Method and apparatus for post-shock evaluation using tissue oxygenation measurements

• US 8,521,245 B2
• Filed: 10/30/2009
• Issued: 08/27/2013
• Est. Priority Date: 09/11/2009
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Kuhn, Jonathan L.
• Primary Examiner(s): FULLER, RODNEY EVAN
• Application Number:
  US12/609,538
• Publication Number:
  US 20110066018A1
• Time in Patent Office: 1,397 Days
• Field of Search: 600/323
• US Class Current: 600/323
• CPC Class Codes: A61B 5/14551 for measuring blood gases
• CPC Class Codes: A61B 5/1459 invasive, e.g. introduced into the body by a catheter A61B5/1464 takes precedence
• CPC Class Codes: A61B 5/6846 specially adapted to be brought in contact with an internal body part, i.e. invasive
• CPC Class Codes: A61B 5/7285 for synchronising or triggering a physiological measurement or image acquisition with a physiological event or waveform, e.g. an ECG signal A61B6/5205, A61B6/541, A61B8/5207, A61B8/543 take precedence
• CPC Class Codes: A61N 1/36557 controlled by chemical substances in blood
• CPC Class Codes: A61N 1/3925 Monitoring; Protecting
• CPC Class Codes: A61N 1/3956 Implantable devices for applying electric shocks to the heart, e.g. for cardioversion

Abstract

A method and apparatus for controlling delivery of therapy that includes an emitting portion emitting light at a predetermined emitted light intensity to a volume of tissue at a plurality of wavelengths, and a detecting portion detecting the emitted light scattered by the volume of tissue to generate corresponding detected light intensity output signals. A control module adjusts the detected light intensity output signals for shifts in intensity corresponding to the emitted light intensity, and determines a tissue oxygenation index in response to only the adjusted detected light intensity output signals, and a therapy delivery module controlling therapy in response to the determined tissue oxygenation index.

Claims

1. A method of delivering therapy in a medical device, comprising:

emitting light from an emitting portion of a sensor at a predetermined emitted light intensity to an adjacent volume of tissue at a plurality of wavelengths;

detecting the emitted light scattered by the volume of tissue to generate corresponding detected light intensity output signals;

detecting, in the emitting portion of the sensor, a change corresponding to a shift in the emitted light intensity from the predetermined intensity before the emitted light enters the adjacent tissue volume;

adjusting the detected light intensity output signals in response to the detected change;

determining a tissue oxygenation index in response to only the adjusted detected light intensity output signals; and

controlling delivery of a therapy in response to the determined tissue oxygenation index.

2. The method of claim 1, further comprising:

generating an emitted light reference signal from a reference light detector in the emitting portion configured to detect the emitted light before it enters the adjacent tissue volume; and

adjusting drive signals associated with the light emission in response to the generated emitted light reference signal.

3. The method of claim 1, wherein the wavelengths of the plurality of wavelengths are equally spaced.

4. The method of claim 1, wherein determining a tissue oxygenation index comprises:

determining an attenuation measurement for each wavelength of the plurality of wavelengths in response to the detected light intensity output signals;

determining a second derivative of the attenuation measurement for a first wavelength and a second wavelength of the plurality of wavelengths in response to only the adjusted detected light intensity output signals; and

determining the tissue oxygenation index in response to the determined second derivative.

5. The method of claim 4, wherein determining a tissue oxygenation index further comprises:

determining a scaled second derivative of the attenuation measurement of the first wavelength using the determined second derivative of the attenuation of the second wavelength of the predetermined wavelengths; and

determining the tissue oxygenation index in response to the determined scaled second derivative.

6. The method of claim 5, further comprising determining at least one of an oxygen saturation index and a hemoglobin volume fraction in response to one of the second derivative and the scaled second derivative, wherein the tissue oxygenation index is determined in response to at least one of the oxygen saturation index and the hemoglobin volume fraction.

7. The method of claim 1, wherein adjusting the detected light intensity output signals comprises:

generating an emitted light reference signal from a reference light detector in the emitting portion configured to detect the emitted light before it enters the adjacent tissue volume;

determining a correction term in response to the generated reference signal; and

adjusting the detected light intensity output signals in response to the correction term.

8. The method of claim 1, wherein detecting, in the emitting portion of the sensor, a change corresponding to a shift in the emitted light intensity comprises controlling a drive signal applied to a light source;

wherein adjusting the detected light intensity output signal comprises adjusting a calibration constant in response to a change in the drive signal.

