Detecting ventilator system anomalies while in a speaking mode

• US 8,161,972 B2
• Filed: 08/17/2007
• Issued: 04/24/2012
• Est. Priority Date: 09/11/2006
• Status: Active Grant

• Current Assignee: Philips RS North America LLC (Koninklijke Philips N.V.)
• Original Assignee: RIC INVESTMENTS LLC (Respironics Incorporated)
• Inventors: Isaza, Fernando
• Primary Examiner(s): Yu, Justine
• Assistant Examiner(s): YOUNG, RACHEL T
• Application Number:
  US11/893,796
• Publication Number:
  US 20080060656A1
• Time in Patent Office: 1,712 Days
• Field of Search: 128/204.21, 128/204.18, 128/205.24, 128/207.14, 128/207.15, 128/207.16
• US Class Current: 128/207.16
• CPC Class Codes: A61M 16/042 with separate conduits for in-and expiration gas, e.g. for limited dead volume
• CPC Class Codes: A61M 16/0468 with valves at the proximal end limiting exhalation, e.g. during speaking or coughing air passages from trachea to oesophagus or to pharynx, artificial epiglottis A61F2/203
• CPC Class Codes: A61M 16/0833 T- or Y-type connectors, e.g. Y-piece
• CPC Class Codes: A61M 16/204 used for inhalation control
• CPC Class Codes: A61M 16/205 used for exhalation control
• 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 2039/1005 Detection of disconnection
• CPC Class Codes: A61M 2202/0208 Oxygen

Abstract

A method of operating a ventilator assembly having inhalation and exhalation passages communicating with one another, and a respiration assembly that can perform repetitive respiratory cycles. The method includes (a) repetitively cycling the respiration assembly so that during the inhalation phase, gas in the inhalation passage flows to the patient, and during the exhalation phase, an exhalation valve is maintained relatively closed and the exhaled gases flow pass the vocal cords and out of the mouth thereby facilitating the patient'"'"'s ability to speak, (c) monitoring the pressure within at least one of the passages during the exhalation phase, and (d) determining whether a circuit disconnect or an occlusion exists based on the pressure monitoring.

Claims

1. A method of operating a ventilator assembly having inhalation and exhalation passages communicating with one another, a controller, inhalation and exhalation monitors, and a respiration assembly including inhalation and exhalation valves respectively communicating with the inhalation and exhalation passages, the respiration assembly performing repetitive respiratory cycles, each cycle including inhalation and exhalation phases, the method comprising acts of:

the controller repetitively operating the respiration assembly through the respiratory cycles by controlling the inhalation and exhalation valves so that

during the inhalation phase the inhalation valve is relatively open for the passage of gas therethrough into the inhalation passage to a patient and the exhalation valve is relatively closed, thus the gas in the inhalation passage flows through an endotracheal tube into the patient'"'"'s airway and lungs below the patient'"'"'s vocal cords, and

during the exhalation phase the controller providing talking and non-talking modes, in the talking mode the inhalation valve is maintained relatively closed and the exhalation valve is maintained relatively closed to enable the patient to exhale the gases in the patient'"'"'s airway and lungs past the patient'"'"'s vocal cords and out of the patient'"'"'s mouth, thereby facilitating the patient'"'"'s ability to speak, and in the non-talking mode the inhalation valve is maintained relatively closed restricting inhalation gas from the patient and the atmosphere and the exhalation valve is maintained relatively open;

one or more of the inhalation and exhalation monitors monitoring a pressure within at least one of the inhalation and exhalation passages during the exhalation phase; and

the controller determining whether a circuit disconnect or an occlusion exists based on the pressure monitoring, wherein the endotracheal tube has a check valve so that the gas exhaled by the patient during each exhalation phase is prevented from communicating with the passages.

2. The method of claim 1, wherein determining whether the circuit disconnect exists includes acts of:

determining a peak pressure during the exhalation phase; and

comparing the peak pressure to a first threshold.

3. The method of claim 2, wherein determining whether the circuit disconnect exists further comprises acts of:

determining a minimum pressure during the exhalation phase;

determining a delta pressure as a difference between the minimum pressure and the peak pressure; and

comparing the delta pressure to a second threshold.

4. The method of claim 1, wherein determining whether an occlusion exists further comprises acts of:

comparing the pressure to a threshold; and

monitoring an amount of time that the pressure exceeds the threshold.

