Methods of monitoring oxygenation by positive end expiratory pressure using photoplethysmography

• US 9,198,586 B2
• Filed: 12/05/2013
• Issued: 12/01/2015
• Est. Priority Date: 06/20/2002
• Status: Expired due to Term

• Current Assignee: Beta Biomed Services, Inc., University of Florida Research Foundation, Incorporated (State University System of Florida)
• Original Assignee: University of Florida Research Foundation, Incorporated (State University System of Florida)
• Inventors: Melker, Richard J
• Primary Examiner(s): Natnithithadha, Navin
• Assistant Examiner(s): WEARE, MEREDITH H
• Application Number:
  US14/097,819
• Publication Number:
  US 20140158132A1
• Time in Patent Office: 726 Days
• Field of Search: 128/204.23, 600/529
• US Class Current: 1/1
• CPC Class Codes: A61B 2560/0276 Determining malfunction
• CPC Class Codes: A61B 2562/247 Hygienic covers, i.e. for covering the sensor or apparatus during use
• 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 5/02416 using photoplethysmograph signals, e.g. generated by infrared radiation A61B5/14552 takes precedence
• 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 5/0295 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 5/036 by means introduced into body tracts A61B5/032 and A61B5/035 take precedence
• CPC Class Codes: A61B 5/0816 Measuring devices for examining respiratory frequency measuring frequency of electric signals G01R23/00
• CPC Class Codes: A61B 5/0836 Measuring rate of CO2 production
• CPC Class Codes: A61B 5/087 Measuring breath flow
• CPC Class Codes: A61B 5/0873 using optical means
• CPC Class Codes: A61B 5/14551 for measuring blood gases
• CPC Class Codes: A61B 5/14552 Details of sensors specially adapted therefor
• CPC Class Codes: A61B 5/4818 Sleep apnoea
• CPC Class Codes: A61B 5/4836 Diagnosis combined with treatment in closed-loop systems or methods A61B5/0036 takes precedence
• CPC Class Codes: A61B 5/6819 Nose
• CPC Class Codes: A61B 5/682 Mouth, e.g., oral cavity; tongue; Lips; Teeth
• CPC Class Codes: A61B 5/6826 Finger
• CPC Class Codes: A61B 5/6829 Foot or ankle
• 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: A61M 16/0003 : Accessories therefor, e.g. sensors, vibrators, negative pressure
• CPC Class Codes: A61M 16/0051 : with alarm devices
• CPC Class Codes: A61M 16/0057 : Pumps therefor
• CPC Class Codes: A61M 16/021 : operated by electrical means A61M16/202 – A61M16/205 take precedence
• CPC Class Codes: A61M 16/0666 : Nasal cannulas or tubing devices for improving normal breathing through the nose A61F5/08; nose filters A62B23/06; outside holding devices A61M25/02
• CPC Class Codes: A61M 16/0672 : Nasal cannula assemblies for oxygen therapy
• CPC Class Codes: A61M 16/08 : Bellows; Connecting tubes having means for taking samples G01N1/22; Water traps; Patient circuits
• CPC Class Codes: A61M 16/085 : Gas sampling
• CPC Class Codes: A61M 16/20 : Valves specially adapted to medical respiratory devices
• CPC Class Codes: A61M 2202/0007 : introduced into the body
• CPC Class Codes: A61M 2202/0208 : Oxygen
• CPC Class Codes: A61M 2202/03 : Gases in liquid phase, e.g. cryogenic liquids
• CPC Class Codes: A61M 2205/3561 : local, e.g. within room or hospital
• CPC Class Codes: A61M 2205/3569 : sublocal, e.g. between console and disposable
• CPC Class Codes: A61M 2210/0618 : Nose
• CPC Class Codes: A61M 2210/0625 : Mouth
• CPC Class Codes: A61M 2210/0662 : Ears
• CPC Class Codes: A61M 2230/005 : Parameter used as control input for the apparatus
• CPC Class Codes: A61M 2230/06 : Heartbeat rate only
• CPC Class Codes: A61M 2230/205 : partial oxygen pressure (P-O2)
• CPC Class Codes: A61M 2230/30 : Blood pressure A61M2230/04 takes precedence
• CPC Class Codes: A61M 2230/42 : Rate
• CPC Class Codes: A61M 2230/432 : partial CO2 pressure (P-CO2)

