Noninvasive method and apparatus for determining cardiac output

• US 5,971,934 A
• Filed: 10/03/1997
• Issued: 10/26/1999
• Est. Priority Date: 10/04/1996
• Status: Expired due to Term

• Current Assignee: Trustees Of The University Of Pennsylvania (University of Pennsylvania)
• Original Assignee: Trustees Of The University Of Pennsylvania (University of Pennsylvania)
• Inventors: Scherer, Peter W., Neufeld, Gordon R.
• Primary Examiner(s): Hindenberg, Max
• Assistant Examiner(s): Natnithithadha, Navin
• Application Number:
  US08/943,555
• Time in Patent Office: 753 Days
• Field of Search: 600/484, 600/526, 600/532, 600/204.23, 600/483, 128/920, 128/923
• US Class Current: 600/526
• 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 5/0836 Measuring rate of CO2 production
• CPC Class Codes: A61B 5/742 using visual displays A61B5/339 takes precedence
• CPC Class Codes: Y10S 128/923 by comparison of patient data to other data

Abstract

Cardiac output of a test individual is determined in a noninvasive method, by processing CO₂ expirogram data obtained from the individual. The method also noninvasively determines pulmonary arterial blood CO₂ concentration for the test individual. An apparatus for carrying out this noninvasive method includes a database of computed numerical CO₂ expirograms, a device for measuring experimental CO₂ expirogram data and means for processing the data sets to determine cardiac output.

Claims

1. A noninvasive method for determining cardiac output for an individual which comprises

(i) obtaining a data set of multiple CO₂ expirograms from a test individual;

(ii) determining an airway factor for the data set of multiple CO₂ expirograms, to obtain an airway factor characteristic of the test individual;

(iii) generating a database of computed numerical CO₂ expirograms from an airway numerical model using the airway factor that is characteristic of the test individual and using a range of assumed numerical values for cardiac output that overlaps the expected cardiac output of the test individual;

(iv) comparing differences between numerical values of a CO₂ expirogram first parameter and an experimental counterpart parameter value from a CO₂ expirogram of the test individual and determining, as a function of the numerical cardiac output values, for which cardiac output values such differences are minimized;

(v) comparing differences between numerical values of a CO₂ expirogram second parameter and an experimental counterpart parameter value from a CO₂ expirogram of the test individual and determining, as a function of the numerical cardiac output values, for which cardiac output values such differences are minimized; and

(vi) determining a cardiac output for the test individual by cross-comparing the information from (iv) and (v) to obtain a cardiac output value at which the respective differences for the CO₂ expirogram first parameter and for the CO₂ expirogram second parameter are each minimized, said value being the cardiac output noninvasively determined for the test individual.

2. The method of claim 1 which comprises carrying out step (iii) in advance of step (i), to create a database of computed numerical CO₂ expirograms that includes ranges of parameter values that overlap the expected values of such parameters for a population of individuals that includes the test individual.

3. A noninvasive method for determining cardiac output (Q_B) for an individual which comprises

(i) obtaining multiple CO₂ expirograms from a test individual wherein such expirograms include Phase III data;

(ii) calculating a normalized Phase III slope, NS, as a function of tidal volume for individual CO₂ expirograms obtained from the test individual, to generate a population of experimental paired values of normalized Phase III slope as function of tidal volume for such CO₂ expirograms;

(iii) determining an airway area reduction factor for the population of experimental paired values of normalized slope and tidal volume, to obtain an airway area reduction factor characteristic of the test individual;

(iv) generating a population of computed numerical CO₂ expirograms with associated paired numerical normalized Phase III slope and CO₂ volume exhalation rate values, from an airway numerical model using the airway area reduction factor that is characteristic of the test individual and using a range of assumed numerical values for cardiac output, Q_B, and pulmonary arterial blood CO₂ concentration, c_B, with ranges that overlap the expected Q_B and c_B of the test individual;