9. A medical device having a sensor for controlling delivery of therapy by the device, comprising:

an emitting portion configured to emit light at a predetermined emitted light intensity to an adjacent volume of tissue at a plurality of wavelengths;

a detecting portion configured to detect the emitted light scattered by the volume of tissue to generate corresponding detected light intensity output signals;

a control module configured to;

detect, in the emitting portion of the sensor, a change corresponding to a shift in the emitted light intensity from the predetermined intensity before the emitted light enters the adjacent tissue volume;

adjust the detected light intensity output signals in response to the detected change, and

determine a tissue oxygenation index in response to only the adjusted detected light intensity output signals; and

a therapy delivery module configured to control delivery of a therapy in response to the determined tissue oxygenation index.

10. The device of claim 9, further comprising a reference light detector in the emitting portion for detecting the emitted light before it enters the adjacent tissue volume and generating an emitted light reference signal, wherein the control module adjusts drive signals associated with the light emission in response to the generated emitted light reference signal.

11. The device of claim 9, wherein the wavelengths of the plurality of wavelengths are equally spaced.

12. The device of claim 9, wherein the control module is configured to determine an attenuation measurement for each wavelength of the plurality of wavelengths in response to the detected light intensity output signals, determine a second derivative of the attenuation measurement for a first wavelength and a second wavelength of the plurality of wavelengths in response to only the detected light intensity output signals, and determine the tissue oxygenation index in response to the determined second derivative.

13. The device of claim 12, wherein the control module is configured to determine a scaled second derivative of the attenuation measurement of the first wavelength using the determined second derivative of the attenuation of a second wavelength, and determine the first tissue oxygenation index in response to the determined scaled second derivative.

14. The device of claim 13, wherein the control module is configured to determine at least one of an oxygen saturation index and a hemoglobin volume fraction in response to one of the second derivative and the scaled second derivative, and determine the tissue oxygenation index in response to at least one of the oxygen saturation index and the hemoglobin volume fraction.

15. The device of claim 9, further comprising a reference detector for detecting the emitted light before it enters the adjacent tissue volume to generate an emitted light reference signal, wherein the control module is configured to determine a correction term in response to the generated reference signal and adjust the detected light intensity output signals in response to the correction term.

16. A non-transitory computer readable medium having computer executable instructions for performing a method comprising:

emitting light from an emitting portion of a sensor at a predetermined emitted light intensity to an adjacent volume of tissue at a plurality of wavelengths;

detecting the emitted light scattered by the volume of tissue to generate corresponding detected light intensity output signals;

detecting, in the emitting portion of the sensor, a change corresponding to a shift in the emitted light intensity from the predetermined intensity before the emitted light enters the adjacent tissue volume;

adjusting the detected light intensity output signals in response to the detected change;

determining a tissue oxygenation index in response to only the adjusted detected light intensity output signals; and

controlling delivery of a therapy in response to the determined tissue oxygenation index.

17. The computer readable medium of claim 16, the method further comprising:

generating an emitted light reference signal from a reference light detector in the emitting portion configured to detect the emitted light before it enters the adjacent tissue volume; and

adjusting drive signals associated with the light emission in response to the generated emitted light reference signal.

18. The computer readable medium of claim 16, wherein the wavelengths of the plurality of wavelengths are equally spaced.

19. The computer readable medium of claim 16, wherein determining a tissue oxygenation index comprises:

determining an attenuation measurement for each wavelength of the plurality of wavelengths in response to the detected light intensity output signal;

determining a second derivative of the attenuation measurement for a first wavelength and a second wavelength of the plurality of wavelengths in response to only the detected light intensity output signals; and

determining the tissue oxygenation index in response to the determined second derivative.

20. The computer readable medium of claim 19, wherein determining a tissue oxygenation index comprises:

determining a scaled second derivative of the attenuation measurement of the first wavelength using the determined second derivative of the attenuation of the second wavelength of the predetermined wavelengths; and

determining the tissue oxygenation index in response to the determined scaled second derivative.

21. The computer readable medium of claim 20, the method further comprising determining at least one of an oxygen saturation index and a hemoglobin volume fraction in response to one of the second derivative and the scaled second derivative, wherein the tissue oxygenation index is determined in response to at least one of the oxygen saturation index and the hemoglobin volume fraction.

22. The computer readable medium of claim 16, wherein adjusting the detected light intensity output signal comprises:

generating an emitted light reference signal from a reference light detector in the emitting portion configured to detect the emitted light before it enters the adjacent tissue volume;

determining a correction term in response to the generated reference signal; and

adjusting the detected light intensity output signals in response to the correction term.