Methods of non-invasively estimating intrapulmonary shunt fraction and measuring cardiac output

• US 6,258,038 B1
• Filed: 12/16/1999
• Issued: 07/10/2001
• 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): Winakur, Eric F.
• Assistant Examiner(s): Natnithithadha, Navin
• Application Number:
  US09/465,059
• Time in Patent Office: 572 Days
• Field of Search: 600/481, 600/483, 600/504, 600/508, 600/526, 600/538
• US Class Current: 600/504
• 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 5/083 Measuring rate of metabolism by using breath test, e.g. measuring rate of oxygen consumption
• CPC Class Codes: A61B 5/0836 Measuring rate of CO2 production
• CPC Class Codes: A61B 5/14551 for measuring blood gases

Abstract

A method of non-invasively estimating the intrapulmonary shunt in a patient. The method includes non-invasively measuring respiratory flow, respiratory carbon dioxide content, and arterial blood oxygen content. A re-breathing process is employed to facilitate an estimate of the patient'"'"'s pulmonary capillary blood flow. Any inaccuracies of the arterial blood oxygen content are corrected to provide a substantially accurate arterial blood oxygen content measurement. The respiratory flow, carbon dioxide content and arterial blood oxygen content measurements, and the pulmonary capillary blood flow estimate are employed to estimate an intrapulmonary shunt of the patient. The invention also includes a method of determining the total cardiac output of the patient which considers the estimated intrapulmonary shunt.

Claims

1. A method of estimating a cardiac output of a patient, comprising:

determining an oxygen saturation of arterial blood of the patient;

determining a fraction of inspired oxygen of the patient;

determining a pulmonary capillary blood flow of the patient; and

determining an intrapulmonary shunt fraction from said oxygen saturation and said fraction of inspired oxygen.

2. The method of claim 1, wherein said determining said intrapulmonary shunt fraction comprises employing an iso-shunt plot.

3. The method of claim 1, wherein said determining said intrapulmonary shunt fraction comprises calculating said intrapulmonary shunt fraction with an iso-shunt equation.

4. The method of claim 1, wherein said determining said intrapulmonary shunt fraction further comprises employing said pulmonary capillary blood flow.

5. The method of claim 1, further comprising calculating the cardiac output with said intrapulmonary shunt fraction and said pulmonary capillary blood flow.

6. The method of claim 1, further comprising calculating an intrapulmonary shunt flow of the patient with said intrapulmonary shunt fraction and said pulmonary capillary blood flow.

7. The method of claim 6, further comprising calculating the cardiac output with said intrapulmonary shunt flow and said pulmonary capillary blood flow.

8. The method of claim 1, wherein said determ ining said pulmonary capillary blood flow comprises re-breathing.

9. The method of claim 8, wherein said re-breathing comprises total or partial re-breathing.

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

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

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

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

14. The method of claim 1, further comprising correcting said oxygen saturation of arterial blood.

15. The method of claim 14, wherein said correcting comprises generating a correction summand and modifying said oxygen saturation of arterial blood by said correction summand.

16. The method of claim 15, wherein said generating comprises selecting an assumed value.

17. The method of claim 16, wherein said assumed value comprises about 2% to 3% of said oxygen saturation of arterial blood.

18. The method of claim 16, wherein said generating comprises directly obtaining another measurement of arterial oxygen saturation of arterial blood and comparing said another measurement to said oxygen saturation of arterial blood.

19. The method of claim 16, wherein said generating comprises generating an equation for converting said oxygen saturation of arterial blood to a substantially accurate value.

20. The method of claim 1, wherein said determining said oxygen saturation of arterial blood comprises non-invasively determining said oxygen saturation of arterial blood.

21. The method of claim 20, wherein said non-invasively determining said oxygen saturation of arterial blood is effected by a technique comprising pulse oximetry.

22. The method of claim 1, wherein said determining said fraction of inspired oxygen comprises measuring an oxygen fraction of respiration of the patient.

23. The method of claim 1, wherein said determining said fraction of inspired oxygen comprises a set fraction of oxygen with which the patient is artificially ventilated.

24. The method of claim 1, further comprising determining an end capillary blood oxygen content of the patient.

25. The method of claim 24, wherein said determining said end capillary blood oxygen content comprises employing an end tidal oxygen partial pressure of respiration of the patient.

26. The method of claim 24, wherein said determining said end capillary blood oxygen content comprises employing an end tidal carbon dioxide partial pressure of respiration of the patient.

27. A method of determining a cardiac output of a patient, comprising:

determining a respiratory flow and a respiratory carbon dioxide content of gas mixtures inhaled and exhaled by the patient;

calculating a first carbon dioxide elimination and a first alveolar carbon dioxide content of the patient;

conducting a re-breathing process on the patient'"'"'s breathing;

calculating a second carbon dioxide elimination and a second alveolar carbon dioxide content of the patient during said conducting;

estimating a pulmonary capillary blood flow of the patient;

non-invasively determining an arterial blood oxygen content of the patient;

estimating an intrapulmonary shunt of the patient; and

calculating the cardiac output from said estimated intrapulmonary shunt and said estimated pulmonary capillary blood flow.

28. The method of claim 27, further comprising correcting for an inaccuracy of said arterial blood oxygen content.

29. A method of estimating an intrapulmonary shunt fraction of a cardiac output of a patient, comprising:

determining an oxygen saturation of arterial blood of the patient;

determining a fraction of inspired oxygen of the patient;

determining a pulmonary capillary blood flow of the patient; and

employing said oxygen saturation of arterial blood and said fraction of inspired oxygen to determine the intrapulmonary shunt fraction of said pulmonary capillary blood flow.

30. The method of claim 29, wherein said determining said pulmonary capillary blood flow comprises re-breathing.

31. The method of claim 30, wherein said re-breathing comprises partial or total re-breathing.

32. The method of claim 29, wherein said employing comprises employing said oxygen saturation of arterial blood and said fraction of inspired oxygen with at least one of an iso-shunt plot and an iso-shunt equation.

33. The method of claim 29, wherein said determining said pulmonary capillary blood flow comprises adjusting a respiratory rate.

34. The method of claim 29, wherein said determining said pulmonary capillary blood flow comprises adjusting a period of inspiration or expiration.

35. The method of claim 29, wherein said determining said pulmonary capillary blood flow comprises adjusting a tidal volume.

36. The method of claim 29, wherein said determining said pulmonary capillary blood flow comprises adding a volume of carbon dioxide to ventilation of the patient.

37. The method of claim 29, wherein said determining said oxygen saturation of arterial blood comprises obtaining a pulse oximetry measurement and converting said pulse oximetry measurement to said oxygen saturation of arterial blood.

38. The method of claim 37, further comprising generating a correction summand for said oxygen saturation of arterial blood.

39. The method of claim 38, wherein said correction summand comprises an assumed value.

40. The method of claim 38, wherein said generating comprises directly obtaining another measurement of oxygen saturation of arterial blood and comparing said another measurement to said oxygen saturation of arterial blood.

41. The method of claim 38, wherein said generating comprises generating an equation for converting said oxygen saturation of arterial blood to a substantially accurate value.

42. The method of claim 35, wherein said determining said fraction of inspired oxygen comprises measuring said fraction of inspired oxygen.

43. The method of claim 32, wherein said fraction of inspired oxygen comprises a set fraction of oxygen with which the patient is artificially ventilated.