Method for assessing pulmonary stress and breathing apparatus employing the method

• US 6,533,730 B2
• Filed: 12/15/2000
• Issued: 03/18/2003
• Est. Priority Date: 12/17/1999
• Status: Expired due to Term

• Current Assignee: Maquet Critical Care AB (Getinge AB)
• Original Assignee: Siemens AG
• Inventors: Ström, Christer
• Primary Examiner(s): Freay, Charles G.
• Assistant Examiner(s): BELENA, JOHN F
• Application Number:
  US09/736,346
• Publication Number:
  US 20010004677A1
• Time in Patent Office: 823 Days
• Field of Search: 600/529, 600/533, 600/538, 600/543, 128/200.24, 128/202.22, 128/204.21
• US Class Current: 600/533
• CPC Class Codes: A61B 5/085 Measuring impedance of respiratory organs or lung elasticity
• CPC Class Codes: A61M 16/00 Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes stimulating the respiratory movement by mechanical, pneumatic or electrical means, iron lungs combined with gas breathing means A61H31/00
• CPC Class Codes: A61M 16/0051 with alarm devices
• CPC Class Codes: A61M 16/0063 Compressors
• CPC Class Codes: A61M 16/024 including calculation means, e.g. using a processor
• CPC Class Codes: A61M 16/12 by mixing different gases
• CPC Class Codes: A61M 2016/0021 with a proportional output signal, e.g. from a thermistor
• 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

Abstract

In a method for assessing pulmonary stress, a flow of respiratory gas is supplied to the lungs of a subject, an ensuing pressure is measured in relation to time and the pressure-time relationship is analyzed. In this analysis, the profile of the pressure-time relationship is determined. In summary, the profile is straight when no stress is present, is convex when there is a risk for over-distension, and is concave when alveolar units are opened up. Implemented in a breathing apparatus the method can be used to assist an operator in diagnostic and therapeutic considerations in relation to a patient.

Claims

1. A method for assessing pulmonary stress, comprising the steps of:

connecting a respirating subject to an inspiration/expiration gas flow path;

supplying respiratory gas to said subject'"'"'s respiratory system via said flow path;

measuring pressure in relation to time in one of said respiratory system and said gas flow path; and

assessing pulmonary stress of said subject by determining a profile of said pressure-time relationship of gas in said gas flow path.

2. A method as claimed in claim 1 wherein the step of determining said profile comprises determining a convexity/concavity of said profile.

3. A method as claimed in claim 2 wherein the step of determining said profile comprises adapting said pressure-time relationship to a power equation P_ao=a*t^b+c, wherein P_ao is pressure, t is time, and a, b and c are constants, and determining at least the constant b as a determinant for said profile, by determining said profile to be concave if b<

1 indicative of an increase in lung compliance, determining said profile to be straight if b=1 indicative of a constant lung compliance, and determining said profile to be convex if b>

1 indicating a reduction in lung compliance.

4. A method as claimed in claim 2 wherein the step of determining said profile comprises adapting said pressure-time relationship to a polynomial equation P_ao=α

+β

*t+γ

*t², wherein P_ao is pressure, t is time, and α

, β and

γ

are constants, and determining at least the constant γ

as a determinant for said profile, whereby said profile is concave if γ

<

0 indicative of an increase in lung compliance, said profile is straight if γ

=0 indicative of a constant lung compliance, and said profile is convex if γ

>

0 indicative of a reduction in lung compliance.

5. A method as claimed in claim 1 comprising determining said profile during each breath of said subject.

6. A method as claimed in claim 1 comprising determining said profile as an average over a plurality of breaths of said subject.

7. A breathing apparatus comprising:

an inspiration/expiration gas flow path adapted for connection to a respirating subject'"'"'s respiratory system;

a gas regulator connected in said gas flow path for regulating respiratory gas flow in said gas flow path;

a pressure gauge for measuring pressure in one of said respiratory system and said gas flow path; and

a control unit connected to said pressure gauge and to said gas regulator for determining a profile of a pressure-time relationship of gas in said gas flow path from said pressure measured by said pressure gauge, and for assessing pulmonary stress and operating said gas regulator dependent on said profile.

8. A breathing apparatus as claimed in claim 7 wherein said control unit determines a convexity/concavity of said profile.

9. A breathing apparatus as claimed in claim 8 wherein said control unit determines said profile by adapting said pressure-time relationship to a power equation P_ao=a*t^b+c, wherein P_ao is pressure, t is time, and a, b and c are constants, by determining at least the constant b as a determinant for said profile, and wherein said control unit determines said profile is concave if b<

1 indicative of an increase in lung compliance, determines said profile is straight if b=1 indicative of a constant lung compliance, and determines said profile is convex if b>

1 indicative of a reduction in lung compliance.

10. A breathing apparatus as claimed in claim 9 wherein said control unit compares the determined constant b with a predefined interval and analyzes said pulmonary stress as being a minimum if b is within said interval, analyzes an existence of pulmonary stress due to alveolar opening and closing to be present if b is below said predefined interval, and determines alveolar over-distension to be present if b is above said interval.

11. A breathing apparatus as claimed in claim 10 comprising defining said predefined interval for the constant b as having a lower limit between 0.5 and 0.95 and an upper limit between 1.05 and 1.5.

12. A breathing apparatus as claimed in claim 8 wherein said control unit determines said profile by adapting said pressure-time relationship to a polynomial equation P_ao=α

+β

*t+γ

*t², wherein P_ao is pressure, t is time, and α

, β and

γ

are constants, and wherein said control unit determines at least the constant γ

as a determinant for said profile and wherein said control unit compares the determined constant γ

with a predefined interval and determines a minimum of pulmonary stress to be present if γ

is within said interval, determines pulmonary stress due to alveolar opening and closing to be present if γ

is below said interval, and determines alveolar over-distension to be present if γ

is above said interval.

