Adaptive inverse control of pressure based ventilation

• US 6,557,553 B1
• Filed: 09/05/2000
• Issued: 05/06/2003
• Est. Priority Date: 09/05/2000
• Status: Expired due to Term

• Current Assignee: Covidien LP (Medtronic Plc)
• Original Assignee: Mallinckrodt Incorporated (Mallinckrodt plc)
• Inventors: Borrello, Michael
• Primary Examiner(s): Lewis, Aaron J.
• Assistant Examiner(s): WEISS JR, JOSEPH
• Application Number:
  US09/655,969
• Time in Patent Office: 973 Days
• Field of Search: 128/204.18, 128/204.21, 128/204.23, 128/204.22, 600/529, 600/533, 600/538
• US Class Current: 128/204.18
• CPC Class Codes: A61M 16/0051 with alarm devices
• CPC Class Codes: A61M 16/026 specially adapted for predicting, e.g. for determining an information representative of a flow limitation during a ventilation cycle by using a root square technique or a regression analysis
• CPC Class Codes: A61M 2016/0021 with a proportional output signal, e.g. from a thermistor
• CPC Class Codes: A61M 2016/0036 in the breathing tube and used in both inspiratory and expiratory phase

Abstract

The adaptive control method for controlling pressure based ventilation utilizes a specific regulator structure designed according to a linear model of the patient/ventilator system. The same model is also used to derive a real time estimate of patient airway resistance, lung compliance, and the connecting tube compliance. These estimates are used to adjust regulator parameters in real time such that closed loop dynamics quickly approach those of a specified system. In the patient/connecting circuit system, G(s) inlet flow and circuit pressure are fed to a parameter estimator, and the output of the parameter estimator is used to adjust the parameters of the compensator, C(s).

Claims

1. In a method for determining real time estimates of patient airway resistance, patient lung compliance, and connecting tube circuit compliance, in a ventilator system providing gas at a desired pressure to a patient airway and lungs through a connecting tube circuit during pressure based ventilation, the method comprising the steps of:

measuring the flow of gas to the connecting tube circuit;

measuring the pressure of gas within the connecting tube circuit;

determining a real time estimate of patient airway resistance based upon the flow of gas to the connecting tube circuit and the pressure of gas within the connecting tube circuit;

determining a real time estimate of patient lung compliance based upon the flow of gas to the connecting tube circuit and the pressure of gas within the connecting tube circuit;

determining a real time estimate of the connecting tube circuit compliance based upon the flow of gas to the connecting tube circuit and the pressure of gas within the connecting tube circuit; and

determining an estimate of the flow into the patient lungs from the estimates of the patient airway resistance, the patient lung compliance, and the connecting tube circuit compliance, by discretizing the following equation;

$Q_L<br><br>\left(s\right)=\frac{\frac{1}{\hat{R}<br><br>{\hat{C}}_T}}{s+\frac{{\hat{C}}_L+{\hat{C}}_T}{\hat{R}<br><br>{\hat{C}}_L<br><br>{\hat{C}}_T}}·<br><br>Q_V<br><br>\left(s\right)$

where Q_L is the flow into the patient lungs, R is the patient airway resistance, C_L is the patient lung compliance, and C_T is the connecting tube circuit compliance.

2. The method of claim 1, further comprising controlling the pressure of gas provided to the patient by the steps of:

determining a lung and connecting circuit transfer function for determining compensator parameters for compensating the pressure of gas delivered to the desired pressure based upon said real time estimates of patient airway resistance, patient lung compliance, and connecting tube circuit compliance;

comparing the actual pressure of gas within the connecting tube circuit and the desired pressure of gas, and generating an error signal representing the difference between said desired pressure and the actual pressure of gas within the connecting tube circuit; and

compensating the pressure of gas provided to the patient airway to the desired pressure of gas to the patient airway based upon said desired pressure, and said compensator parameters, and said error signal representing the difference between said desired pressure and the actual pressure of gas within the connecting tube circuit.

3. In a method for determining real time estimates of patient airway resistance, patient lung compliance, and connecting tube circuit compliance, in a ventilator system providing gas at a desired pressure to a patient airway and lungs through a connecting tube circuit during pressure based ventilation, the method comprising the steps of:

measuring the flow of gas to the connecting tube circuit;

measuring the pressure of gas within the connecting tube circuit;

determining a real time estimate of patient airway resistance based upon the flow of gas to the connecting tube circuit and the pressure of gas within the connecting tube circuit;

determining a real time estimate of patient lung compliance based upon the flow of gas to the connecting tube circuit and the pressure of gas within the connecting tube circuit;

determining a real time estimate of the connecting tube circuit compliance based upon the flow of gas to the connecting tube circuit and the pressure of gas within the connecting tube circuit; and

determining an estimate of the patient lung pressure from the estimates of the patient airway resistance, the patient lung compliance, and the connecting tube circuit compliance, by discretizing the following equation;

