Method for determining hemodynamic effects

• US 9,414,769 B2
• Filed: 08/20/2013
• Issued: 08/16/2016
• Est. Priority Date: 09/17/2008
• Status: Active Grant

• Current Assignee: Covidien LP (Medtronic Plc)
• Original Assignee: Covidien LP (Medtronic Plc)
• Inventors: Karst, Edward, Vandine, Joseph Douglas, Porges, Charles E., Baker, Clark R. Jr.
• Primary Examiner(s): Kahelin, Michael
• Assistant Examiner(s): TRAN, THO Q
• Application Number:
  US13/971,478
• Publication Number:
  US 20130338514A1
• Time in Patent Office: 1,092 Days
• Field of Search: 600/507, 600/504, 600/481, 600/483, 600/484
• US Class Current: 1/1
• 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 5/029 Measuring or recording blood output from the heart, e.g. minute volume A61B8/065 takes precedence
• CPC Class Codes: A61B 5/0806 by whole-body plethysmography measuring blood flow using plethysmography A61B5/0295; impedance plethysmography A61B5/053; measuring volume of the body or parts thereof A61B5/1073
• CPC Class Codes: A61B 5/14551 for measuring blood gases
• CPC Class Codes: A61B 5/4035 Evaluating the autonomic nervous system

Abstract

The present disclosure relates, in some embodiments, to devices, systems, and/or methods for collecting, processing, and/or displaying stroke volume and/or cardiac output data. For example, a device for assessing changes in cardiac output and/or stroke volume of a subject receiving airway support may comprise a processor; an airway sensor in communication with the processor, wherein the airway sensor is configured and arranged to sense pressure in the subject'"'"'s airway, lungs, and/or intrapleural space over time; a blood volume sensor in communication with the processor, wherein the blood volume sensor is configured and arranged to sense pulsatile volume of blood in a tissue of the subject over time; and a display configured and arranged to display a representative of an airway pressure, a pulsatile blood volume, a photoplethysmogram, a photoplethysmogram ratio, the determined cardiac output and/or stroke volume, or combinations thereof. A method of assessing changes in cardiac output or stroke volume of a subject receiving airway support from a breathing assistance system may comprise sensing pressure in the subject'"'"'s airway as a function of time, sensing pulsatile volume of blood in a tissue of the subject as a function of time, producing a photoplethysmogram from the sensed pulsatile volume, determining the ratio of the amplitude of the photoplethysmogram during inhalation to the amplitude of the photoplethysmogram during exhalation, and determining the change in cardiac output or stroke volume of the subject using the determined ratio.

Claims

1. A method of assessing changes in stroke volume or cardiac output of a ventilated subject, the method comprising:

sensing pressure in the ventilated subject'"'"'s airway during at least one breathing cycle comprising an inhalation and an exhalation with an airway sensor;

sensing a blood volume in the ventilated subject during the at least one breathing cycle with a blood volume sensor;

producing a photoplethysmogram spanning the at least one breathing cycle using the blood volume sensed by the blood volume sensor;

determining, with a breathing assistance system, a ratio of the amplitude of the photoplethysmogram during inhalation to the amplitude of the photoplethysmogram during exhalation; and

determining, with the breathing assistance system, a change in cardiac output or stroke volume of the subject using the determined amplitude ratio.

2. The method of according to claim 1, further comprising:

referencing a stroke volume to current active ventilation settings of the breathing assistance system; and

comparing changes in ventilation settings to the current active ventilation settings.

3. The method of according to claim 2, further comprising:

determining a change in ventilation settings based on the change in cardiac output or stroke volume, wherein the change in ventilation settings comprises a change in a setting selected from the group consisting of positive end-expiratory pressure (PEEP), continuous positive airway pressure, inspiratory pressure target, inspiratory volume target, I;

E ratio, and combinations thereof.

