Rebreathing methods including oscillating, substantially equal rebreathing and nonrebreathing periods

• US 7,135,001 B2
• Filed: 03/20/2001
• Issued: 11/14/2006
• Est. Priority Date: 03/20/2001
• Status: Expired due to Term

• Current Assignee: RIC INVESTMENTS LLC (Respironics Incorporated)
• Original Assignee: RIC INVESTMENTS LLC (Respironics Incorporated)
• Inventors: Kuck, Kai, Orr, Joseph A., Brewer, Lara
• Primary Examiner(s): Marmor, II, Charles A
• Assistant Examiner(s): Mallari, Patricia C.
• Application Number:
  US09/813,225
• Publication Number:
  US 20020174866A1
• Time in Patent Office: 2,065 Days
• Field of Search: 600/300, 600/481, 600529-534, 600/526
• US Class Current: 600/526
• 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 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)

Abstract

A differential Fick technique including a first phase in which baseline breathing parameters may be established and a second phase in which a change in the effective ventilation of a patient is induced. The durations of the first and second phases may be substantially the same and may be abbreviated relative to the durations of comparable phases of previously known differential Fick techniques. The disclosed differential Fick technique also lacks a recovery period in which the respiratory parameters of a patient are permitted to return to “normal” levels.

Claims

1. A differential Fick technique, comprising:

inducing a change in effective ventilation of a subject for a first duration of time of approximately eighteen seconds to approximately forty-two seconds;

removing the change in effective ventilation for a second duration of time of approximately eighteen seconds to approximately forty-two seconds immediately following the first duration of time, wherein a transition between inducing the change and removing the change is gradual; and

obtaining measurements of at least one respiratory gas and of respiratory flow during both the first duration of time and the second duration of time.

2. The differential Fick technique of claim 1, further comprising repeating inducing immediately following the second duration of time.

3. The differential Fick technique of claim 2, wherein repeating is again effected for the first duration of time.

4. The differential Fick technique of claim 2, including obtaining measurements of the at least one respiratory gas and the respiratory flow during repeating.

5. The differential Fick technique of claim 1, wherein the firs duration of time of inducing and the second duration of time of removing are substantially the same.

6. The differential Fick technique of claim 5, wherein the first duration of time of inducing is at least about 30% of a combined duration of the first duration of time and the second duration of time.

7. The differential Fick technique of claim 5, wherein the second duration of time of removing is at least about 30% of a combined duration of the first duration of time and the second duration of time.

8. The differential Fick technique of claim 5, wherein inducing and removing are both effected for about 30 seconds.

9. The differential Fick technique of claim 5, wherein a combined duration of inducing and removing is at most about two minutes.

10. The differential Fick technique of claim 1, wherein inducing comprises causing the subject to rebreathe.

11. The differential Fick technique of claim 1, wherein obtaining measurements comprises obtaining measurements of carbon dioxide in respiration of the subject.

12. The differential Fick technique of claim 1, further comprising optimizing at least one of the first duration of time and the second duration of time.

13. The differential Fick technique of claim 1, further comprising optimizing the first and second durations of time.

14. The differential Fick technique of claim 13, wherein optimizing is based on ventilation of the subject.

15. The differential Fick technique of claim 14, wherein optimizing is further based on at least one of a pulmonary capillary blood flow and a cardiac output of the subject.

16. A method for noninvasively determining at least one of a pulmonary capillary blood flow and a cardiac output of a subject, comprising:

inducing a change in effective ventilation of the subject for a first period of time;

removing the change in effective ventilation of the subject for a second period of time, which is substantially the same as the first period of time, immediately following inducing; and

repeating inducing immediately following the second period of time.

17. The method of claim 16, including obtaining measurements of at least one respiratory gas and respiratory flow during inducing and removing.

18. The method of claim 17, wherein obtaining measurements comprises obtaining a measurement of at least carbon dioxide in respiration of the subject.

19. The method of claim 16, wherein the first period of time of inducing and the second period of time of removing are substantially the same.

20. The method of claim 16, wherein inducing comprises rebreathing.

21. The method of claim 16, further comprising optimizing at least one of the first period of time and the second period of time.

22. The method of claim 16, wherein a transition between inducing the change and removing the change is gradual.

23. The method of claim 16, further comprising optimizing the first and second periods of time.

24. The method of claim 23, wherein optimizing is based on effective ventilation of the subject.

25. The method of claim 24, wherein optimizing is further based on at least one of a pulmonary capillary blood flow and a cardiac output of the subject.

