Cardiovascular measurements by sound velocity dilution

• US 5,595,182 A
• Filed: 06/07/1995
• Issued: 01/21/1997
• Est. Priority Date: 10/24/1994
• Status: Expired due to Term

• Current Assignee: Transonic Systems, Inc. (Measurement Innovations Corp.)
• Original Assignee: Transonic Systems, Inc. (Measurement Innovations Corp.)
• Inventors: Krivitski, Nikolai M.
• Primary Examiner(s): MANUEL, GEORGE C
• Application Number:
  US08/485,790
• Time in Patent Office: 594 Days
• Field of Search: 128/660.01, 128/660.02, 128/661.07, 128/661.08, 128/661.1, 128/672, 128/691, 128/698, 128/747, 128/692, 128/662.06, 73/40, 73/40.5 R, 73/40.5 A, 73/596, 73/597, 73/754, 73/861.25, 356/28, 356/28.5, 424/9.52
• US Class Current: 600/505
• CPC Class Codes: A61B 5/0275 using tracers, e.g. dye dilution
• CPC Class Codes: A61M 1/16 with membranes
• CPC Class Codes: A61M 1/3653 Interfaces between patient blood circulation and extra-corporal blood circuit
• CPC Class Codes: A61M 1/3656 Monitoring patency or flow at connection sites; Detecting disconnections
• CPC Class Codes: A61M 1/3658 Indicating the amount of purified blood recirculating in the fistula or shunt
• CPC Class Codes: A61M 1/3659 Cannulae pertaining to extracorporeal circulation
• CPC Class Codes: A61M 1/3661 for haemodialysis
• CPC Class Codes: A61M 1/3669 Electrical impedance measurement of body fluids; transducers specially adapted therefor
• CPC Class Codes: A61M 2205/3368 Temperature

Abstract

An apparatus and method for measuring hemodynamic parameters includes a sound velocity sensor coupled to at least one of an arterial or venous portion of a blood system. An indicator medium is injected into the blood system upstream of the sensor to dilute the bloodstream, and the sensor detects the dilution through changes in measured sound velocity. The changes are recorded and used to determine hemodynamic parameters.

Claims

1. Apparatus for measuring selected parameters of blood, comprising:

a blood circulating system having an arterial portion leading from an upstream blood flow and a venous portion leading to a downstream blood flow, said arterial and venous portions being connected in said circulating system to allow blood to travel from said upstream flow through the circulating system to said downstream flow;

a sound velocity sensor coupled to at least one of said arterial and venous portions for detecting the velocity of blood traveling therein;

an injection port in at least one of said arterial and venous portions;

an indicator injectable through said injection port to produce a bolus in blood flowing in said blood circulating system, said bolus having sound velocity characteristics different from sound velocity characteristics of blood flowing within said system in the absence of said indicator;

a sound velocity detector connected to each said sound velocity sensor for producing an output signal corresponding to sensed sound velocity in blood flowing in said stream to thereby produce sound velocity dilution signals representing changes in blood characteristics due to said bolus; and

an evaluating device for determining from said dilution signals selected blood characteristics.

2. A method of measuring hemodynamic parameters by indicator dilution, comprising:

coupling a sound velocity sensor to at least one of an arterial or venous portion of a blood circulating system;

producing a bolus of indicator material in the blood circulating system, said bolus having a sound velocity characteristic which differs from sound velocity characteristics of blood flowing in the blood circulating system to thereby dilute said blood;

detecting, by said sound velocity sensor, changes in sound velocity within said blood caused by dilution of the blood due to said bolus and producing output signals representing changes in blood sound velocity parameters over time caused by said bolus; and

evaluating said output signals to determine selected blood characteristics.

3. The method of claim 2, wherein coupling a sound velocity sensor includes positioning the sensor within the arterial or venous portion.

