Ventilator-initiated prompt regarding auto-peep detection during ventilation of non-triggering patient

• US 9,030,304 B2
• Filed: 01/03/2014
• Issued: 05/12/2015
• Est. Priority Date: 05/07/2010
• Status: Active Grant

• Current Assignee: Covidien LP (Medtronic Plc)
• Original Assignee: Covidien LP (Medtronic Plc)
• Inventors: Milne, Gary, Hensley, Kirk, Doyle, Peter R., Kimm, Gardner
• Primary Examiner(s): Swarthout, Brent
• Application Number:
  US14/147,296
• Publication Number:
  US 20140121553A1
• Time in Patent Office: 494 Days
• Field of Search: 340/286.07, 340/539.12, 600/323, 600/529, 128/204.18, 128/204.21, 128/204.23, 128/205.23
• US Class Current: 340/286.07
• CPC Class Codes: A61B 5/0803 Recording apparatus specially adapted therefor
• CPC Class Codes: A61B 5/085 Measuring impedance of respiratory organs or lung elasticity
• CPC Class Codes: A61B 5/087 Measuring breath flow
• CPC Class Codes: A61B 5/0871 Peak expiratory flowmeters
• CPC Class Codes: A61B 5/4836 Diagnosis combined with treatment in closed-loop systems or methods A61B5/0036 takes precedence
• CPC Class Codes: A61B 5/743 Displaying an image simultaneously with additional graphical information, e.g. symbols, charts, function plots
• CPC Class Codes: A61B 5/7435 Displaying user selection data, e.g. icons in a graphical user interface
• 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
• CPC Class Codes: A61M 16/0051 with alarm devices
• CPC Class Codes: A61M 16/0057 Pumps therefor
• CPC Class Codes: A61M 16/0063 Compressors
• CPC Class Codes: A61M 16/026 specially adapted for predicting, e.g. for determining an information representative of a flow limitation during a ventilation cycle by using a root square technique or a regression analysis
• CPC Class Codes: A61M 16/04 Tracheal tubes catheters in general A61M25/00
• CPC Class Codes: A61M 16/0833 T- or Y-type connectors, e.g. Y-piece
• CPC Class Codes: A61M 16/0875 Connecting tubes
• CPC Class Codes: A61M 2016/0021 with a proportional output signal, e.g. from a thermistor
• CPC Class Codes: A61M 2016/0036 in the breathing tube and used in both inspiratory and expiratory phase
• CPC Class Codes: A61M 2205/18 with alarm
• CPC Class Codes: A61M 2205/3375 Acoustical, e.g. ultrasonic, measuring means
• CPC Class Codes: A61M 2205/505 Touch-screens; Virtual keyboard or keypads; Virtual buttons; Soft keys; Mouse touches
• CPC Class Codes: A61M 2205/584 : having a color code
• CPC Class Codes: A61M 2230/43 : Composition of exhalation
• CPC Class Codes: G08B 5/22 : using electric transmission; using electromagnetic transmission

Abstract

This disclosure describes systems and methods for monitoring and evaluating ventilatory parameters, analyzing those parameters and providing useful notifications and recommendations to clinicians. That is, modern ventilators monitor, evaluate, and graphically represent a myriad of ventilatory parameters. However, many clinicians may not easily identify or recognize data patterns and correlations indicative of certain patient conditions, changes in patient condition, and/or effectiveness of ventilatory treatment. Further, clinicians may not readily determine appropriate ventilatory adjustments that may address certain patient conditions and/or the effectiveness of ventilatory treatment. Specifically, clinicians may not readily detect or recognize the presence of Auto-PEEP during volume ventilation of a non-triggering patient. According to embodiments, a ventilator may be configured to monitor and evaluate diverse ventilatory parameters to detect Auto-PEEP and may issue suitable notifications and recommendations to the clinician when Auto-PEEP is implicated. The suitable notifications and recommendations may further be provided in a hierarchical format.

Claims

1. A ventilator-implemented method for detecting Auto-PEEP during ventilation of a non-triggering patient, the method implemented by a ventilator having at least one processor, the method comprising:

receiving one or more ventilatory settings associated with ventilation of the non-triggering patient;

determining one or more predetermined thresholds for detecting Auto-PEEP based at least in part on the one or more ventilatory settings;

monitoring ventilation of the non-triggering patient to obtain ventilatory data;

determining, by the at least one processor, that Auto-PEEP is implicated for the non-triggering patient upon detecting that the ventilatory data breaches the one or more predetermined thresholds;

determining a list of entries for mitigating Auto-PEEP based at least in part on identifying the patient as non-triggering, wherein at least one entry of the list of entries is different for the non-triggering patient than for a triggering patient; and

issuing a prompt when Auto-PEEP is implicated, the prompt displaying;

a notification that Auto-PEEP is implicated; and

the list of entries for mitigating Auto-PEEP.

2. The ventilator-implemented method of claim 1, wherein the list of entries includes primary entries comprising one or more of:

decrease respiratory rate;

decrease inspiratory time;

increase flow;

adjust ventilatory settings until end-expiratory flow (EEF) approximates zero;

investigate reasons for increased resistance; and

investigate reasons for increased compliance.

3. The ventilator-implemented method of claim 2, wherein the list of entries further includes secondary entries, comprising one or more of:

decrease tidal volume (V_T); and

change to a square flow waveform.

4. The ventilator-implemented method of claim 2, wherein the secondary entries comprise:

decrease inspiratory pressure in order to decrease delivered tidal volume (V_T) so that expiratory time (T_E) is adequate to completely exhale delivered V_T.