13. A breathing apparatus as claimed in claim 7 further comprising a display unit and an alarm unit, and wherein said control unit, dependent on the determination of said profile, initiates at least one action selected from the group of actions consisting of generating an alarm via said alarm unit, generating a warning on said display that pulmonary stress is present, determining a change in at least one control parameter for said gas regulator, determining a change in at least one control parameter for said gas regulator and displaying the determined change on said display, determining a change in at least one control parameter for said gas regulator and automatically resetting said at least one control parameter dependent on said change, displaying a recommendation for a recruiting maneuver on said display, and automatically performing a recruiting maneuver.

14. A breathing apparatus as claimed in claim 13 wherein said control parameter is selected from the group consisting of positive end expiratory pressure, fraction of oxygen in said respiratory gas, and tidal volume.

15. A breathing apparatus comprising:

an inspiration/expiration gas flow path adapted for connection to a respirating subject'"'"'s respiratory system;

a first gas regulator connected in said gas flow path and a second gas regulator connected in said gas flow path for, in combination, regulating respiratory gas flow in said gas flow path;

a pressure gauge connected in one said respiratory system and said gas flow path for measuring pressure of said respiratory gas in said one of said respiratory system and said gas flow path;

a control unit connected to said first gas regulator, said second gas regulator and said pressure gauge for identifying a pressure-time relationship of said respiratory gas in said gas flow path from said pressure measured by said pressure gauge and for analyzing pulmonary stress by determining a profile of said pressure time relationship;

said control unit, in a first phase, operating said first gas regulator and said second gas regulator to provide respiration cycles having an initial tidal volume, an initial respiratory rate, an initial inspiratory time relative to a total respiration cycle time, a constant inspiratory gas flow, an initial oxygen fraction of said respiratory gas, and an initial PEEP value;

said control unit in a second phase operating said first gas regulator and said second gas regulator to progressively increase said PEEP value from said initial PEEP value, and wherein said control unit determines said profile by adapting said pressure-time relationship to a power equation P_ao=a*t^b+c, wherein P_ao is pressure, t is time, and a, b and c are constants, and determining at least the constant b as a determinant for said profile, and wherein said control unit compares the determined constant b to a predefined interval and if b is within said interval, said control unit proceeds to a third phase;

in said third phase, said control unit operating said first gas regulator and said second gas regulator to execute a recruiting maneuver having a specific lung inflation pressure and a specific lung inflation time and wherein said control unit compares the determined constant b to said interval and if b is below said interval, said control unit operates said first gas regulator and said second gas regulator to further progressively increase said PEEP value and repeatedly executes said recruiting maneuver until b is within said interval; and

in a fourth phase, said control unit compares the determined constant b to said interval and operates said first gas regulator and said second gas regulator to progressively decrease said PEEP value until b is within said interval.

16. A breathing apparatus as claimed in claim 15 further comprising an operator interface allowing an operator to set said initial tidal volume, said initial respiratory rate, said initial inspiratory time relative to said total respiration cycle time, said initial oxygen fraction in said respiratory gas and said initial PEEP value.

17. A breathing apparatus comprising:

an inspiration/expiration gas flow path adapted for connection to a respirating subject'"'"'s respiratory system;

a first gas regulator connected in said gas flow path and a second gas regulator connected in said gas flow path for, in combination, regulating respiratory gas flow in said gas flow path;

a pressure gauge connected in one of said respiratory system and said gas flow path for measuring pressure of said respiratory gas in said one of said respiratory system and, said gas flow path;

a control unit connected to said first gas regulator, said second gas regulator and said pressure gauge for identifying a pressure-time relationship of said respiratory gas in said gas flow path from said pressure measured by said pressure gauge and for analyzing pulmonary stress by determining a profile of said pressure time relationship;

said control unit, in a first phase, operating said first gas regulator and said second gas regulator to provide respiration cycles having an initial tidal volume, an initial respiratory rate, an initial inspiratory time relative to a total respiration cycle time, a constant inspiratory gas flow, an initial oxygen fraction of said respiratory gas, and an initial PEEP value;

said control unit in a second phase operating said first gas regulator and said second gas regulator to progressively increase said PEEP value from said initial PEEP value, and wherein said control unit determines said profile by adapting said pressure-time relationship to a polynomial equation P_ao=α

+β

*t+γ

*t², wherein P_ao is pressure, t is time, and α

, β and

γ

are constants, and determining at least the constant γ

as a determinant for said profile, and wherein said control unit compares the determined constant γ

to a predefined interval and if γ

is within said interval, said control unit proceeds to a third phase;

in said third phase, said control unit operating said first gas regulator and said second gas regulator to execute a recruiting maneuver having a specific lung inflation pressure and a specific lung inflation time and wherein said control unit compares the determined constant b to said interval and if γ

is below said interval, said control unit operates said first gas regulator and said second gas regulator to further progressively increase said PEEP value and repeatedly executes said recruiting maneuver until γ

is within said interval; and

in a fourth phase, said control unit compares the determined constant b to said interval and operates said first gas regulator and said second gas regulator to progressively decrease said PEEP value until γ

is within said interval.

18. A breathing apparatus as claimed in claim 17 further comprising an operator interface allowing an operator to set said initial tidal volume, said initial respiratory rate, said initial inspiratory time relative to said total respiration cycle time, said initial oxygen fraction in said respiratory gas and said initial PEEP value.