System and method for assessing pulmonary performance through transthoracic impedance monitoring

• US 7,329,226 B1
• Filed: 07/06/2004
• Issued: 02/12/2008
• Est. Priority Date: 07/06/2004
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Stahmann, Jeffrey E., Hartley, Jesse W., Lee, Kent, Ni, Quan
• Primary Examiner(s): Marmor, II; Charles A.
• Assistant Examiner(s): Mallari; Patricia C
• Application Number:
  US10/885,145
• Time in Patent Office: 1,316 Days
• Field of Search: 600/536
• US Class Current: 600/529
• CPC Class Codes: A61B 5/0002 Remote monitoring of patients using telemetry, e.g. transmission of vital signals via a communication network A61B5/07 takes precedence; transmission systems for measured values G08C; transmission H04B; transmission of digital information H04L; wireless communication networks H04W
• CPC Class Codes: A61B 5/0535 Impedance plethysmography for measuring blood flow A61B5/0295
• CPC Class Codes: A61B 5/0809 by impedance pneumography
• CPC Class Codes: A61N 1/36521 the parameter being derived from measurement of an electrical impedance
• CPC Class Codes: G16H 40/67 for remote operation
• CPC Class Codes: G16H 50/30 for calculating health indices; for individual health risk assessment

Abstract

A system and method for assessing pulmonary performance through transthoracic impedance monitoring is described. Transthoracic impedance measures are directly collected through an implantable medical device. The transthoracic impedance measures are correlated to pulmonary functional measures relative to performance of at least one respiration cycle. The transthoracic impedance measures are grouped into at least one measures set corresponding to one of an inspiratory phase and an expiratory phase. The at least one transthoracic impedance measures set are evaluated to identify a respiratory pattern relative to the inspiratory phase or the expiratory phase to represent pulmonary performance.

Claims

1. A system for assessing pulmonary performance through transthoracic impedance monitoring, comprising:

an implantable medical device to directly collect transthoracic impedance measures;

a correlation component to correlate the transthoracic impedance measures to pulmonary functional measures relative to performance of at least one respiration cycle and to group the transthoracic impedance measures into at least one measures set corresponding to one of an inspiratory phase and an expiratory phase; and

an analysis component to evaluate the pulmonary functional measures which were determined from the at least one transthoracic impedance measures set to identify a respiratory pattern relative to the inspiratory phase or the expiratory phase to represent pulmonary performance, comprising;

a trending subcomponent to evaluate a trend in changes in the respiratory pattern relative to at least one previous respiratory pattern;

a monitoring subcomponent to monitor the trend and the changes; and

an alert subcomponent to compare the trends to thresholds and to generate an alert upon sufficient deviation from the thresholds.

2. A system according to claim 1, wherein the at least one respiration cycle comprises a forced expiration.

3. A system according to claim 2, wherein the pulmonary functional measures comprise at least one of volumetric, rate and derived measures.

4. A system according to claim 3, wherein the pulmonary functional measures further comprise at least one of respiration rate, tidal volume and minute ventilation.

5. A system according to claim 2, further comprising:

a set of sensors to measure forced vital capacity and forced expiratory volume by respectively measuring a total volume exhaled during performance of the forced expiration and a volume expired during a tracked time period.

6. A system according to claim 5, wherein the forced vital capacity and the forced expiratory volume are analyzed to characterize one of an obstructive respiratory pattern and a restrictive respiratory pattern.

7. A system according to claim 2, further comprising:

a set of sensors to measure a forced expiratory flow by identifying a middle volume of the forced expiration and tracking a duration of the forced expiration.

8. A system according to claim 2, further comprising:

a derivation subcomponent to derive at least one of a ratio of forced expiratory volume to forced vital capacity and a maximal midexpiratory flow rate.

9. A system according to claim 8, further comprising:

a comparison subcomponent to respectively compare the at least one of the forced expiratory volume to forced vital capacity ratio and the maximal midexpiratory flow rate to predicted values of the forced expiratory volume to forced vital capacity ratio and the maximal midexpiratory flow rate.

10. A system according to claim 2, wherein the implantable medical device is calibrated and a baseline set of transthoracic impedance measures is established.

11. A system according to claim 2, further comprising:

a reference electrode and a sensor to measure blood pH through the implantable medical device; and

control circuitry to determine pH information from the measured blood pH.

