Apparatus and method for non-invasively measuring cardiac output

• US 7,018,340 B2
• Filed: 09/08/2003
• Issued: 03/28/2006
• Est. Priority Date: 12/19/1996
• 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., Jaffe, Michael B., Westenskow, Dwayne, Kofoed, Scott A.
• Primary Examiner(s): Nasser, Robert L.
• Application Number:
  US10/657,577
• Publication Number:
  US 20040059239A1
• Time in Patent Office: 932 Days
• Field of Search: 600/532, 73/233, 422/84
• US Class Current: 600/532
• 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 5/0836 Measuring rate of CO2 production
• CPC Class Codes: A61M 16/0045 Means for re-breathing exhaled gases, e.g. for hyperventilation treatment
• CPC Class Codes: A61M 16/0833 T- or Y-type connectors, e.g. Y-piece
• CPC Class Codes: A61M 2016/0036 in the breathing tube and used in both inspiratory and expiratory phase
• CPC Class Codes: A61M 2230/432 partial CO2 pressure (P-CO2)
• CPC Class Codes: G01N 33/004 CO or CO2
• CPC Class Codes: Y02A 50/20 Air quality improvement or preservation, e.g. vehicle emission control or emission reduction by using catalytic converters

Abstract

Apparatus and methods for non-invasively determining the cardiac output or pulmonary capillary blood flow of a patient using partial re-breathing techniques. The apparatus includes a substantially instantaneously adjustable deadspace volume for accommodating differences in sizes or breathing capacities of various patients. The apparatus may be constructed of inexpensive elements, including one or more two-way valves, which render the apparatus very simple to use and inexpensive so that the unit may be employed as a disposable product. The method of the invention includes estimating the cardiac output or pulmonary capillary blood flow of a patient based on partial pressure of alveolar CO₂, rather than on the partial pressure of end tidal CO₂, as previously practiced. A computer program for calculating the cardiac output or pulmonary capillary blood flow of a patient is also disclosed.

Claims

1. A method for estimating the cardiac output of an individual, comprising:

determining a carbon dioxide elimination (V_CO2) of the individual for a before re-breathing period and for a during re-breathing period;

calculating a carbon dioxide elimination difference between the carbon dioxide elimination of the before re-breathing period and the carbon dioxide elimination of the during re-breathing period;

estimating a partial pressure of carbon dioxide in alveoli (P_ACO₂) of the individual for the before re-breathing period and for the during re-breathing period based on partial pressure of end tidal carbon dioxide (PetCO₂) measurements of the individual during the before re-breathing period and during the during re-breathing period, respectively;

converting each estimation of the partial pressure of carbon dioxide in alveoli to a carbon dioxide content (C_CO2);

calculating a carbon dioxide content difference between the carbon dioxide content of the before re-breathing period and the carbon dioxide content of the during re-breathing period; and

dividing the carbon dioxide elimination difference by the carbon dioxide content difference to estimate cardiac output.

2. The method of claim 1, wherein determining the carbon dioxide elimination comprises accounting for at least one of serial deadspace and parallel deadspace.

3. The method of claim 1, wherein determining the carbon dioxide elimination comprises accounting for functional residual capacity.

4. The method of claim 3, wherein accounting for functional residual capacity comprises determining a corrected carbon dioxide elimination (V_{CO2 corrected}) during at least one of the before rebreathing period and the during rebreathing period as follows:

V_{CO2 corrected}=V_CO2+FRC×

Δ

Pet_CO2/P_bar,

where V_CO2 is the carbon dioxide elimination that has been determined, Δ

Pet_CO2 is the breath-to-breath change in Pet_CO2, and P_bar is barometric pressure.

5. The method of claim 1, wherein determining the carbon dioxide elimination for at least one of the before rebreathing period and the during rebreathing period comprises determining an average carbon dioxide elimination over a period of time.

6. The method of claim 5, wherein determining the average carbon dioxide elimination over a period of time comprises determining the average carbon dioxide elimination over a plurality of breaths.

7. The method of claim 5, wherein determining the average carbon dioxide elimination is effected at at least about twenty-five seconds into the during rebreathing period.

8. The method of claim 1, wherein estimating the partial pressure of carbon dioxide in alveoli includes accounting for at least one of functional residual capacity and carbon dioxide in parallel deadspace.

9. The method of claim 8, wherein accounting comprises employing the following formula:

$\begin{array}{c}{\mathrm{PDS}}_{{\mathrm{CO}}_2<br><br>\mathrm{PDS}}<br><br>\left(n\right)=<br><br>\left[\mathrm{FRC}/\left(\mathrm{FRC}+V_t\right)\right]·<br><br>P_{{\mathrm{CO}}_2<br><br>\mathrm{PDS}}<br><br>\left(n-1\right)+\\ <br><br>(P_{\mathrm{bar}}·<br><br>([{\mathrm{Vi}}_{{\mathrm{CO}}_2}+\mathrm{deadspace}·<br><br>({\mathrm{Pet}}_{{\mathrm{CO}}_2}<br><br>\left(n-1\right)/\\ <br><br>P_{\mathrm{bar}})]/V_t)<br><br>\left[V_t/\left(V_t+\mathrm{FRC}\right)\right]),\end{array}$

where (n) represents one breath, (n−

1) represents a prior breath, FRC is the functional residual capacity, V_t is the tidal volume, Vi_CO2 is the volume of inspired carbon dioxide, P_{CO2 PDS} is the partial pressure of carbon dioxide in the parallel deadspace, and P_bar is barometric pressure.

10. The method of claim 1, wherein converting at least one estimation of the partial pressure of carbon dioxide in alveoli to a carbon dioxide content comprises predicting a stable carbon dioxide content.

11. The method of claim 10, wherein predicting the stable carbon dioxide content comprises plotting the partial pressure of carbon dioxide in alveoli from at least one of the before rebreathing phase and the during rebreathing phase against a breath-to-breath change in a content of carbon dioxide in blood in the alveolar capillaries (Δ

C_ACO₂).

12. A method for estimating the cardiac output of a subject, comprising:

estimating a carbon dioxide elimination of the subject for a before re-breathing period and for a during re-breathing period;

estimating a carbon dioxide content in blood passing by the alveoli of the subject for the before re-breathing period and for the during re-breathing period;

dividing a difference between carbon dioxide elimination from the before and during rebreathing periods by a difference between carbon dioxide content from the before and during rebreathing periods to estimate cardiac output.

13. The method of claim 12, wherein estimating the carbon dioxide elimination or estimating the carbon dioxide content for at least one of the before and during rebreathing periods comprises considering at least one of serial deadspace, parallel deadspace, and functional residual capacity.

14. A method for estimating the cardiac output of a subject, comprising:

estimating a carbon dioxide elimination of the subject and a carbon dioxide content of blood of the subject during baseline respiration;

providing for a change in effective ventilation of the subject;

estimating a carbon dioxide elimination of the subject and a carbon dioxide content of blood of the subject following the change in effective ventilation;

and dividing a change in the carbon dioxide elimination from before to after the change in effective ventilation by a change in the carbon dioxide content from before to after the change in effective ventilation to estimate cardiac ouput.

15. The method of claim 14, wherein providing for the change in effective ventilation comprises causing the subject to rebreathe previously exhaled gases.

16. The method of claim 14, wherein providing for the change in effective ventilation comprises having the subject inhale gases including an above-ambient amount of carbon dioxide.

17. The method of claim 14, wherein estimating the carbon dioxide elimination or estimating the carbon dioxide content before or after the change in effective ventilation comprises considering at least one of serial deadspace, parallel deadspace, and functional residual capacity.