Automatic pressure titration

• US 9,056,172 B2
• Filed: 01/22/2010
• Issued: 06/16/2015
• Est. Priority Date: 02/25/2009
• Status: Active Grant

• Current Assignee: Koninklijke Philips N.V.
• Original Assignee: Koninklijke Philips N.V.
• Inventors: Shelly, Benjamin Irwin, Kane, Michael T., Matthews, Gregory Delano, Ressler, Heather Dawn
• Primary Examiner(s): Dixon, Annette
• Application Number:
  US13/202,331
• Publication Number:
  US 20110297156A1
• Time in Patent Office: 1,971 Days
• Field of Search: 128/200.24, 128/204.18, 128/204.21, 128/204.23
• US Class Current: 1/1
• CPC Class Codes: A61M 16/0003 Accessories therefor, e.g. sensors, vibrators, negative pressure
• CPC Class Codes: A61M 16/0006 with means for creating vibrations in patients' airways
• CPC Class Codes: A61M 16/0069 the speed thereof being controlled by respiratory parameters, e.g. by inhalation
• CPC Class Codes: A61M 16/024 including calculation means, e.g. using a processor
• CPC Class Codes: A61M 16/06 Respiratory or anaesthetic masks
• CPC Class Codes: A61M 2016/0027 pressure meter
• CPC Class Codes: A61M 2016/003 with a flowmeter
• CPC Class Codes: A61M 2205/3334 Measuring or controlling the flow rate
• CPC Class Codes: A61M 2205/50 with microprocessors or computers
• CPC Class Codes: A61M 2205/52 with memories providing a history of measured variating parameters of apparatus or patient

Abstract

A pressure support methodology and system that utilizes at least two, and possibly all three, of information relating to (i) airway patency, i.e., the degree to which the patient'"'"'s airway is open, (ii) the primary cause of the current sleep disordered breathing event, and (iii) the patient'"'"'s response to previous pressure changes to automatically titrate pressure when presented with a sleep disordered breathing event. In another embodiment, pressure may be automatically titrated based solely on the primary cause of the sleep disordered breathing event.

Claims

1. A method of providing pressure support to a patient, comprising:

monitoring whether the patient is responsive or non-responsive to previous pressure increases in a flow of gas provided to the patient, wherein the patient is responsive to previous pressure increases if the previous pressure increases have resolved previous sleep disordered breathing events of the patient and the patient is non-responsive to previous pressure increases if the previous pressure increases have not resolved the previous sleep disordered breathing events of the patient;

detecting an occurrence of a current sleep disordered breathing event in the patient; and

in response to the detecting, performing one or both of;

(i) determining whether an airway of the patient is open or closed, and (ii) determining whether the sleep disordered breathing event is centrally mediated;

in response to determining;

(a) that the airway of the patient is closed, (b) that the sleep disordered breathing event is centrally mediated, or (c) both (a) and (b), determining whether the patient is responsive or non-responsive to previous pressure increases;

in response to determining that the patient is responsive to previous pressure increases, increasing the pressure of the flow of gas provided to the patient; and

in response to determining that the patient in non-responsive to previous pressure increases, decreasing the pressure of the flow of gas provided to the patient or not changing the pressure of the flow of gas provided to the patient.

2. The method according to claim 1, wherein in response to the detecting, the method includes performing both of:

(i) determining whether an airway of the patient is open or closed, and (ii) determining whether the sleep disordered breathing event is centrally mediated.

3. The method according to claim 2, wherein the method further includes (i) performing no titration of the pressure if the airway is determined to be open, and (ii) increasing the pressure if the airway is determined to be closed and if the sleep disordered breathing event is determined to not be centrally-mediated.

4. The method according to claim 1, further comprising, in response to the detecting, determining whether the airway of the patient is open or closed by providing a test pressure increase of predetermined amplitude to the patient, evaluating a degree of flow response to the test pressure increase and comparing a volume of the flow response to a predetermined volume threshold, wherein if the volume is greater than the predetermined volume threshold the airway is determined to be open and if the volume is less than or equal to the predetermined volume threshold the airway is determined to be closed.