12. A system according to claim 2, wherein the implantable medical device comprises at least one of an implantable cardiac pacemaker, an implantable cardioverter defibrillator, an implantable cardiac resynchronization device, an implantable cardiovascular monitor, and a therapeutic device that monitors and treats structural problems of the heart.

13. A system according to claim 2, further comprising:

a communication subcomponent to communicate the pulmonary performance through at least one of an implantable medical device and a non-implantable medical device.

14. A system according to claim 2, further comprising:

a sensor to measure oxygen saturation through the implantable medical device; and

control circuitry to determine blood gases from the measured oxygen saturation.

15. A method for assessing pulmonary performance through transthoracic impedance monitoring, comprising:

directly collecting transthoracic impedance measures through an implantable medical device;

correlating the transthoracic impedance measures to pulmonary functional measures relative to performance of at least one respiration cycle;

grouping the transthoracic impedance measures into at least one measures set corresponding to one of an inspiratory phase and an expiratory phase; and

evaluating the pulmonary functional measures which were determined from the at least one transthoracic impedance measures set to identify a respiratory pattern relative to the inspiratory phase or the expiratory phase to represent pulmonary performance, comprising;

evaluating a trend in changes in the respiratory pattern relative to at least one previous respiratory pattern;

monitoring the trend and the changes;

comparing the trends to thresholds; and

generating an alert upon sufficient deviation from the thresholds.

16. A method according to claim 15, wherein the at least one respiration cycle comprises a forced expiration.

17. A method according to claim 16, further comprising:

measuring oxygen saturation through the implantable medical device; and

determining blood gases from the measured oxygen saturation.

18. A method according to claim 16, further comprising:

measuring arterial pH through the implantable medical device; and

determining pH information from the measured arterial pH.

19. A method according to claim 16, wherein the pulmonary functional measures comprise at least one of volumetric, rate and derived measures.

20. A method according to claim 19, wherein the pulmonary functional measures further comprise at least one of respiration rate, tidal volume and minute ventilation.

21. A method according to claim 16, further comprising performing at least one of an implantable cardiac pacemaker therapy, an implantable cardioverter defibrillator therapy, an implantable cardiac resynchronization therapy, an implantable cardiovascular monitoring, and a therapeutic device that monitors and treats structural problems of the heart.

22. A method according to claim 16, further comprising:

measuring forced vital capacity and forced expiratory volume by respectively measuring a total volume exhaled during performance of the forced expiration and a volume expired during a tracked time period.

23. A method according to claim 22, further comprising:

analyzing the forced vital capacity and the forced expiratory volume characterizing one of an obstructive respiratory pattern and a restrictive respiratory pattern.

24. A method according to claim 16, further comprising:

measuring a forced expiratory flow by identifying a middle volume of the forced expiration and tracking a duration of the forced expiration.

25. A method according to claim 16, further comprising:

deriving at least one of a ratio of forced expiratory volume to forced vital capacity and a maximal midexpiratory flow rate.

26. A method according to claim 25, further comprising:

respectively comparing the at least one of the forced expiratory volume to forced vital capacity ratio and the maximal midexpiratory flow rate to predicted values of the forced expiratory volume to forced vital capacity ratio and the maximal midexpiratory flow rate.

27. A method according to claim 16, further comprising:

calibrating the implantable medical device; and

establishing a baseline set of transthoracic impedance measures.

28. A method according to claim 16, further comprising:

communicating the pulmonary performance through at least one of an implantable medical device and a non-implantable medical device.

29. An apparatus for assessing pulmonary performance through transthoracic impedance monitoring, comprising:

means for directly collecting transthoracic impedance measures through an implantable medical device;

means for correlating the transthoracic impedance measures to pulmonary functional measures relative to performance of at least one respiration cycle;

means for grouping the transthoracic impedance measures into at least one measures set corresponding to one of an inspiratory phase and an expiratory phase; and

means for evaluating the pulmonary functional measures which were determined from the at least one transthoracic impedance measures set to identify a respiratory pattern relative to the inspiratory phase or the expiratory phase to represent pulmonary performance, comprising;

means for evaluating a trend in changes in the respiratory pattern relative to at least one previous respiratory pattern;

means for monitoring the trend and the changes;

means for comparing the trends to thresholds; and

means for generating an alert upon sufficient deviation from the thresholds.