Abstract

The present invention relates to novel lip/cheek probes for detection of pulse-based differences in light absorbence across the vascularized tissue of a lip or cheek of a patient. These probes are fabricated to provide signals to estimate arterial oxygen saturation, and/or to obtain other photoplethysmographic data. The present invention also relates to a combined probe/cannula. The present invention also relates to other devices that combine a pulse oximeter probe with a device supplying oxygen or other oxygen-containing gas to a person in need thereof, and to sampling means for exhaled carbon dioxide in combination with the novel lip/cheek probes. In certain embodiments, an additional limitation of a control means to adjust the flow rate of such gas is provided, where such control is directed by the blood oxygen saturation data obtained from the pulse oximeter probe.

Claims

1. A method of optimizing oxygenation in a patient comprising:

(a) securing a photoplethysmography (PPG) sensor and a positive end expiratory pressure (PEEP) apparatus to a central source site of the patient,

(b) applying PEEP to the patient at a first level;

(c) evaluating with a computer (1) a blood oxygen saturation; and

(2) changes in a magnitude of an envelope of a PPG signal and/or an amplitude of a PPG signal, to determine whether the level of PEEP is appropriate; and

(d) if the level of PEEP is not appropriate, (1) increasing or decreasing the level of PEEP to a second level, (2) increasing fluid volume in the patient, (3) providing drug treatment to the patient, or (4) a combination thereof.

2. The method of claim 1, wherein the changes in the magnitude of the envelope of the PPG signal are evaluated to determine whether the level of PEEP is appropriate.

3. The method of claim 2, wherein the changes in the magnitude of the envelope of the PPG signal are evaluated to determine whether the level of PEEP is optimal for the patient.

4. The method of claim 2, wherein the changes in the baseline of the envelope of the PPG signal are further evaluated to determine whether the level of PEEP is appropriate.

5. The method of claim 4, wherein the changes in the baseline of the envelope of the PPG signal are evaluated to determine whether the level of PEEP is optimal for the patient.

6. The method of claim 1, wherein the magnitude of amplitude of the PPG signal is evaluated to determine whether the level of PEEP is appropriate.

7. The method of claim 6, wherein the amplitude of the PPG signal is evaluated to determine whether the level of PEEP is optimal for the patient.

8. The method of claim 1, wherein if the amplitude of the PPG signal is sufficiently small at the first level, the level of PEEP is decreased to the second level.

9. The method of claim 1, comprising providing fluids or drug treatment to the patient if the first level of PEEP causes the magnitude of the amplitude of the PPG signal to decrease.

10. The method of claim 1, wherein if the level of PEEP is not appropriate, the PEEP is increased or decreased to a second level.

11. The method of claim 1, wherein if the level of PEEP is not appropriate, the fluid volume of the patient is increased.

12. The method of claim 1, wherein if the level of PEEP is not appropriate, drug treatment is provided to the patient.

13. A method of optimizing positive end expiratory pressure (PEEP) in a patient comprising

evaluating with a computer (1) a blood oxygen saturation of the patient;

and (2) changes in a magnitude of an envelope of a PPG signal obtained at a central source site of the patient and/or a magnitude of an amplitude of a PPG signal obtained at a central source site of the patient, to determine whether the level of PEEP is appropriate; and

if the level of PEEP is not appropriate, (1) increasing or decreasing the level of PEEP, (2) increasing fluid volume in the patient, (3) providing drug treatment to the patient, or (4) a combination thereof.

14. The method of claim 13, wherein the changes in the magnitude of the envelope of the PPG signal are evaluated to determine whether the level of PEEP is appropriate.

15. The method of claim 14, wherein the changes in the baseline of the envelope of the PPG signal are further evaluated to determine whether the level of PEEP is appropriate.

16. The method of claim 13, wherein the magnitude of the amplitude of the PPG signal is evaluated to determine whether the level of PEEP is appropriate.

17. The method of claim 13, wherein if the amplitude of the PPG signal is sufficiently small, the level of PEEP is decreased.

18. The method of claim 13, wherein if the level of PEEP is not appropriate, the PEEP is increased or decreased.

19. The method of claim 13, wherein if the level of PEEP is not appropriate, the fluid volume of the patient is increased.

20. The method of claim 13, wherein if the level of PEEP is not appropriate, drug treatment is provided to the patient.