Method of assessing pulmonary stress and a breathing apparatus

• US 6,718,975 B2
• Filed: 06/12/2002
• Issued: 04/13/2004
• Est. Priority Date: 06/19/2001
• Status: Active Grant

• Current Assignee: Maquet Critical Care AB (Getinge AB)
• Original Assignee: Siemens Elema AB
• Inventors: Blomberg, Urban
• Primary Examiner(s): Lo, Weilun
• Assistant Examiner(s): MENDOZA, MICHAEL G
• Application Number:
  US10/171,340
• Publication Number:
  US 20020193699A1
• Time in Patent Office: 671 Days
• Field of Search: 128/200.24, 128/202.22, 128/204.21, 128/204.22, 128/204.23, 128/204.26
• US Class Current: 128/204.23
• CPC Class Codes: A61B 5/085 Measuring impedance of respiratory organs or lung elasticity
• 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 2016/0039 in the inspiratory circuit
• CPC Class Codes: A61M 2016/0042 in the expiratory circuit
• CPC Class Codes: A61M 2205/3553 remote, e.g. between patient's home and doctor's office
• CPC Class Codes: A61M 2205/3584 using modem, internet or bluetooth
• CPC Class Codes: A61M 2205/505 Touch-screens; Virtual keyboard or keypads; Virtual buttons; Soft keys; Mouse touches

Abstract

In a method for assessing pulmonary stress, a volume of respiratory gas is received from the lungs of a subject, an ensuing pressure is measured and the pressure-volume (P-V) relationship is analyzed. The analysis includes a determination of the profile of the pressure-volume (P-V) relationship. The profile is straight when no stress is present, convex when there is a risk for over-distension and 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:

obtaining a volume of expired gas from a passively expiring subject;

measuring pressure in relation to said volume; and

assessing pulmonary stress of said subject by determining a profile of said pressure-volume relationship.

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-volume relationship to a power equation P=a*V^b+c, wherein P is pressure, V is said volume, 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-volume relationship to a polynomial equation P=α

+β

*V+γ

*V², wherein P is pressure, V is said volume, 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:

a gas flow path adapted for connection to a respirating, passively expiring subject;

a gas regulator connected to said gas flow path, and a control unit for controlling said gas regulator dependent on at least one set parameter to regulate gas flow in said gas flow path;

a pressure gauge connected to said gas flow path for measuring pressure in said gas flow path;

a volume measuring arrangement connected to said gas flow path for measuring a volume of expired gas from said subject in said gas flow path; and

said control unit assessing pulmonary stress of said subject by determining a relationship between said pressure and said volume in said gas flow path, and assessing pulmonary stress of said subject by determining a profile of said pressure-volume relationship, and controlling said gas regulator dependent on said pulmonary stress.

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-volume relationship to a power equation P=a*V^b+c, wherein P is pressure, V is said volume, 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 9 wherein said control unit determines said profile by adapting said pressure-volume relationship to a polynomial equation P=α

+β

*V+γ

*V², wherein P is pressure, V is said volume, 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 as claimed in claim 7 wherein said control unit alters said parameter dependent on said pulmonary stress.