${\hat{P}}_L<br><br>\left(s\right)=\frac{\frac{1}{\hat{R}<br><br>{\hat{C}}_L<br><br>\widehat{C_T}}}{s<br><br>\left(s+\frac{{\hat{C}}_L+{\hat{C}}_T}{{\hat{C}}_L<br><br>{\hat{C}}_T<br><br>\hat{R}}\right)}·<br><br>Q_V<br><br>\left(s\right)$

where P_L is the patient lung pressure, R is the patient airway resistance, C_L is the patient lung compliance, and C_T is the connecting tube circuit compliance.

4. A method for controlling pressure of gas provided to a patient airway and lungs through a connecting tube circuit in a ventilation system providing pressure based ventilation, comprising the steps of:

providing pressurized gas to the patient airway through the connecting tube circuit;

determining a desired pressure of gas provided to the patient airway through the connecting tube circuit;

measuring the flow of gas to the connecting tube circuit;

measuring the pressure of gas within the connecting tube circuit;

determining a real time estimate of patient airway resistance based upon the flow of gas to the connecting tube circuit and the pressure of gas within the connecting tube circuit;

determining a real time estimate of patient lung compliance based upon the flow of gas to the connecting tube circuit and the pressure of gas within the connecting tube circuit;

determining a real time estimate of the connecting tube circuit compliance based upon the flow of gas to the connecting tube circuit and the pressure of gas within the connecting tube circuit;

determining an estimate of the flow into the patient lungs from the estimates of the patient airway resistance, the patient lung compliance, and the connecting tube circuit compliance, by discretizing the following equation;

$Q_L<br><br>\left(s\right)=\frac{\frac{1}{\hat{R}<br><br>{\hat{C}}_T}}{s+\frac{{\hat{C}}_L+{\hat{C}}_T}{\hat{R}<br><br>{\hat{C}}_L<br><br>{\hat{C}}_T}}·<br><br>Q_V<br><br>\left(s\right)$

 

where Q_L is the flow into the patient lungs, R is the patient airway resistance, C_L is the patient lung compliance, and C_T is the connecting tube circuit compliance;

determining a lung and connecting circuit transfer function for determining compensator parameters for compensating the pressure of gas delivered to the desired pressure based upon said real time estimates of patient airway resistance, patient lung compliance, and connecting tube circuit compliance;

comparing the pressure of gas within the connecting tube circuit and the desired pressure of gas, and generating an error signal representing the difference between said desired pressure and the pressure of gas within the connecting tube circuit; and

compensating the pressure of gas provided to the patient airway to the desired pressure of gas to the patient airway based upon said desired pressure, and said compensator parameters, and said error signal representing the difference between said desired pressure and the pressure of gas within the connecting tube circuit.

5. In a method for controlling pressure of gas provided to a patient airway and lungs through a connecting tube circuit in a ventilation system providing pressure based ventilation, the method including the steps of providing pressurized gas to the patient airway through the connecting tube circuit;

determining a desired pressure of gas provided to the patient airway through the connecting tube circuit;

measuring the flow of gas to the connecting tube circuit;

measuring the pressure of gas within the connecting tube circuit;

comparing the pressure of gas within the connecting tube circuit and the desired pressure of gas, and generating an error signal representing the difference between said desired pressure and the pressure of gas within the connecting tube circuit; and

compensating the pressure of gas provided to the patient airway to the desired pressure of gas to the patient airway based upon said desired pressure, and said error signal representing the difference between said desired pressure and the pressure of gas within the connecting tube circuit, the improvement comprising the steps of;

determining a real time estimate of patient airway resistance based upon the flow of gas to the connecting tube circuit and the pressure of gas within the connecting tube circuit;

determining a real time estimate of patient lung compliance based upon the flow of gas to the connecting tube circuit and the pressure of gas within the connecting tube circuit;

determining a real time estimate of the connecting tube circuit compliance based upon the flow of gas to the connecting tube circuit and the pressure of gas within the connecting tube circuit;

determining an estimate of the flow into the patient lungs from the estimates of the patient airway resistance, the patient lung compliance, and the connecting tube circuit compliance, by discretizing the following equation;

$Q_L<br><br>\left(s\right)=\frac{\frac{1}{\hat{R}<br><br>{\hat{C}}_T}}{s+\frac{{\hat{C}}_L+{\hat{C}}_T}{\hat{R}<br><br>{\hat{C}}_L<br><br>{\hat{C}}_T}}·<br><br>Q_V<br><br>\left(s\right)$

 

where Q_L is the flow into the patient lungs, R is the patient airway resistance, C_L is the patient lung compliance, and C_T is the connecting tube circuit compliance;

determining a lung and connecting circuit transfer function for determining compensator parameters for compensating the pressure of gas delivered to the desired pressure based upon said real time estimates of patient airway resistance, patient lung compliance, and connecting tube circuit compliance; and

compensating the pressure of gas provided to the patient airway to the desired pressure of gas to the patient airway based upon said desired pressure, said compensator parameters, and said error signal representing the difference between said desired pressure and the pressure of gas within the connecting tube circuit.