5. The ventilator-implemented method of claim 1, wherein the ventilatory data includes expiratory flow data, the method further comprising:

receiving one or more predetermined thresholds associated with end-expiratory flow (EEF);

detecting that EEF is positive when the EEF breaches the one or more predetermined thresholds; and

determining that Auto-PEEP is implicated for the non-triggering patient when EEF is positive for a predetermined number of breaths.

6. The ventilator-implemented method of claim 1, wherein the ventilatory data includes respiratory resistance data and respiratory compliance data, the method further comprising:

calculating a time required to reach functional residual capacity (FRC);

comparing the time required to reach FRC with expiratory time (T_E); and

determining that Auto-PEEP is implicated for the non-triggering patient when the time required to reach FRC is greater than T_E.

7. The ventilator-implemented method of claim 1, wherein the ventilatory data includes pressure data, the method further comprising:

receiving a positive end-expiratory pressure (PEEP) setting, wherein the PEEP setting is about 0 cm H₂O or greater;

receiving one or more predetermined thresholds associated with end-expiratory pressure (EEP);

detecting that the EEP breaches the one or more predetermined thresholds when the EEP minus the PEEP setting is greater than the one or more predetermined thresholds; and

determining that Auto-PEEP is implicated for the non-triggering patient when the EEP breaches the one or more predetermined thresholds.

8. The ventilator-implemented method of claim 1, wherein the ventilatory data includes respiratory resistance data, the method further comprising:

receiving one or more predetermined thresholds associated with the respiratory resistance data;

detecting that respiratory resistance has increased when the respiratory resistance data breaches the one or more predetermined thresholds; and

determining that Auto-PEEP is implicated for the non-triggering patient when the respiratory resistance has increased.

9. The ventilator-implemented method of claim 1, wherein the ventilatory data includes a pulmonary time constant and an expiratory time (T_E), and the method further comprising:

comparing the pulmonary time constant to the T_E; and

determining that Auto-PEEP is implicated for the non-triggering patient when the T_E is less than three pulmonary time constants.

10. A ventilatory system for issuing a prompt when Auto-PEEP is implicated during ventilation of a non-triggering patient, comprising:

at least one processor; and

at least one memory, communicatively coupled to the at least one processor and containing instructions that, when executed by the at least one processor, cause a controller to;

receive one or more ventilatory settings associated with ventilation of the non-triggering patient;

detect that Auto-PEEP is implicated for the non-triggering patient upon detecting that parameter data breaches one or more predetermined thresholds, wherein the one or more predetermined thresholds are based at least in part on the one or more ventilatory settings;

determine a list of entries for mitigating Auto-PEEP based at least in part on identifying the patient as non-triggering, wherein at least one entry of the list of entries is different for the non-triggering patient than for a triggering patient; and

issue a prompt when Auto-PEEP is implicated, the prompt displaying;

a notification that Auto-PEEP is implicated; and

a list of entries for mitigating Auto-PEEP.

11. The ventilatory system of claim 10, further comprising:

determine the notification based at least in part on the parameter data that implicated Auto-PEEP.

12. The ventilatory system of claim 11, wherein the notification-comprises information regarding the parameter data that implicated Auto-PEEP.

13. The ventilatory system of claim 10, wherein the list of entries for mitigating Auto-PEEP are based at least in part on evaluating the parameter data that implicated Auto-PEEP.

14. The ventilatory system of claim 10, wherein the list of entries comprises primary entries comprising one or more of:

decrease respiratory rate;

decrease inspiratory time;

increase flow;

adjust ventilatory settings until end-expiratory flow (EEF) approximates zero;

investigate reasons for increased resistance; and

investigate reasons for increased compliance.

15. The ventilatory system of claim 14, wherein the list of entries includes one or more secondary entries, the one or more secondary entries comprising increasing expiratory time (T_E) by one or more of:

decreasing tidal volume (V_T); and

changing to a square flow waveform.

16. The ventilatory system of claim 14, wherein the list of entries includes one or more secondary entries, the one or more secondary entries comprising:

decrease inspiratory pressure in order to decrease delivered tidal volume (V_T) so that expiratory time (T_E) is adequate to completely exhale delivered V_T.

17. A ventilator-implemented method for detecting Auto-PEEP during ventilation of a non-triggering patient, the method implemented on a ventilator having at least one processor, the method comprising:

collecting data associated with ventilatory parameters;

determining one or more predetermined thresholds for detecting Auto-PEEP; and

determining, by the at least one processor, that Auto-PEEP is implicated for the non-triggering patient upon detecting that the ventilatory parameter data breaches the one or more predetermined thresholds;

determining a list of entries for mitigating Auto-PEEP based at least in part on identifying the patient as non-triggering, wherein at least one entry of the list of entries is different for the non-triggering patient than for a triggering patient; and

issuing a prompt when Auto-PEEP is implicated, the prompt displaying;

a notification that Auto-PEEP is implicated; and

the list of entries for mitigating Auto-PEEP.

18. The ventilator-implemented method of claim 17, wherein the list of entries includes primary entries comprising one or more of:

decrease respiratory rate;

decrease inspiratory time;

increase flow;

adjust ventilatory settings until end-expiratory flow (EEF) approximates zero;

investigate reasons for increased resistance; and

investigate reasons for increased compliance.

19. The ventilator-implemented method of claim 18, wherein the list of entries further includes one or more secondary entries, the one or more secondary entries comprising increasing expiratory time (T_E) by one or more of:

decreasing tidal volume (V_T); and

changing to a square flow waveform.

20. The ventilator-implemented method of claim 18, wherein the list of entries further includes one or more secondary entries, the one or more secondary entries comprising:

decrease inspiratory pressure in order to decrease delivered tidal volume (V_T) so that expiratory time (T_E) is adequate to completely exhale delivered V_T.