4. The method of claim 2, wherein coupling a sound velocity sensor includes positioning the sensor on an artery or vessel of a patient'"'"'s blood circulating system.

5. The method of claim 2, wherein coupling a sound velocity sensor includes positioning the sensor on tubing connected between a patient'"'"'s vascular system and external blood treatment equipment.

6. The method of claim 2, further including generating from said output signals dilution curves representing said changes in blood parameters, and wherein evaluating said output signals includes determining selected blood characteristics from said dilution curves.

7. The method of claim 6, further including coupling a sound amplitude sensor to at least one of said arterial or venous portions of the blood circulating system, detecting, by said sound amplitude sensor, changes in the amplitude of sound waves traveling through blood in said circulating system due to blood dilution caused by said bolus, and evaluating said changes in sound amplitude to determine additional blood characteristics.

8. The method of claim 6, further including detecting, by an impedance sensor, changes in the electrical impedance of blood in said circulating system due to blood dilution caused by said bolus, and evaluating said changes in impedance to determine additional blood characteristics.

9. The method of claim 6, further including detecting, by an optical sensor, changes in the optical density of blood in said circulating system due to blood dilution caused by said bolus, and evaluating said changes in density to determine additional blood characteristics.

10. The method of claim 6, further including detecting, by a thermal sensor, changes in the temperature of blood in said circulating system due to blood dilution caused by said bolus, and evaluating said changes in temperature to determine additional blood characteristics.

11. The method of claim 6, wherein coupling a sound velocity sensor to at least one arterial or venous portion comprises coupling the sound velocity sensor to the venous portion, and wherein the bolus is produced in the arterial portion of said blood circulating system, whereby evaluating said output signals determines solution clearance in said circulating system.

12. The method of claim 6, wherein coupling a sound velocity sensor to at least one arterial or venous portion comprises coupling a corresponding sound velocity sensor to each of said arterial and venous portions to produce respective output signals.

13. The method of claim 12, further including:

coupling a blood dilution sensor to each of said arterial and venous portions;

detecting, by said blood dilution sensors, changes in blood dilution due to said bolus and producing corresponding blood dilution signals; and

evaluating said blood dilution signals with said output signals to determine selected blood characteristics.

14. The method of claim 13, wherein producing a bolus includes injecting into said blood circulating system an indicator fluid and wherein detecting changes in blood dilution includes measuring lung water.

15. A method of measuring a volume of a selected portion of a vascular system, comprising:

injecting into an inlet blood stream flowing into a selected portion of a vascular system a first-quantity of an isotonic solution having a characteristic substantially equal to the same characteristic of said vascular system;

measuring in an outlet blood stream flowing out of said selected portion changes in said blood parameter as said first quantity of said isotonic solution flows through said outlet blood stream to obtain a blood characteristic curve;

injecting into said inlet blood stream a second quantity of said isotonic solution having a characteristic substantially different than that of said blood system;

measuring in said outlet blood stream changes in said blood parameter as said second quantity of said isotonic solution flows through said outlet blood stream;

determining differences in said blood parameter changes to obtain a difference curve; and

comparing said difference curve with said blood characteristic curve to yield a measurement of said volume of said blood system.

16. The method of claim 15, wherein the measuring of a selected blood parameter includes measuring sound velocity in blood in said outlet blood stream;

wherein the injecting of a first isotonic solution includes injecting a solution having a temperature substantially the same as that of said blood system; and

wherein the injecting of a second isotonic solution includes injecting a solution having a temperature substantially different than that of said blood system to determine the thermal volume of said blood system.

17. The method of claim 15, wherein the measuring of a selected blood parameter includes measuring the electrical impedance of blood in said outlet blood stream;

wherein the injecting of a first isotonic solution includes injecting a solution having a temperature substantially the same as that of said blood system; and

wherein the injecting of a second isotonic solution includes injecting a solution having a temperature substantially different than that of said blood system to determine the thermal volume of said blood system.