5. The method according to claim 1, further comprising, in response to the detecting, determining whether the airway of the patient is open or closed by providing a pressure increase having an independently-controlled magnitude to the patient, measuring a flow response to the pressure increase, and determining whether the airway is open or closed based on the flow response to the pressure increase.

6. The method according to claim 5, wherein the determining whether the airway is open or closed based on the flow response to the pressure increase comprises computing a volume of the flow response, and comparing the volume to a predetermined volume threshold that is determined by a magnitude of the pressure increase, wherein if the volume is greater than the predetermined volume threshold the airway is determined to be open and if the volume is less than or equal to the predetermined volume threshold the airway is determined to be closed.

7. A pressure support system, comprising:

a pressure generating system adapted to produce a flow of gas;

a patient circuit operatively coupled to the pressure generating system to deliver the flow of gas to an airway of a patient; and

a controller operatively coupled to the pressure generating system, the controller being adapted to control a pressure of the flow of gas by;

monitoring whether the patient is responsive or non-responsive to previous pressure increases in a flow of gas provided to the patient, wherein the patient is responsive to previous pressure increases if the previous pressure increases have resolved previous sleep disordered breathing events of the patient and the patient is non-responsive to previous pressure increases if the previous pressure increases have not resolved the previous sleep disordered breathing events of the patient;

detecting an occurrence of a current sleep disordered breathing event in the patient;

in response to the detecting, performing one or both of;

(i) determining whether an airway of the patient is open or closed, and (ii) determining whether the sleep disordered breathing event is centrally mediated;

in response to determining;

(a) that the airway of the patient is closed, (b) that the sleep disordered breathing event is centrally mediated, or (c) both (a) and (b), determining whether the patient is responsive or non-responsive to previous pressure increases;

in response to determining that the patient is responsive to previous pressure increases, increasing the pressure of the flow of gas provided to the patient; and

in response to determining that the patient in non-responsive to previous pressure increases, decreasing the pressure of the flow of gas provided to the patient or not changing the pressure of the flow of gas provided to the patient.

8. The pressure support system according to claim 7, wherein the controller is adapted to, in response to the detecting, perform both:

(i) determining whether an airway of the patient is open or closed, and (ii) determining whether the sleep disordered breathing event is centrally mediated.

9. The pressure support system according to claim 8, wherein the controller is further adapted to perform no titration of the pressure if the airway is determined to be open, and (ii) increase the pressure if the airway is determined to be closed and if the sleep disordered breathing event is determined to not be centrally-mediated.

10. The pressure support system according to claim 7, wherein in response to the detecting, the controller is adapted to determine whether the airway of the patient is open or closed by providing a test pressure increase of predetermined amplitude to the patient, evaluating a degree of flow response to the test pressure increase and comparing a volume of the flow response to a predetermined volume threshold, wherein if the volume is greater than the predetermined volume threshold the airway is determined to be open and if the volume is less than or equal to the predetermined volume threshold the airway is determined to be closed.

11. The pressure support system according to claim 7, wherein in response to the detecting, the controller is adapted to determine whether the airway of the patient is open or closed by providing a pressure increase having an independently-controlled magnitude to the patient, measuring a flow response to the pressure increase, and determining whether the airway is open or closed based on the flow response to the pressure increase.

12. The pressure support system according to claim 11, wherein the controller is adapted to determine whether the airway is open or closed based on the flow response to the pressure increase comprises computing a volume of the flow response, and comparing the volume to a predetermined volume threshold that is determined by a magnitude of the pressure increase, wherein if the volume is greater than the predetermined volume threshold the airway is determined to be open and if the volume is less than or equal to the predetermined volume threshold the airway is determined to be closed.