4. The method of according to claim 2, further comprising:

displaying at least one of a representative parameter of the sensed airway pressure, a sensed pulsatile blood volume, the produced photoplethysmogram, the determined photoplethysmogram amplitude ratio, the cardiac output, or the stroke volume, the determined change in the cardiac output, the stroke volume.

5. The method of according to claim 2, wherein a representative parameter is a graphical representation of an actual parameter value.

6. The method of according to claim 2, wherein a representative parameter is an actual parameter value.

7. The method of according to claim 2, further comprising:

sensing a pulse rate of the subject.

8. The method of according to claim 7, further comprising:

determining the stroke volume of the subject from the determined photoplethysmogram amplitude ratio;

calculating a cardiac output by multiplying the stroke volume by the pulse rate.

9. The method of according to claim 2, further comprising:

changing the current active ventilation settings based on the comparing of the changes in ventilation settings to the current active ventilation settings,

wherein the current active ventilation settings include at least one of positive-end expiratory pressure (PEEP), ratio of inspiratory time to expiratory time (I;

E ratio), peak inspiratory pressure, volume delivered, and percent support.

10. The method of according to claim 1, further comprising:

determining the stroke volume of the subject from the determined photoplethysmogram amplitude ratio;

referencing the stroke volume to a parameter selected from a group consisting of zero end-expiratory pressure, current active breathing assistance system control settings, and combinations thereof.

11. A method of assessing a relative strength of an autonomic neural response of a subject connected to a breathing assistance system, the method comprising:

determining a cardiac output of the subject at a first airway pressure;

changing the subject'"'"'s airway pressure to a second airway pressure via the breathing assistance system;

monitoring the cardiac output of the subject at the second airway pressure;

comparing, with the breathing assistance system, the cardiac output of the subject at the second airway pressure with the cardiac output of the subject at the first airway pressure;

measuring a time required for the cardiac output of the subject at the second airway pressure to return to the cardiac output of the subject at a first airway pressure;

comparing, with the breathing assistance system, the required time to a reference time; and

determining, with the breathing assistance system, the relative strength of an autonomic neural response of the subject using the comparing of the required time to the reference time.

12. The method of according to claim 11, further comprising:

displaying at least one of a representative parameter of a sensed airway pressure, a pulsatile blood volume, a cardiac output and a stroke volume.

13. The method of according to claim 11, further comprising:

displaying at least one of the required time and the reference time.

14. The method of according to claim 11, further comprising:

displaying the determined relative strength of the autonomic neural response of the subject.

15. A processor comprising memory and a device, wherein the memory stores logic instructions and the device-executes the logic instructions stored on the memory, the logic instructions comprising:

instructions to produce a photoplethysmogram spanning at least one breathing cycle using processed sensor input;

instructions to determine a ratio of an amplitude of the photoplethysmogram during inhalation to an amplitude of the photoplethysmogram during exhalation; and

instructions to determine a change in cardiac output or stroke volume of a subject using the determined ratio.

16. The processor of claim 15, wherein the logic instructions further comprise:

instructions to monitor pressure in the subject'"'"'s airway during at least one breathing cycle comprising an inhalation and an exhalation; and

instruction to monitor pulsatile volume of blood in a tissue of the subject as a function of time.

17. The processor of claim 15, wherein the logic instructions further comprise:

instructions to determine the stroke volume of the subject from the determined photoplethysmogram amplitude ratio;

instructions to calculate a cardiac output by multiplying the stroke volume by the pulse rate; and

instructions to display at least one of a representative parameter of an airway pressure, a pulsatile blood volume, the produced photoplethysmogram, the determined photoplethysmogram amplitude ratio, the cardiac output, the stroke volume, or the determined change in the cardiac output.

18. The method of according to claim 17, wherein the representative parameter is a graphical representation of an actual parameter value.

19. The method of according to claim 15, wherein the logic instructions further comprise:

instructions to sense a pulse rate of the subject.

20. The method of according to claim 19, wherein the logic instructions further comprise:

instructions to calculate a cardiac output by multiplying a stroke volume by the pulse rate.