Assisted ventilation to match patient respiratory need

• US 6,810,876 B2
• Filed: 07/03/2002
• Issued: 11/02/2004
• Est. Priority Date: 09/23/1996
• Status: Expired due to Term

• Current Assignee: Resmed Limited (ResMed Incorporated)
• Original Assignee: Resmed Limited (ResMed Incorporated)
• Inventors: Berthon-Jones, Michael
• Primary Examiner(s): Lewis, Aaron J.
• Application Number:
  US10/188,489
• Publication Number:
  US 20030079750A1
• Time in Patent Office: 853 Days
• Field of Search: 128/200.24, 128/204.18, 128/204.21, 128/204.23, 700/50, 706/1, 706/7-9
• US Class Current: 128/204.21
• CPC Class Codes: A61B 5/085 Measuring impedance of respiratory organs or lung elasticity
• CPC Class Codes: A61B 5/087 Measuring breath flow
• CPC Class Codes: A61B 5/7264 Classification of physiological signals or data, e.g. using neural networks, statistical classifiers, expert systems or fuzzy systems neural networks per se G06N3/00; expert systems per se G06N5/00
• 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 16/0003 Accessories therefor, e.g. sensors, vibrators, negative pressure
• CPC Class Codes: A61M 16/0069 the speed thereof being controlled by respiratory parameters, e.g. by inhalation
• CPC Class Codes: A61M 16/024 including calculation means, e.g. using a processor
• CPC Class Codes: A61M 16/06 Respiratory or anaesthetic masks
• CPC Class Codes: A61M 16/1055 bacterial
• CPC Class Codes: A61M 16/107 in the inspiratory path
• 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 2016/0036 in the breathing tube and used in both inspiratory and expiratory phase
• CPC Class Codes: A61M 2205/15 Detection of leaks
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems

Abstract

The apparatus provides for the determination of the instantaneous phase in the respiratory cycle, subject'"'"'s average respiration rate and the provision of ventilatory assistance. A microprocessor (16) receives an airflow signal from a pressure transducer (18) coupled to a port (17) at a mask (11). The microprocessor (16) controls a servo (19), that in turn controls the fan motor (20) and thus the pressure of air delivered by the blower (10). The blower (10) is coupled to a subject'"'"'s mask (ii) by a conduit (12). The invention seeks to address the following goals: while the subject is awake and making substantial efforts the delivered assistance should be closely matched in phase with the subject'"'"'s efforts; the machine should automatically adjust the degree of assistance to maintain at least a specified minimum ventilation without relying on the integrity of the subject'"'"'s chemoreflexes; and it should continue to work correctly in the pesence of large leaks.

Claims

1. A readable medium for storing programmed instructions for use by an electronic processor for controlling ventilatory assistane in a spontaneously breathing subject, said instructions for controlling the steps, performed at repeated sampling intervals, of:

(a) calculating an instantaneous phase φ

in a respiratory cycle as a continuous variable from 0 to 1 revolution;

(b) selecting a desired pressure modulation amplitude A;

(c) calculating a desired instantaneous delivery pressure as a function of an end expiratory pressure plus the desired pressure modulation amplitude A multiplied by the value of a waveform template function Π

(φ

) at the calculated instantaneous phase φ

; and

(d) setting a delivery pressure at the calculated desired instantaneous delivery pressure.

2. The medium of claim 1, wherein the selected desired pressure modulation amplitude A includes a fixed amplitude.

3. The medium of claim 1, wherein the selected desired pressure modulation amplitude A includes a component equal to an elastance multiplied by an estimate of the subject'"'"'s tidal volume.

4. The medium of claim 1, with further instructions for controlling the determination of a component of the selected desired pressure modulation amplitude A by:

specifying an expected breath duration,

specifying a preset pressure modulation amplitude to apply for said expected breath duration,

calculating the actual breath duration of said subject, and

calculating the component of said pressure modulation amplitude as a function of at least said specified preset pressure modulation amplitude multiplied by said calculated actual breath duration divided by the specified expected breath duration.

5. The medium of claim 1, with further instructions for controlling the calculation of phase in the respiratory cycle by:

determining the extent to which the subject is adequately ventilated,

to said extent setting the phase in the respiratory cycle in accordance with the subject'"'"'s respiratory airflow, and

to the converse extent setting the phase in accordance with a preset respiratory rate.

6. The medium of claim 1, wherein the instructions for controlling the calculation of phase in the respiratory cycle include controlling the sub-steps of:

estimating respiratory airflow,

deriving a measure of mask leak stability,

to the extent that mask leak is stable, calculating the phase in accordance with the estimate of respiratory airflow, and

to the converse extent, calculating the phase in the respiratory cycle in accordance with a preset respiratory rate.

7. The medium of claim 1, wherein the selected desired pressure modulation amplitude includes a component chosen to servo-control the degree of ventilation to at least exceed a specified ventilation.

8. The medium of claim 7, in which said component is calculated with instructions controlling the sub-steps of:

calculating an error term proportional to the absolute value of estimated respiratory airflow minus twice said specified ventilation, and

setting said component proportional to the time integral of said error term.

9. The medium of claim 8, wherein said time integral is clipped to fall between a preset minimum and a preset maximum.