18. The method of claim 15, wherein the measuring of a selected blood parameter includes measuring sound velocity in blood in said outlet blood stream;

wherein the injecting of a first isotonic solution includes injecting a solution having an osmolality substantially the same as said blood system; and

wherein the injecting of a second isotonic solution includes injecting a solution having an osmolality substantially different than that of said blood system to determine the extravascular volume of a blood system including a selected organ of a patient.

19. The method of claim 15, further including placing a calibrating sensor in an inlet blood stream flowing into said selected portion of said blood system for calibration of said measurements.

20. The method of claim 19, further including injecting calibrating qualities of said isotonic solution in said outlet blood stream prior to said calibrating sensor.

21. The method of claim 15, further including placing a calibrating sensor in said inlet blood stream for calibrating measurements of blood parameters.

22. The method of claim 15, further including measuring a second blood parameter different than the first-named blood parameter, and measuring changes in two blood parameters as each of said first and second quantities of said isotonic solution flow through said outlet blood stream.

23. A method of measuring the extravascular volume of an organ in a patient, comprising injecting a first isotonic solution having a first osmolality into an organ vascular system prior to the organ to dilute blood flowing in said system and passing through said organ;

measuring in said vascular system following said organ changes in the velocity of sound in said blood due to said first solution;

injecting a second isotonic solution having a second osmolality into said system prior to said organ;

measuring in said vascular system following said organ changes in the velocity of sound in said blood due to said second solution; and

comparing said measurements to obtain the extravascular volume of said organ.

24. The method of claim 23, further including calibrating said measurements by further measuring the velocity of sound in said blood in said vascular system prior to said organ.

25. The method of claim 24, further including calibrating said measurements by further injecting a third isotonic solution having said first osmolality and a fourth isotonic solution having said second osmolality in said system after said organ and measuring changes in the velocity of sound in said blood due to said third and fourth solutions.

26. The method of claim 23, wherein said injections and measurements are made prior to and following a patient'"'"'s lung, respectively, and wherein comparing said measurements provides a measurement of lung water in a patient.

27. A method of measuring blood flow in a patient, comprising:

injecting, from a catheter placed in the vascular system leading to a selected organ of a patient, a first saline solution at a temperature substantially equal to the patient'"'"'s body temperature;

measuring, in the vascular system leading from the selected organ of the patient, changes in the velocity of ultrasound in blood flowing in the vascular system caused by said first solution;

establishing a curve representing said changes in velocity; and

determining from an area under said curve the flow of blood from the selected organ.

28. The method of claim 27, including injecting said first saline solution into the vascular system leading to a patient'"'"'s heart;

measuring changes in the velocity of ultrasound in blood flowing in an artery leading from the patient'"'"'s heart; and

determining cardiac output from said curve.

29. The method of claim 28, further including measuring changes in temperature in said blood flowing in said artery, and correcting said measurement of velocity changes for variations in temperature.

30. A method of measuring total organ blood flow in a patient, comprising:

injecting a first quantity of an indicator solution in a vascular system downstream of a patient'"'"'s organ;

measuring by a first sensor a first selected parameter of said blood flow downstream of said injection and measuring by a second sensor blood flow rate downstream of said injection to measure changes produced by said first indicator solution to calibrate said first sensor;

injecting a second quantity of said indicator solution upstream of said organ;

measuring changes in said first selected parameter and changes in blood flow rate produced downstream of said organ by said second quantity of indicator solution; and

comparing changes produced by said first and second quantities of indicator solution to obtain a measure of total organ blood flow.

31. The method of claim 30, wherein measuring said first parameter comprises measuring the optical density of ultrasound in of blood flowing in said vascular system.

32. The method of claim 30, wherein measuring said first parameter comprises measuring the velocity of ultrasound in blood flowing in said vascular system.