6. In a method for determining real time estimates of patient airway resistance, patient lung compliance, and connecting tube circuit compliance, in a ventilator system providing gas at a desired pressure to a patient airway and lungs through a connecting tube circuit during volume based ventilation, the method to be used to control the exhalation phase of volume ventilation, the method comprising the steps of:

measuring the flow of gas in the exhalation circuit;

measuring the pressure of gas within the exhalation circuit;

determining a real time estimate of patient airway resistance based upon the flow of gas in the exhalation circuit and the pressure of gas within the exhalation circuit;

determining a real time estimate of patient lung compliance based upon the flow of gas in the exhalation circuit and the pressure of gas within the exhalation circuit;

determining a real time estimate of the exhalation circuit compliance based upon the flow of gas in the exhalation circuit and the pressure of gas within the exhalation circuit; and

determining an estimate of the flow into the patient lungs from the estimates of the patient airway resistance, the patient lung compliance, and the connecting tube circuit compliance, by discretizing the following equation;

$Q_L<br><br>\left(s\right)=\frac{\frac{1}{\hat{R}<br><br>{\hat{C}}_T}}{s+\frac{{\hat{C}}_L+{\hat{C}}_T}{\hat{R}<br><br>{\hat{C}}_L<br><br>{\hat{C}}_T}}·<br><br>Q_V<br><br>\left(s\right)$

 

where Q_L is the flow into the patient lungs, R is the patient airway resistance, C_L is the patient lung compliance, and C_T is the connecting tube circuit compliance.

7. The method of claim 6, further comprising controlling the volume of gas provided to the patient by the steps of:

determining a lung and connecting circuit transfer function for determining compensator parameters for compensating the volume of gas delivered to the patient based upon said real time estimates of patient airway resistance, patient lung compliance, and connecting tube circuit compliance;

comparing the actual volume of gas within the connecting tube circuit and the desired pressure of gas, and generating an error signal representing the difference between said desired pressure and the actual pressure of gas within the connecting tube circuit; and

compensating the volume of gas provided to the patient airway to the desired volume of gas to the patient airway based upon said desired pressure, and said resistance, patient lung compliance, and connecting tube circuit compliance; and

compensating the pressure of gas provided to the patient airway to the desired pressure of gas to the patient airway based upon said desired pressure, said compensator parameters, and said error signal representing the difference between said desired pressure and the actual pressure of gas within the connecting tube circuit.

8. In a method for controlling pressure of gas provided to a patient airway and lungs through a connecting tube circuit in a ventilation system providing pressure based ventilation, the method including the steps of providing pressurized gas to the patient airway through the connecting tube circuit;

determining a desired pressure of gas provided to the patient airway through the connecting tube circuit;

measuring the flow of gas to the connecting tube circuit;

measuring the pressure of gas within the connecting tube circuit;

comparing the pressure of gas within the connecting tube circuit and the desired pressure of gas, and generating an error signal representing the difference between said desired pressure and the pressure of gas within the connecting tube circuit; and

compensating the pressure of gas provided to the patient airway to the desired pressure of gas to the patient airway based upon said desired pressure, and said error signal representing the difference between said desired pressure and the pressure of gas within the connecting tube circuit, the improvement comprising the steps of;

determining a real time estimate of patient airway resistance based upon the flow of gas to the connecting tube circuit and the pressure of gas within the connecting tube circuit;

determining a real time estimate of patient lung compliance based upon the flow of gas to the connecting tube circuit and the pressure of gas within the connecting tube circuit;

determining a real time estimate of the connecting tube circuit compliance based upon the flow of gas to the connecting tube circuit and the pressure of gas within the connecting tube circuit;

determining an estimate of the patient lung pressure from the estimates of the patient airway resistance, the patient lung compliance, and the connecting tube circuit compliance, by discretizing the following equation;

