/0027 pressure meter
• CPC Class Codes: A61M 2016/0039 in the inspiratory circuit
• CPC Class Codes: A61M 2016/0042 in the expiratory circuit
• CPC Class Codes: A61M 2205/15 Detection of leaks
• 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 2205/52 with memories providing a history of measured variating parameters of apparatus or patient
• CPC Class Codes: A61M 2230/06 Heartbeat rate only
• CPC Class Codes: A61M 2230/42 Rate
• CPC Class Codes: A61M 2230/46 Resistance or compliance of the lungs

Abstract

Systems and methods are provided for monitoring and evaluating diverse ventilatory parameters to detect an asynchrony and may issue notifications and recommendations suitable for a patient to the clinician when asynchrony, such as an ineffective effort and an auto-trigger, is implicated. The suitable notifications and recommendations may further be provided in a hierarchical format such that the clinician may selectively access summarized and/or detailed information regarding the presence of asynchrony. In more automated systems, recommendations may be automatically implemented.

Claims

1. A ventilator-implemented method for detecting asynchrony during ventilation of a patient, the method comprising:

collecting data associated with ventilatory parameters;

processing the collected ventilatory parameter data, wherein processing the collected ventilatory parameter data comprises deriving ventilatory parameter data from the collected ventilatory parameter data, wherein the processed ventilator parameter data includes at least one of a respiration rate and an expiratory time;

determining that an auto-trigger is implicated upon detecting that the processed ventilator parameter data breaches a received predetermined threshold; and

issuing a smart prompt when the auto-trigger is implicated.

2. The method of claim 1, further comprising:

identifying that the patient is being ventilated with one of a pressure assist breath type, a tube compensation breath type, or a pressure support breath type that provides less than 5 cm of H₂O to the patient,

wherein the processed ventilator parameter data is a tidal volume and the respiration rate, and

wherein the received predetermined threshold is a determined tidal volume of less than 1 mL/kg for more than 10 seconds and a determined respiration rate of less than a derived respiration rate based on a predicted body weight of the patient for more than 10 seconds.

3. The method of claim 1, further comprising:

identifying that the patient is being ventilated with one of an assist control or a synchronized intermittent mandatory ventilation (SIMV) mode,

wherein the processed ventilator parameter data is the respiration rate and the expiratory time, and

wherein the received predetermined threshold is a determined respiration rate of greater than a set respiration rate and greater than a derived respiration rate based on a predicted body weight of the patient for more than 10 seconds and a determined expiratory time that does not vary for more than 10 seconds.

4. The method of claim 1, wherein the processed ventilator parameter data is the respiration rate and a heart rate, and

wherein the received predetermined threshold is a determined respiration rate of greater than a derived respiration rate from a predicted body weight of the patient for at least 5 seconds and that is substantially equivalent to the heart rate of the patient for at least 5 seconds.

5. The method of claim 4, wherein the determined respiration rate is substantially equivalent to the heart rate when the determined respiration rate is greater than 0.9 times the heart rate.

6. The method of claim 1, wherein the processed ventilator parameter data is the expiratory time, and

wherein the received predetermined threshold is a determined expiratory time of greater than a minimum expiratory time for more than three consecutive breaths.

7. The method of claim 1, wherein the collected ventilatory parameter data comprises:

at least one of airway flow and airway pressure.

8. The method of claim 1, further comprising:

determining an appropriate recommendation message for the issued smart prompt based at least in part on identifying at least one secondary condition,

wherein the at least one secondary condition includes determining if a leak is detected, and

wherein the appropriate recommendation message includes one of;

a recommendation to adjust trigger sensitivity to a less sensitive setting;

a recommendation to enable leak compensation;

a recommendation to change a trigger type;

a recommendation to check a patient circuit for condensate; and

a recommendation to check a seal of a patient interface.

9. The method of claim 1, further comprising:

determining an appropriate recommendation message for the issued smart prompt based at least in part on identifying one or more ventilatory settings associated with a ventilatory treatment of the patient,

wherein the one or more ventilatory settings include a patient interface type, and

wherein the appropriate recommendation message includes one of;

a recommendation to adjust trigger sensitivity to a less sensitive setting;

a recommendation to enable leak compensation;

a recommendation to change a trigger type;

a recommendation to check a patient circuit for condensate; and

a recommendation to check a seal of a patient interface.

