Hypovolemia diagnosis technique

• US 8,880,155 B2
• Filed: 02/24/2012
• Issued: 11/04/2014
• Est. Priority Date: 02/24/2012
• Status: Active Grant

• Current Assignee: Covidien LP (Medtronic Plc)
• Original Assignee: Covidien LP (Medtronic Plc)
• Inventors: Mestek, Michael, Lisogurski, Daniel
• Primary Examiner(s): Roy, Baisakhi
• Application Number:
  US13/404,402
• Publication Number:
  US 20130226009A1
• Time in Patent Office: 984 Days
• Field of Search: 600/484, 600/485, 600/509, 600/515, 600/479
• US Class Current: 600/479
• CPC Class Codes: A61B 5/02042 Determining blood loss or bleeding, e.g. during a surgical procedure
• CPC Class Codes: A61B 5/0205 Simultaneously evaluating both cardiovascular conditions and different types of body conditions, e.g. heart and respiratory condition
• CPC Class Codes: A61B 5/02405 Determining heart rate variability
• CPC Class Codes: A61B 5/02427 Details of sensor
• CPC Class Codes: A61B 5/0261 using optical means, e.g. infrared light
• 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 5/0295 using plethysmography, i.e. measuring the variations in the volume of a body part as modified by the circulation of blood therethrough, e.g. impedance plethysmography
• CPC Class Codes: A61B 5/0816 Measuring devices for examining respiratory frequency measuring frequency of electric signals G01R23/00
• CPC Class Codes: A61B 5/14551 for measuring blood gases
• CPC Class Codes: A61B 5/4848 Monitoring or testing the effects of treatment, e.g. of medication
• CPC Class Codes: A61B 5/7203 for noise prevention, reduction or removal
• CPC Class Codes: A61B 5/7246 using correlation, e.g. template matching or determination of similarity
• CPC Class Codes: A61B 5/726 using Wavelet transforms
• CPC Class Codes: A61B 5/7275 Determining trends in physiological measurement data; Predicting development of a medical condition based on physiological measurements, e.g. determining a risk factor
• CPC Class Codes: A61B 5/7278 Artificial waveform generation or derivation, e.g. synthesising signals from measured signals A61B5/327 takes precedence
• CPC Class Codes: A61B 5/7282 Event detection, e.g. detecting unique waveforms indicative of a medical condition A61B5/4094, A61B5/4818, A61B5/349, A61B5/0823 take precedence
• CPC Class Codes: A61B 5/742 using visual displays A61B5/339 takes precedence
• CPC Class Codes: A61B 5/746 Alarms related to a physiological condition, e.g. details of setting alarm thresholds or avoiding false alarms alarms per se G08B

Abstract

Embodiments of the present disclosure relate to a system and method for determining a risk, onset, or presence of hypovolemia based on one or more features of a plethysmographic waveform during a patient breathing cycle. For example, a hypovolemic patient may exhibit characteristic changes in pulse amplitude or stroke volume during inhalation and exhalation relative to a healthy patient. Further, a trend or pattern of such features may be used to assess the patient'"'"'s fluid condition.

Claims

1. A method, comprising:

using a processor;

receiving a plethysmographic waveform signal from a sensor applied to a patient;

determining one or more features of the plethysmographic waveform over time;

correlating in time the one or more features of the plethysmographic waveform to at least one of an exhalation portion or an inhalation portion of a respiratory cycle of the patient; and

determining a measure of the patient'"'"'s blood volume based on a change in the one or more features of the plethysmographic waveform correlated in time with the respiratory cycle during the at least one of the exhalation portion or the inhalation portion of the respiratory cycle, wherein the one or more features comprise a pulse amplitude and wherein an increase in pulse amplitude during the exhalation portion of the respiratory cycle that is greater than a range or threshold is indicative of a change in the patient'"'"'s blood volume.

2. The method of claim 1, wherein a decrease in pulse amplitude during the inhalation portion of the respiratory cycle that is greater than a range or threshold is indicative of a change in the patient'"'"'s blood volume.

3. The method of claim 1, comprising analyzing the one or more features of the plethysmographic waveform over time after fluid therapy has been administered to the patient;

and

determining if the patient'"'"'s blood volume has changed after administration of fluid therapy.