26. A method for noninvasively determining at least one of a pulmonary capillary blood flow and a cardiac output of a subject, comprising:

evaluating respiration of the subject during a first phase in which a change in effective ventilation of the subject is induced for a first period of time; and

evaluating respiration of the subject following removal of the change in effective ventilation of the subject;

the removal being effected for a second period of time immediately following the first period of time, the first and second periods of time each lasting for approximately eighteen seconds to approximately forty-two seconds;

repeating the first phase immediately following the second period of time and evaluating respiration of the subject during repeating.

27. The method of claim 26, wherein evaluating respiration of the subject during the first phase and evaluating respiration of the subject following removal of the change in effective ventilation are effected for substantially the same duration of time.

28. The method of claim 26, wherein each of evaluating respiration during the first phase and evaluating respiration following removal of the change comprises measuring at least one respiratory gas and respiratory flow of the subject.

29. The method of claim 28, wherein measuring at least one respiratory gas comprises measuring at least respiratory carbon dioxide of the subject.

30. The method of claim 26, wherein evaluating respiration of the subject during the first phase comprises evaluating respiration of the subject during rebreathing.

31. The method of claim 26, further comprising optimizing at least one of the first period of time and the second period of time.

32. The method of claim 26, wherein a transition between the first phase and the removal is gradual.

33. The method of claim 26, further comprising optimizing the first and second periods of time.

34. The method of claim 33, wherein optimizing is based on ventilation of the subject.

35. The method of claim 34, wherein optimizing is further based on at least one of a pulmonary capillary blood flow and a cardiac output of the subject.

36. A method for noninvasively estimating at least one of a pulmonary capillary blood flow and a cardiac output of a subject, comprising:

evaluating respiration of the subject during a first ventilation state having a duration of approximately eighteen seconds to approximately forty-two seconds;

evaluating respiration of the subject during a second ventilation state having a duration of approximately eighteen seconds to approximately forty-two seconds; and

optimizing a duration of at least one of the first ventilation state and the second ventilation state.

37. The method of claim 36, wherein evaluating respiration of the subject during the first ventilation state is effected for about 30 seconds.

38. The method of claim 36, wherein evaluating respiration of the subject during the second ventilation state is effected for about 30 seconds.

39. The method of claim 36, wherein evaluating respiration of the subject during the first ventilation state is effected for a duration of at least about 30% of a combined duration of evaluating respiration of the subject during both the first ventilation state and the second ventilation state.

40. The method of claim 36, wherein evaluating respiration of the subject during the second ventilation state is effected for a duration of at least about 30% of a combined duration of evaluating respiration of the subject during both the first ventilation state and the second ventilation state.

41. The method of claim 36, wherein evaluating respiration of the subject during the first ventilation state and the evaluating respiration of the subject during the second ventilation state are effected for a combined duration of at most about two minutes.

42. The method of claim 36, wherein evaluating respiration of the subject during the first ventilation state comprises evaluating respiration of the subject during rebreathing.

43. The method of claim 36, wherein evaluating respiration of the subject during the first ventilation state comprises employing a best-fit line method of rebreathing.

44. The method of claim 36, wherein evaluating respiration of the subject during the second ventilation state comprises evaluating respiration of the subject while the subject is breathing air.

45. The method of claim 36, wherein evaluating respiration of the subject during the second ventilation state comprises evaluating respiration of the subject while the subject is breathing gas or a gas mixture comprising at least a concentration of oxygen present in air.

46. The method of claim 36, wherein evaluating respiration of the subject during the first ventilation state is conducted immediately before evaluating respiration of the subject during the second ventilation state.

47. The method of claim 36, wherein evaluating respiration of the subject during the second ventilation state is effected before calculating the pulmonary capillary blood flow or cardiac output of the subject.

48. The method of claim 36, wherein a transition between the first and second ventilation states is gradual.

49. The method of claim 36, wherein optimizing includes optimizing durations of the first and second ventilation states.

50. The method of claim 49, wherein optimizing is based on ventilation of the subject.

51. The method of claim 50, wherein optimizing is further based on at least one of a pulmonary capillary blood flow and a cardiac output of the subject.