(v) comparing the differences between numerical normalized Phase III slope values and an experimental normalized Phase III slope value from a CO₂ expirogram of the test individual and determining, as a function of the numerical Q_B and c_B values, for which paired Q_B and c_B values such differences are minimized;

(vi) comparing the differences between numerical CO₂ volume exhalation rate values and an experimental CO₂ volume exhalation rate value from a CO₂ expirogram of the test individual and determining, as a function of the numerical Q_B and c_B values, for which paired Q_B and c_B values such differences are minimized; and

(vii) determining a cardiac output for the test individual by cross-comparing the information from (v) and (vi) to obtain a paired value of Q_B and c_B at which the respective differences of both normalized Phase III slope and CO₂ volume exhalation rate are minimized, the value of cardiac output in said paired value being the cardiac output determined for the test individual.

4. The method of claim 3 wherein the CO₂ expirograms of step (i) are steady-state single breath CO₂ expirograms of the test individual breathing ambient air.

5. The method of claim 3 wherein the CO₂ expirograms of step (i) are steady-state non-rebreathing CO₂ expirograms of the test individual breathing ambient air.

6. The method of claim 3 wherein the CO₂ expirograms are obtained from the test individual under breathing conditions selected from the group consisting of normal breathing, shallow breathing, rapid breathing, rapid-shallow breathing, slow breathing, deep breathing, and slow-deep breathing.

7. The method of claim 3 wherein at least ten CO₂ expirograms are obtained from the test individual.

8. The method of claim 3 wherein the CO₂ expirograms are obtained from the test individual under conditions selected from the group consisting of resting, light exercise, moderate exercise, heavy exercise, sleeping, mechanically ventilated, anesthetized and unconscious.

9. The method of claim 3 wherein the airway numerical model is a single-path airway model.

10. The method of claim 9 wherein the single-path airway model utilizes a morphometric lung model selected from the group consisting of Weibel Model A, Hansen &

Ampaya, and Haefeli-Bleuer &

Weibel.

11. The method of claim 3 wherein the assumed values of Q_B used in step (iv) are within the range of from about 1 to about 20 l/min.

12. The method of claim 3 wherein the assumed values of c_B used in step (iv) are within the range of from about 30 to about 80 mm Hg.

13. The method of claim 3 which comprises carrying out step (iv) in advance of step (i), to create a database of computed numerical CO₂ expirograms that includes ranges of values of airway area reduction factor, tidal volume, breathing frequency, cardiac output and pulmonary arterial blood CO₂ concentration that overlap the expected values of such parameters for a population of individuals that includes the test individual.

14. The method of claim 13 wherein, in step (iv), the airway area reduction factor ranges from about 0.2 to about 2.

15. The method of claim 13 wherein, in step (iv), the tidal volume ranges from about 200 to about 2500 ml.

16. The method of claim 13 wherein, in step (iv), the breathing frequency ranges from about 4 to about 40 breaths per minute.

17. The method of claim 3 wherein the comparison of differences between numerical values and an experimental value is carried out with said values being obtained from CO₂ expirograms at equivalent tidal volumes and breathing frequencies.

18. The method of claim 3 wherein the same CO₂ expirogram of the test individual is used in steps (v) and (vi).

19. The method of claim 3 wherein the CO₂ expirogram of the test individual used in steps (v) and (vi) is an average of two or more CO₂ expirograms of the test individual.

20. The method of claim 3 wherein the CO₂ expirograrn of the test individual used in steps (v) and (vi) is a CO₂ expirogram obtained from the individual at rest and breathing normally.

21. The method of claim 3 which further comprises repeating steps (v) and (vii) with a different CO₂ expirogram from the test individual to obtain multiple values of cardiac output for the test individual and then selecting a single value or averaged value of cardiac output as the cardiac output representative of such test individual.

22. The method of claim 3 which further comprises determining the pulmonary arterial blood CO₂ concentration for the test individual, the paired values of Q_B and c_B obtained from the cross-comparison in step (vii) being the cardiac output and pulmonary arterial blood CO₂ concentration determined for the test individual.