4. The method of claim 1, wherein determining one or more features of the plethysmographic waveform over time comprises extracting the one or more features from a wavelet transform of the plethysmographic waveform signal.

5. The method of claim 4, comprising eliminating arrhythmic beats from the plethysmographic waveform signal before determining the one or more features of the plethysmographic waveform over time.

6. The method of claim 4, wherein the one or more features of the plethysmographic waveform over time comprise a number of arrhythmic beats.

7. The method of claim 1, comprising determining a trend of the one or more features of the plethysmographic waveform during the inhalation portion or the exhalation portion of the respiratory cycle and determining a risk of hypovolemia based on the trend.

8. The method of claim 7, wherein determining the trend comprises determining a decrease in pulse amplitude during the inhalation portion of the respiratory cycle.

9. The method of claim 7, wherein determining the trend comprises determining an increase in pulse amplitude during the exhalation portion of the respiratory cycle.

10. The method of claim 1, wherein a trend of an increase in pulse amplitude during the exhalation portion of the respiratory cycle and a trend of a decrease in pulse amplitude during the inhalation portion of the respiratory cycle are indicative of hypovolemia.

11. The method of claim 1, comprising displaying an indicator related to a risk of hypovolemia on a display.

12. A method, comprising:

using a processor;

receiving a plethysmographic waveform signal from a sensor applied to a patient;

transforming the plethysmographic waveform signal using a wavelet transform to generate a scalogram from the plethysmographic waveform;

estimating a stroke volume over time for the patient based on the scalogram;

correlating the stroke volume in time to an exhalation portion of a respiratory cycle of the patient; and

determining if the patient is at risk of developing hypovolemia based on an increase in the stroke volume during the exhalation portion of the respiratory cycle relative to a range or threshold.

13. The method of claim 12, wherein determining if the patient is at risk of developing hypovolemia comprises determining an increased risk based on a trend of an increase in the stroke volume during the exhalation portion of the respiratory cycle.

14. The method of claim 12, wherein determining if the patient is at risk of developing hypovolemia comprises determining a reduced risk based on a relative decrease in the stroke volume during the exhalation portion of the respiratory cycle after administration of fluid therapy.

15. A monitor, comprising:

an input circuit configured to receive a plethysmographic waveform signal;

a memory storing an algorithm configured to;

determine a pattern of one or more features of the plethysmographic waveform over time;

correlate in time the pattern of the one or more features of the plethysmographic waveform to a portion of a breathing cycle of the patient; and

calculate a presence or risk of hypovolemia based on the pattern of the one or more features of the plethysmographic waveform correlated in time with the breathing cycle during only the portion of the breathing cycle of the patient, wherein the one or more features comprise a pulse amplitude and wherein a pattern of an increase in pulse amplitude during an exhalation portion of the breathing cycle that is greater than a range or threshold is indicative of the presence or risk of hypovolemia; and

an output circuit configured to provide an indication of the presence or risk of hypovolemia.

16. The monitor of claim 15, wherein the one or more features of the plethysmographic waveform comprise at least two of:

a baseline, a pulse to pulse interval (RSA), or any parameter derived therefrom comprising a derivative, maximum, a change, or rate of change.

17. The monitor of claim 15, wherein the pattern comprises a pattern during an inhalation portion of the breathing cycle.

18. The monitor of claim 15, comprising correcting the pattern based on a number of arrhythmic beats in the plethysmographic waveform signal.

19. A monitor, comprising:

an input circuit configured to receive a plethysmographic waveform signal from a patient;

a memory storing an algorithm configured to;

transform the plethysmographic waveform signal using a wavelet transform to generate a scalogram from the plethysmographic waveform;

estimate a stroke volume over time for the patient based on the scalogram;

correlate the stroke volume in time to an exhalation portion of a respiratory cycle of the patient; and

determine if the patient is at risk of developing hypovolemia based on an increase in the stroke volume during the exhalation portion of the respiratory cycle relative to a range or threshold; and

an output circuit configured to provide an indication if the patient is at risk of developing hypovolemia.