${\hat{P}}_L<br><br>\left(s\right)=\frac{\frac{1}{\hat{R}<br><br>{\hat{C}}_L<br><br>\widehat{C_T}}}{s<br><br>\left(s+\frac{{\hat{C}}_L+{\hat{C}}_T}{{\hat{C}}_L<br><br>{\hat{C}}_T<br><br>\hat{R}}\right)}·<br><br>Q_V<br><br>\left(s\right)$

 

where P_L is the patient lung pressure, R is the patient airway resistance, C_L is the patient lung compliance, and C_T is the connecting tube circuit compliance;

determining a lung and connecting circuit transfer function for determining compensator parameters for compensating the pressure of gas delivered to the desired pressure based upon said real time estimates of patient airway resistance, patient, lung compliance, and connecting tube circuit compliance; and

compensating the pressure of gas provided to the patient airway to the desired pressure of gas to the patient airway based upon said desired pressure, said compensator parameters, and said error signal representing the difference between said desired pressure and the pressure of gas within the connecting tube circuit.

9. In a method for determining real time estimates of patient airway resistance, patient lung compliance, and connecting tube circuit compliance, in a ventilator system providing gas at a desired pressure to a patient airway and lungs through a connecting tube circuit during volume based ventilation, the method to be used to control the exhalation phase of volume ventilation, the method comprising the steps of:

measuring the flow of gas in the exhalation circuit;

measuring the pressure of gas within the exhalation circuit;

determining a real time estimate of patient airway resistance based upon the flow of gas in the exhalation circuit and the pressure of gas within the exhalation circuit;

determining a real time estimate of patient lung compliance based upon the flow of gas in the exhalation circuit and the pressure of gas within the exhalation circuit;

determining a real time estimate of the exhalation circuit compliance based upon the flow of gas in the exhalation circuit and the pressure of gas within the exhalation circuit; and

determining an estimate of the patient lung pressure from the estimates of the patient airway resistance, the patient lung compliance, and the connecting tube circuit compliance, by discretizing the following equation;

${\hat{P}}_L<br><br>\left(s\right)=\frac{\frac{1}{\hat{R}<br><br>{\hat{C}}_L<br><br>\widehat{C_T}}}{s<br><br>\left(s+\frac{{\hat{C}}_L+{\hat{C}}_T}{{\hat{C}}_L<br><br>{\hat{C}}_T<br><br>\hat{R}}\right)}·<br><br>Q_V<br><br>\left(s\right)$

 

where P_L is the patient lung pressure, R is the patient airway resistance, C_L is the patient lung compliance, and C_T is the connecting tube circuit compliance.

10. In a method for determining real time estimates of patient airway resistance, patient lung compliance, and connecting tube circuit compliance, in a ventilator system providing gas at a desired pressure to a patient airway and lungs through a connecting tube circuit during pressure based ventilation, the method comprising the steps of:

measuring the flow of gas to the connecting tube circuit;

measuring the pressure of gas within the connecting tube circuit;

determining a real time estimate of patient airway resistance based upon the flow of gas to the connecting tube circuit and the pressure of gas within the connecting tube circuit;

determining a real time estimate of patient lung compliance based upon the flow of gas to the connecting tube circuit and the pressure of gas within the connecting tube circuit;

determining a real time estimate of the connecting tube circuit compliance based upon the flow of gas to the connecting tube circuit and the pressure of gas within the connecting tube circuit; and

determining an estimate of the patient lung pressure from the estimates of the patient airway resistance, the patient lung compliance, and the connecting tube circuit compliance, by discretizing the following equation;

${\hat{P}}_L<br><br>\left(s\right)=\frac{\frac{1}{\hat{R}<br><br>{\hat{C}}_L<br><br>\widehat{C_T}}}{s<br><br>\left(s+\frac{{\hat{C}}_L+{\hat{C}}_T}{{\hat{C}}_L<br><br>{\hat{C}}_T<br><br>\hat{R}}\right)}·<br><br>Q_V<br><br>\left(s\right)$

 

where P_L is the patient lung pressure, R is the patient airway resistance, C_L is the patient lung compliance, and C_T is the connecting tube circuit compliance; and

controlling the pressure of gas provided to the patient by the steps of;

determining a lung and connecting circuit transfer function for determining compensator parameters for compensating the pressure of gas delivered to the desired pressure based upon said real time estimates of patient airway resistance, patient lung compliance, and connecting tube circuit compliance;

comparing the actual pressure of gas within the connecting tube circuit and the desired pressure of gas, and generating an error signal representing the difference between said desired pressure and the actual pressure of gas within the connecting tube circuit; and

compensating the pressure of gas provided to the patient airway to the desired pressure of gas to the patient airway based upon said desired pressure, and said compensator parameters, and said error signal representing the difference between said desired pressure and the actual pressure of gas within the connecting tube circuit.