5. The method of claim 1, wherein determining comprises acts of:

determining occlusion criteria, wherein the occlusion criteria is a time varying function based on the pressure;

comparing the pressure to the occlusion criteria.

6. The method of claim 1, wherein determining whether an occlusion exists further comprises acts of:

determining a critical volume of gas expected to leave the patient in the presence of an obstruction; and

comparing a volume of gas delivered from the ventilator assembly to the critical volume.

7. The method of claim 1, wherein determining whether an occlusion exists further comprises acts of:

determining an exhaled volume delivered by the ventilator assembly;

determining an inhaled volume delivered by the ventilator assembly;

comparing the exhaled volume to the inhaled volume or a volume determined based on the inhaled volume.

8. The method of claim 1, wherein during the exhalation phase, the inhalation valve or the exhalation valve is controlled to regulate pressure in a conduit providing communication between the inhalation and exhalation passages to facilitate the patient'"'"'s ability to speak.

9. The method of claim 1, wherein the pressure in a conduit providing communication between the inhalation and exhalation passages is regulated by controlling opening and closing of at least one of the valves so as to provide a desired pressure in the conduit to facilitate the patient'"'"'s ability to speak.

10. A patient ventilator assembly comprising:

an endotracheal tube having an exterior open end;

a conduit connected to the exterior open end of the endotracheal tube, the conduit includes inhalation and exhalation passages communicating with one another;

a respiration assembly including inhalation and exhalation valves respectively communicating with the inhalation and exhalation passages;

a pressure sensor adapted to monitor a pressure within at least one of the passages during the exhalation phase; and

a controller for repetitively controlling the inhalation valve and the exhalation valve to provide respiratory cycles, each respiratory cycle including an inhalation phase and an exhalation phase,

during the inhalation phase the inhalation valve is relatively open for the passage of gas therethrough into an inhalation passage to a patient and the exhalation valve is relatively closed, thus a flow of gas is allowed to pass through the inhalation passage and the endotracheal tube into the patient'"'"'s airway and lungs below the patient'"'"'s vocal cords,

during the exhalation phase the controller providing two modes, in a first mode the inhalation valve is maintained relatively closed restricting inhalation gas from the patient and the atmosphere, and the exhalation valve is maintained relatively open allowing the gas in the patient'"'"'s airway and lungs after the preceding inhalation phase to pass through the relatively open exhalation valve and through an outlet of the ventilator assembly, and

a second mode wherein the inhalation valve is maintained relatively closed and the exhalation valve is maintained relatively closed so that the patient causes the gas in the patient'"'"'s airway and lungs after the preceding inhalation phase to flow past the patient'"'"'s vocal cords and out of the patient'"'"'s mouth, thus facilitating the patient'"'"'s ability to talk, and

wherein the controller is adapted to determine whether a circuit disconnect or an occlusion exists based on the monitored pressure and wherein the endotracheal tube has a check valve so that the gas exhaled by the patient during each exhalation phase is prevented from communicating with the passages.

11. The patient ventilator assembly of claim 10, wherein the controller comprises an exhalation controller module that controls the exhalation valve and an inhalation controller module that controls the inhalation valve.

12. The patient ventilator assembly of claim 10, wherein the controller comprises a first algorithm for controlling the inhalation valve, a second algorithm for controlling the exhalation valve, and a third for determining whether the circuit disconnect or the occlusion exists.

13. The patient ventilator assembly of claim 10, wherein the exhalation valve is controlled by the controller to be closed sufficiently during the inhalation phase to enable a desired pressure to build within the conduit.

14. The patient ventilator assembly of claim 10, wherein the exhalation valve is controlled by the controller to be closed sufficiently during the exhalation phase to maintain a desired pressure in the conduit.

15. The patient ventilator assembly of claim 10, wherein the controller determines whether the circuit disconnect exists by determining a peak pressure during the exhalation phase, and comparing the peak pressure to a first threshold.

16. The patient ventilator assembly of claim 15, wherein the controller determines whether the circuit disconnect exists by:

determining a minimum pressure during the exhalation phase;

determining a delta pressure as a difference between the minimum pressure and the peak pressure; and

comparing the delta pressure to a second threshold.

