Method of continuously, non-invasively monitoring pulmonary capillary blood flow and cardiac output

• US 6,217,524 B1
• Filed: 09/09/1998
• Issued: 04/17/2001
• Est. Priority Date: 09/09/1998
• Status: Expired due to Term

• Current Assignee: RIC INVESTMENTS LLC (Koninklijke Philips N.V.)
• Original Assignee: NTC Technology, Inc. (Dixtal Medical, Inc.)
• Inventors: Orr, Joseph A., Kück, Kai, Jaffe, Michael B., Haryadi, Dinesh G.
• Primary Examiner(s): O'Connor, Cary
• Assistant Examiner(s): Astorino, M.
• Application Number:
  US09/150,446
• Time in Patent Office: 951 Days
• Field of Search: 600/500-504, 600/526, 600/528-538, 600/300, 600/301, 600/481-486, 128/204-2-2
• US Class Current: 600/504
• CPC Class Codes: A61B 5/0836 Measuring rate of CO2 production
• CPC Class Codes: A61M 16/021 operated by electrical means A61M16/202 – A61M16/205 take precedence
• CPC Class Codes: A61M 2016/0036 in the breathing tube and used in both inspiratory and expiratory phase
• CPC Class Codes: A61M 2016/103 the CO2 concentration

Abstract

A method of continuously, non-invasively determining the cardiac output of a patient. The method includes intermittently measuring the cardiac output, the volume of carbon dioxide exhaled by the patient per breath, and determining the arterial-venous gradient of the patient or a similar substantially constant value by dividing the volume of carbon dioxide exhaled by the measured cardiac output. The arterial-venous gradient or similar substantially constant value may then be employed to determine the cardiac output of the patient on a breath-by-breath basis. The carbon dioxide elimination, which is non-invasively measured as the volume of carbon dioxide exhaled by the patient per breath, is divided by the arterial-venous gradient or the substantially constant value to determine the cardiac output. The method may also include generating a signal to compensate for any non-metabolic changes in the carbon dioxide elimination, arterial-venous gradient, or other respiratory or blood gas profile measurements that may be caused by a change in ventilation or breathing of the patient. The compensatory signal may be employed to modify one or more of the respiratory or blood gas profile measurements in order to facilitate the accurate determination of cardiac output during or after changes in ventilation or breathing.

Claims

1. A method of substantially continuously determining a pulmonary capillary blood flow of a patient, comprising:

determining an intermittent pulmonary capillary blood flow using a selected method of determining pulmonary capillary blood flow;

measuring a carbon dioxide elimination of the patient;

obtaining a scaling factor with said intermittent pulmonary capillary blood flow and said carbon dioxide elimination; and

modifying a subsequent carbon dioxide elimination of the patient by a scaling value comprising said scaling factor to calculate a pulmonary capillary blood flow value.

2. The method of claim 1, wherein said determining comprises conducting an indicator dilution technique.

3. The method of claim 2, further comprising intermittently repeating said indicator dilution technique at least once.

4. The method of claim 1, wherein said obtaining comprises:

measuring a carbon dioxide content of venous blood of the patient; and

measuring a carbon dioxide content of arterial blood of the patient.

5. The method of claim 1, wherein said obtaining comprises:

measuring an oxygen saturation of arterial blood of the patient; and

measuring an oxygen saturation of venous blood of the patient.

6. The method of claim 1, wherein said obtaining comprises:

measuring an end capillary oxygen content of the patient; and

measuring an oxygen content of arterial blood of the patient.

7. The method of claim 1, wherein said obtaining comprises:

measuring a partial pressure of an arterial blood gas; and

measuring a partial pressure of a venous blood gas.

8. The method of claim 1, wherein said determining comprises conducting a differential Fick cardiac output measurement technique.

9. The method of claim 1, wherein said determining comprises partial or total re-breathing.

10. The method of claim 1, wherein said determining comprises adjusting a respiratory rate.

11. The method of claim 1, wherein said determining comprises adjusting a period of inspiration or expiration.

12. The method of claim 1, wherein said determining comprises adjusting a tidal volume.

13. The method of claim 1, wherein said determining pulmonary capillary blood flow comprises adding a volume of carbon dioxide to ventilation of the patient.

14. The method of claim 8, further comprising intermittently repeating said determining at least once.

15. The method of claim 1, wherein said measuring comprises measuring a per-breath volume of exhaled carbon dioxide.

16. The method of claim 1, further comprising intermittently determining said scaling factor.

17. The method of claim 1, further comprising updating said scaling factor.

18. The method of claim 1, further comprising compensating for a non-metabolic change in said carbon dioxide elimination.

19. The method of claim 18, wherein said compensating comprises detecting said non-metabolic change.

20. The method of claim 18, wherein said compensating comprises generating a compensatory signal in response to said non-metabolic change.

21. The method of claim 20, wherein said compensatory signal is based on a magnitude of said non-metabolic change.

22. The method of claim 20, wherein said compensatory signal is based on an amount of time elapsed since the onset of said non-metabolic change.