33. The method of claim 32, wherein injecting a first quantity of indicator solution in a vascular system comprises injecting said first quantity in extracorporeal tubing leading from a patient to a blood treatment system, and wherein said measurement of velocity of ultrasound is made in said extracorporeal tubing.

34. The method of claim 33, further including correcting the measurement of ultrasound in said tubing for temperature changes by:

transmitting ultrasound through said tubing and through said blood and measuring the velocity of said ultrasound;

simultaneously measuring the amplitude of said ultrasound;

determining changes in said amplitude due to temperature changes to provide a temperature calibration for said tubing;

measuring changes in ultrasound velocity produced by said indicator solution; and

correcting the measured changes in ultrasound velocity due to said indicator solution in accordance with said temperature calibration.

35. Apparatus for measuring blood parameters, comprising:

a blood system having an upstream end and a downstream end and including an arterial portion and a venous portion connected to carry blood between said upstream and said downstream ends;

a first sound velocity sensor coupled to said venous portion of said blood system;

a second sound velocity sensor closely matched to said first sound velocity sensor and coupled to said arterial portion of said blood system;

an indicator injectable through said injection port to produce an indicator bolus in blood flowing in said system, said indicator bolus having sound velocity characteristics different from sound velocity characteristics of blood flowing within said blood system in the absence of said indicator to thereby dilute said blood sound velocity characteristics; and

means responsive to said first and second sound velocity sensors for detecting said bolus in said bloodstream and for producing and recording curves representing said diluted sound velocity characteristics.

36. The apparatus of claim 35, further including a blood flow sensor coupled to at least one of said arterial and venous portions of said blood system.

37. The apparatus of claim 35, wherein said means responsive to said first-named sound velocity sensor and said means responsive to said second sound velocity sensor comprise first and second sound velocity detectors;

the apparatus further including an evaluating device connected to said detectors for determining selected blood characteristics.

38. The apparatus of claim 37, further including a first dilution sensor coupled to said arterial portion of said blood system and a second dilution sensor coupled to said venous portion of said system, wherein said first and second dilution sensors are electrical impedance sensors.

39. The apparatus of claim 37, further including a first dilution sensor coupled to said arterial portion of said blood system and a second dilution sensor coupled to said venous portion of said system, wherein said first and second dilution sensors are optical sensors.

40. The apparatus of claim 37, further including a catheter in at least one of said arterial and venous portions of said blood system, said catheter incorporating said first-named sound velocity sensor and said injection port for intravascular measurement of blood parameters.

41. The apparatus of claim 40, further including a sound amplitude sensor on said catheter and connected to said evaluating device.

42. The apparatus of claim 41, further including a temperature sensor on said catheter connected to said evaluating device.

43. The apparatus of claim 42, further including an electrical impedance sensor on said catheter connected to said evaluating device.

44. The apparatus of claim 42, further including an optical sensor on said catheter connected to said evaluating device.

45. The apparatus of claim 35, further including a first catheter in said arterial portion of said blood system and a second catheter in said venous portion of said blood system, said first catheter incorporating said injection port and said second catheter incorporating said sound sensor, whereby solution clearance is determinable from said dilution curves.

46. The apparatus of claim 35, wherein said arterial portion and said venous portion of said blood system include corresponding extracorporeal arterial tubing and venous tubing, and wherein said injection port is in said arterial tubing and said first-named sound velocity sensor is coupled to said venous tubing, whereby solution clearance is determinable from said dilution curves.

47. The apparatus of claim 46, further including an evaluating device for determining selected blood characteristics, said apparatus further including blood flow measuring means coupled to said tubing and connected to said evaluating device.

48. The apparatus of claim 46, further including an evaluating device determining selected blood characteristics, said apparatus further including an electrical impedance sensor coupled to said tubing and connected to said evaluating device.

49. The apparatus of claim 46, further including an evaluating device for determining selected blood characteristics, said apparatus further including an optical sensor coupled to said tubing and connected to said evaluating device.