52. The method of claim 46, further comprising repeating evaluating respiration of the subject during another first ventilation state immediately following evaluating respiration of the subject during the second ventilation state.

53. A method for noninvasively estimating at least one of a pulmonary capillary blood flow and a cardiac output of a subject, comprising:

evaluating respiration of the subject during a first ventilation state comprising rebreathing;

evaluating respiration of the subject during a second ventilation state immediately following the first ventilation state; and

evaluating respiration of the subject during another first ventilation state immediately following the second ventilation state, each of the first ventilation state, the second ventilation state, and the another first ventilation state having a duration of approximately eighteen seconds to approximately forty-two seconds.

54. The method of claim 53, wherein evaluating respiration of the subject during the first ventilation state and the evaluating respiration of the subject during the second ventilation state are effected for substantially a same duration.

55. The method of claim 53, wherein evaluating respiration of the subject during the first ventilation state is effected for about 30 seconds.

56. The method of claim 53, wherein evaluating respiration of the subject during the second ventilation state is effected for about 30 seconds.

57. The method of claim 53, wherein evaluating respiration of the subject during the another first ventilation state is effected for about 30 seconds.

58. The method of claim 53, wherein evaluating respiration of the subject during the first ventilation state is effected for at least about 30% of a combined duration of the evaluating respiration of the subject during the first ventilation state and evaluating respiration of the subject during the second ventilation state.

59. The method of claim 53, wherein evaluating respiration of the subject during the second ventilation state is effected for at least about 30% of a combined duration of the evaluating respiration of the subject during the first ventilation state and the evaluating respiration of the subject during the second ventilation state.

60. The method of claim 53, wherein evaluating respiration of the subject during the first ventilation state and the evaluating respiration of the subject during the second ventilation state are effected for a combined duration of at most about 2 minutes.

61. The method of claim 54, wherein evaluating respiration of the subject during the another first ventilation state is effected for substantially the same duration.

62. The method of claim 53, wherein evaluating respiration of the subject during the first ventilation state comprises employing a best-fit line method of rebreathing.

63. The method of claim 53, wherein evaluating respiration of the subject during the second ventilation state comprises evaluating respiration of the subject while the subject is breathing air.

64. The method of claim 53, wherein evaluating respiration of the subject during the second ventilation state comprises evaluating respiration of the subject while the subject is breathing gas or a gas mixture comprising at least a concentration of oxygen present in air.

65. The method of claim 53, further comprising optimizing a duration of at least one of the first ventilation state and the second ventilation state.

66. The method of claim 53, wherein a transition between the second ventilation state and at least one of the first ventilation state and the another first ventilation state is gradual.

67. The method of claim 53, further comprising optimizing durations of the first and second ventilation states.

68. The method of claim 67, wherein optimizing is based on ventilation of the subject.

69. The method of claim 68, wherein optimizing is further based on at least one of a pulmonary capillary blood flow and a cardiac output of the subject.

70. A differential Fick technique, consisting essentially of:

a first phase in which a change in the effective ventilation of a subject is induced; and

a second phase following the first phase and during which a change in the effective ventilation of the subject is not present, the first phase and the second phase having substantially the same duration,

wherein the first and second phases are repeated in immediate sequence with one another.

71. The differential Fick technique of claim 70, wherein durations of the first and second phases are optimized.

72. The differential Fick technique of claim 70, wherein the first and second phases each have a duration of about 30 seconds.

73. The differential Fick technique of claim 70, wherein a duration of the first phase is at least about 30% of a combined duration of the first and second phases.

74. The differential Fick technique of claim 70, wherein a duration of the second phase is at least about 30% of a combined duration of the first and second phases.

75. The differential Fick technique of claim 71, wherein optimization of the durations of the first and second phases is based on ventilation of the subject.

76. The differential Fick technique of claim 70, wherein a combined duration of the first and second phases is at most about two minutes.

77. The differential Fick technique of claim 70, wherein the first phase comprises a rebreathing phase and the second phase comprises a nonrebreathing phase.

78. The differential Fick technique of claim 70, further comprising optimizing a duration of at least one of the first and second phases.

79. The differential Fick technique of claim 70, wherein the second phase occurs before the first phase.

80. The differential Fick technique of claim 70, wherein a transition between the first phase as the second phase is gradual.

81. The differential Fick technique of claim 75, wherein the optimization is further based on at least one of a pulmonary capillary blood flow and a cardiac output of the subject.