23. The method of claim 20, further comprising modifying at least one of said carbon dioxide elimination and said scaling value by said compensatory signal.

24. The method of claim 1, wherein said scaling factor comprises an entire scaling value.

25. The method of claim 1, wherein said scaling factor comprises a portion of said scaling value.

26. The method of claim 1, wherein said obtaining comprises dividing said intermittent pulmonary capillary blood flow by said carbon dioxide elimination.

27. The method of claim 26, wherein said modifying comprises dividing said subsequent carbon dioxide elimination by said scaling value.

28. The method of claim 1, further comprising modifying said pulmonary capillary blood flow value by an offset constant.

29. A method of substantially continuously, non-invasively determining a cardiac output of a patient, comprising:

obtaining a scaling value comprising a scaling factor;

non-invasively measuring a carbon dioxide elimination of the patient;

compensating for a non-metabolic change in at least one of said carbon dioxide elimination and said scaling value; and

calculating the cardiac output by dividing said carbon dioxide elimination by said scaling value.

30. The method of claim 29, further comprising detecting said non-metabolic change.

31. The method of claim 29, wherein said compensating comprises modifying at least one of said carbon dioxide elimination and said scaling value.

32. The method of claim 31, wherein said scaling value comprises an arterial-venous gradient of the patient.

33. The method of claim 29, wherein an entire said scaling value comprises said scaling factor.

34. The method of claim 29, wherein said scaling factor comprises at least a portion of said scaling value.

35. The method of claim 29, wherein said calculating comprises modifying the cardiac output by an offset constant.

36. A method of non-invasively measuring cardiac output of a patient on a breath-by-breath basis, comprising:

measuring a per breath volume of carbon dioxide exhaled by the patient;

measuring an arterial-venous gradient of the patient; and

compensating for a non-metabolic change in at least one of said per breath volume of carbon dioxide and said arterial-venous gradient.

37. The method of claim 36, further comprising detecting said non-metabolic change.

38. The method of claim 36, wherein said compensating comprises generating a compensatory signal in response to said non-metabolic change.

39. The method of claim 38, wherein said compensatory signal is based on a magnitude of said non-metabolic change.

40. The method of claim 38, wherein said compensatory signal is based on an amount of time elapsed since the onset of said non-metabolic change.

41. The method of claim 38, further comprising modifying at least one of said per breath volume of carbon dioxide and said arterial-venous gradient by said compensatory signal.

42. A method of substantially continuously determining a cardiac output of a patient, comprising:

determining an intermittent cardiac output using a selected method of determining cardiac output;

non-invasively measuring a carbon dioxide elimination of the patient;

obtaining a scaling factor with said intermittent cardiac output and said carbon dioxide elimination; and

modifying another carbon dioxide elimination with a scaling value comprising said scaling factor to calculate a cardiac output value.

43. The method of claim 42, wherein said obtaining comprises dividing said intermittent cardiac output by said carbon dioxide elimination.

44. The method of claim 43, wherein said modifying comprises multiplying said another carbon dioxide elimination by said scaling value.

45. The method of claim 42, further comprising modifying said cardiac output value by an offset constant.

46. The method of claim 45, wherein said modifying comprises adding said offset constant to or subtracting said offset constant from said cardiac output value.

47. A method of substantially continuously determining a cardiac output of a patient, comprising:

determining an intermittent cardiac output using a selected method of determining cardiac output;

measuring an oxygen consumption of the patient;

obtaining a scaling factor with said intermittent cardiac output and said oxygen consumption; and

calculating a cardiac output value with another oxygen consumption and a scaling value comprising said scaling factor.

48. The method of claim 47, wherein said obtaining comprises dividing said intermittent cardiac output by said oxygen consumption.

49. The method of claim 48, wherein said calculating comprises multiplying said another oxygen consumption by said scaling value.

50. The method of claim 47, wherein said calculating further comprises modifying said cardiac output value by an offset constant.

51. The method of claim 50, wherein said modifying comprise adding said offset constant to or subtracting said offset constant from said cardiac output value.

52. A method of substantially continuously determining a pulmonary capillary blood flow of a patient, comprising:

determining an intermittent pulmonary capillary blood flow using a selected method of determining pulmonary capillary blood flow;

measuring an oxygen consumption of the patient;

obtaining a scaling factor with said intermittent pulmonary capillary blood flow and said oxygen consumption; and

calculating a pulmonary capillary blood flow value with at least one subsequent oxygen consumption measurement and a scaling value comprising said scaling factor to calculate pulmonary capillary blood flow.

53. The method of claim 52, wherein said obtaining comprises dividing said intermittent pulmonary capillary blood flow by said oxygen consumption.

54. The method of claim 53, wherein said calculating comprises multiplying said oxygen consumption value by said scaling value.

55. The method of claim 52, wherein said calculating further comprises modifying said pulmonary capillary blood flow value by an offset constant.

56. The method of claim 55, wherein said modifying comprises adding said offset constant to or subtracting said offset constant from said pulmonary capillary blood flow value.