23. An apparatus for the noninvasive determination of cardiac output for a test individual which comprises

(i) a database comprising a population of computed numerical CO₂ expirograms for a range of assumed parameter values, including cardiac output, that overlap expected values of these parameters in a population of individuals that includes the test individual;

(ii) a device for measuring CO₂ gas expirogram data from the test individual;

(iii) means for processing data from multiple CO₂ expirograms obtained from the test individual to generate a CO₂ expirogram data set for the test individual and for calculating an airway factor characteristic of the test individual from such multiple CO₂ expirogram data set;

(iv) means for computing differences between an experimental value of a first parameter from a CO₂ expirogram of the test individual and computed values of the first parameter from numerical CO₂ expirograms in the database, whose assumed airway factor is comparable to that of the experimental CO₂ expirogram, and for determining for which values of cardiac output such differences are minimized;

(v) means for computing differences between an experimental value of a second parameter from a CO₂ expirogram of the test individual and computed values of the second parameter values from numerical CO₂ expirograms in the database, whose assumed airway factor is comparable to that of the experimental CO₂ expirogram, and for determining for which values of cardiac output such differences are minimized;

(vi) means for determining a cardiac output for the test individual by cross-comparing the information from (iv) and (v) to obtain a value of cardiac output at which the respective differences of the CO₂ expirogram first parameter and the CO₂ expirogram second parameter are each minimized; and

(vii) means for reporting the value of cardiac output determined in (vi) as the cardiac output of the test individual.

24. The apparatus of claim 23 wherein the means for processing the data from the CO₂ expirograms in (iii) is a computer.

25. The apparatus of claim 23 wherein the means for computing the differences between experimental and numerical values in (iv) and (v) and the means for cross-comparing the information in (vi) is a computer.

26. An apparatus for the noninvasive determination of cardiac output for a test individual which comprises

(i) a database comprising a population of computed numerical CO₂ expirograms for a range of assumed values for cardiac output, pulmonary arterial blood CO₂ concentration, airway area reduction factor, tidal volume and breathing frequency that overlap expected values of these parameters in a population of individuals that includes the test individual;

(ii) a device for measuring CO₂ gas concentration, gas volume, breathing frequency and tidal volume for single breaths from the test individual under steady-state non-rebreathing conditions to generate CO₂ expirogram data for the test individual;

(iii) means for processing data from multiple CO₂ expirograms obtained from the test individual to calculate a normalized Phase III slope and tidal volume for each of said multiple CO₂ expirograms and to calculate an airway area reduction factor characteristic of the test individual from such multiple CO₂ expirogram data;

(iv) means for computing differences between an experimental normalized Phase III slope from a CO₂ expirogram of the test individual and computed values of experimental normalized Phase III slopes in the database, for numerical CO₂ expirograms whose assumed airway area reduction factor, tidal volume and breathing frequency are comparable to that of the experimental CO₂ expirogram, and for determining for which values of cardiac output and pulmonary arterial blood CO₂ concentration such differences are minimized;

(v) means for computing differences between an experimental CO₂ volume exhalation rate from a CO₂ expirogram of the test individual and computed values of experimental CO₂ volume exhalation rate values in the database, for numerical CO₂ expirograms whose assumed airway area reduction factor, tidal volume and breathing frequency are comparable to that of the experimental CO₂ expirogram, and for determining for which values of cardiac output and pulmonary arterial blood CO₂ concentration such differences are minimized;

(vi) means for determining a cardiac output for the test individual by cross-comparing the information from (iv) and (v) to obtain paired values of cardiac output and pulmonary arterial blood CO₂ concentration at which the respective differences of both normalized Phase III slope and CO₂ volume exhalation rate are minimized; and

(vii) means for reporting the value of cardiac output determined in (vi) as the cardiac output of the test individual.

27. The apparatus of claim 26 wherein the means for processing the data from the multiple CO₂ expirograms is a computer.

28. The apparatus of claim 26 wherein the means for computing the differences between experimental and numerical values in (iv) and (v) and the means for cross-comparing the information in (vi) is a computer.