10. A ventilatory system for issuing a smart prompt when asynchrony is implicated during ventilation of a patient, comprising:

at least one processor; and

at least one memory, communicatively coupled to the at least one processor and containing instructions that are executed by the at least one processor, the instructions comprising;

detecting that an auto-trigger is implicated for the patient based on at least one of a respiration rate and an expiratory time;

determining an appropriate notification message;

determining an appropriate recommendation message; and

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

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

12. The method of claim 10, further comprising:

determining one or more ventilatory settings associated with a ventilatory treatment of the patient wherein the one or more ventilatory settings is a patient interface type;

identifying at least one secondary condition, wherein the at least one secondary condition includes determining if a leak is detected, and

wherein the determining the appropriate recommendation message is based at least in part on the patient interface type and the at least one secondary condition.

13. The ventilatory system of claim 12, wherein the appropriate recommendation message comprises a primary recommendation message and a secondary recommendation message,

wherein the primary recommendation message comprises one of:

a recommendation to adjust trigger sensitivity to a less sensitive setting;

a recommendation to enable leak compensation; and

a recommendation to change a trigger type, and

wherein the secondary recommendation message comprises one of;

a recommendation to check the patient circuit for condensate; and

a recommendation to check the seal of the patient interface.

14. A ventilator-implemented method for detecting asynchrony during ventilation of a patient, the method comprising:

collecting data associated with ventilatory parameters;

processing the collected ventilatory parameter data, wherein the processing the collected ventilatory parameter data comprises deriving ventilatory parameter data from the collected ventilatory parameter data to determine at least one of a pressure integral during exhalation for a moving time window and a flow integral during exhalation for a moving time window;

determining that an ineffective effort is implicated upon detecting that the processed ventilator parameter data breaches a received predetermined threshold; and

issuing a smart prompt when the ineffective effort is implicated.

15. The method of claim 14, wherein the processed ventilator parameter data is the pressure integral during exhalation for a 200 ms moving time window, and

wherein the received predetermined threshold is a determined pressure integral during exhalation for a 200 ms moving window that is less than 0.2 cm of H₂O*second.

16. The method of claim 14, wherein the processed ventilator parameter data is the flow integral during exhalation for a 200 ms moving time window, and

wherein the received predetermined threshold is a determined flow integral during exhalation for a 200 ms moving window that is greater than a derived tidal volume based on a predicted body weight of the patient when no trigger is detected.

17. The method of claim 14, wherein the processed ventilator parameter data is the pressure integral during exhalation for a 200 ms moving time window and the flow integral during exhalation for a 200 ms moving time window, and

wherein the received predetermined threshold is a determined pressure integral during exhalation for a 200 ms moving window that is less than 0.2 cm of H₂O*second and a determined flow integral during exhalation for a 200 ms moving window that is greater than a derived tidal volume based on a predicted body weight of the patient when no trigger is detected.

18. The method of claim 14, wherein the collected ventilatory parameter data comprises:

at least one of airway flow and airway pressure.

19. The method of claim 14, further comprising:

determining an appropriate recommendation message for the issued smart prompt based at least in part on identifying at least one secondary condition,

wherein the at least one secondary condition includes determining if an elevated resistance is detected.

20. The method of claim 19, wherein the determining the appropriate recommendation message for the issued smart prompt is based at least in part on identifying one or more ventilatory settings associated with a ventilatory treatment of the patient,

wherein the one or more ventilatory settings is a breath type, and

wherein the appropriate recommendation message includes one of:

a recommendation to shorten an inspiration time by increasing a peak flow setting or by changing a waveform shape to square;

a recommendation to lower a tidal volume setting;

a recommendation to check for causes of increased resistance;

a recommendation to check for a need to suction or deliver a bronchodilator;

a recommendation to reduce an inspiratory sensitivity setting or to change to a more sensitive trigger type;

a recommendation to increase an expiratory sensitivity setting or to increase a rise time setting;

a recommendation to lower a pressure support setting;

a recommendation to correct a leak, to enable leak compensation, or to increase the expiratory sensitivity setting;

a recommendation to lower an inspiratory pressure setting; and

a recommendation to increase the expiratory sensitivity setting.