17. The patient ventilator assembly of claim 10, wherein the controller determines whether an occlusion exists by comparing the pressure to a threshold, and monitoring an amount of time that the pressure exceeds the threshold.

18. The patient ventilator assembly of claim 10, wherein the controller determines whether an occlusion exists by determining an occlusion criteria, wherein the occlusion criteria is a time varying function based on the pressure, and comparing the pressure to the occlusion criteria.

19. The patient ventilator assembly of claim 10, wherein the controller determines whether an occlusion exists by determining a critical volume of gas expected to leave the patient in the presence of an obstruction, and comparing a volume of gas delivered from the ventilator assembly to the critical volume.

20. The patient ventilator assembly of claim 10, wherein the controller determines whether an occlusion exists by determining an exhaled volume delivered by the ventilator assembly, determining an inhaled volume delivered by the ventilator assembly, and comparing the exhaled volume to the inhaled volume or a volume determined based on the inhaled volume.

21. A patient ventilating apparatus comprising:

an endotracheal tube constructed and arranged to be installed into a patient'"'"'s trachea below the patient'"'"'s vocal cords so that an exterior open end thereof is exterior of the patient and an interior open end thereof communicates with the patient'"'"'s airway and lungs;

a conduit connected with the exterior open end of the endotracheal tube and providing inhalation and exhalation passages communicating with one another;

a respiration assembly constructed and arranged to provide repetitive respiratory cycles, each cycle including

an inhalation phase during which an inhalation valve in the inhalation passage is maintained relatively open and an exhalation valve in the exhalation passage is maintained relatively closed, enabling a flow of gas to pass through the inhalation passage and the endotracheal tube into the patient'"'"'s airway and lungs, and

an exhalation phase during which the inhalation valve is maintained relatively closed and the exhalation valve is maintained relatively closed, the exhalation phase having talking and non-talking modes;

a check valve operatively coupled to the endotracheal tube, in the talking mode the check valve maintains the exhalation valve relatively closed for enabling the patient to cause the gas in the patient'"'"'s airway and lungs to pass through the patient'"'"'s vocal cords and out of the patient'"'"'s mouth, thus facilitating the patient'"'"'s ability to speak, the check valve being operable to trap pressure within the patient'"'"'s lungs at the end of the inhalation phase when both the inhalation and exhalation valves are relatively closed so as to allow pressure in the passages at the end of each inhalation phase to substantially equalize with the pressure within the patient'"'"'s airway and lungs during the talking mode of the exhalation phase; and

a pressure monitor adapted to monitor a pressure in at least one of the inhalation and exhalation passages during the exhalation phase; and

a controller that controls operation of the inhalation valve and the exhalation valve, and determines whether a circuit disconnect or an occlusion exists based on the monitored pressure.

22. The patient ventilating apparatus of claim 21, wherein during the inhalation phase, the flow of gas is allowed to pass through the exhalation valve.

23. The patient ventilating apparatus of claim 21, wherein the controller determines whether the circuit disconnect exists by determining a peak pressure during the exhalation phase, and comparing the peak pressure to a first threshold.

24. The patient ventilating apparatus of claim 22, wherein the controller determines whether the circuit disconnect exists by:

determining a minimum pressure during the exhalation phase;

determining a delta pressure as a difference between the minimum pressure and the peak pressure; and

comparing the delta pressure to a second threshold.

25. The patient ventilating apparatus of claim 21, wherein the controller determines whether an occlusion exists by comparing the pressure to a threshold, and monitoring an amount of time that the pressure exceeds the threshold.

26. The patient ventilating apparatus of claim 21, wherein the controller determines whether an occlusion exists by determining an occlusion criteria, wherein the occlusion criteria is a time varying function based on the pressure, and comparing the pressure to the occlusion criteria.

27. The patient ventilating apparatus of claim 21, wherein the controller determines whether an occlusion exists by determining a critical volume of gas expected to leave the patient in the presence of an obstruction, and comparing a volume of gas delivered from the ventilator assembly to the critical volume.

28. The patient ventilating apparatus of claim 21, wherein the controller determines whether an occlusion exists by determining an exhaled volume delivered by the ventilator assembly, determining an inhaled volume delivered by the ventilator assembly, and comparing the exhaled volume to the inhaled volume or a volume determined based on the inhaled volume.