Transvascular diaphragm pacing systems and methods of use
First Claim
1. A method of stimulating a diaphragm to provide a diaphragm assist level, comprising:
- (a) obtaining an attribute of a breath cycle of a patient, wherein the patient receives respiratory assistance from a ventilator during the breath cycle;
(b) based on a stimulation parameter, the attribute of the breath cycle, and a desired value of a breath parameter, transmitting a first stimulation signal to a first electrode positioned within a blood vessel of the patient such that the electrode recruits a phrenic nerve of the patient;
(c) after transmitting the first stimulation signal, determining an actual value of the breath parameter from a breath;
(d) comparing the actual value of the breath parameter to the desired value of the breath parameter; and
(e) either (1) maintaining the stimulation parameter if the actual value of the breath parameter is within a selected range of the desired value of the breath parameter;
or (2) modifying the stimulation parameter if the actual value of the breath parameter is not within the selected range of the desired value of the breath parameter; and
(f) repeating steps (b)-(e),wherein the method further includes transmitting a second stimulation signal to a second electrode to recruit the phrenic nerve, and wherein transmitting the first stimulation signal to the first electrode occurs at a different time as transmitting the second stimulation signal to the second electrode.
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Accused Products
Abstract
Transvascular diaphragm pacing systems (TDPS) and methods are disclosed for providing respiratory therapy to a patient. The TDPS can provide rapid insertion and deployment of endovascular pacing electrodes in critically ill patients who require intubation and invasive PPMV in order to support the physiological requirements of the human ventilatory system. The systems and methods make best use of the contractile properties of the diaphragm muscle and prevent muscle disuse and muscle atrophy. This can be carried out by engaging the phrenic nerves using patterned functional electrical stimulation applied to endovascular electrodes that are temporarily and reversibly inserted in central veins of the patient, such as the left subclavian vein and the superior vena cava. The TDPS can be designed to seamlessly interface with any commercially available positive-pressure ventilatory assistance/support equipment such as is commonly in use in hospital intensive care units (ICU) for treating critically ill patients with breathing insufficiencies, pain, trauma, sepsis or neurological diseases or deficits.
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Citations
20 Claims
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1. A method of stimulating a diaphragm to provide a diaphragm assist level, comprising:
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(a) obtaining an attribute of a breath cycle of a patient, wherein the patient receives respiratory assistance from a ventilator during the breath cycle; (b) based on a stimulation parameter, the attribute of the breath cycle, and a desired value of a breath parameter, transmitting a first stimulation signal to a first electrode positioned within a blood vessel of the patient such that the electrode recruits a phrenic nerve of the patient; (c) after transmitting the first stimulation signal, determining an actual value of the breath parameter from a breath; (d) comparing the actual value of the breath parameter to the desired value of the breath parameter; and (e) either (1) maintaining the stimulation parameter if the actual value of the breath parameter is within a selected range of the desired value of the breath parameter;
or (2) modifying the stimulation parameter if the actual value of the breath parameter is not within the selected range of the desired value of the breath parameter; and(f) repeating steps (b)-(e), wherein the method further includes transmitting a second stimulation signal to a second electrode to recruit the phrenic nerve, and wherein transmitting the first stimulation signal to the first electrode occurs at a different time as transmitting the second stimulation signal to the second electrode. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11)
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12. A method of stimulating a diaphragm of a patient to provide a diaphragm assist level, comprising:
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obtaining an attribute of a breath cycle of a patient receiving respiratory assistance from a ventilator; and during a breath cycle that includes respiratory assistance from the ventilator, transmitting a stimulation signal to at least one electrode positioned within a blood vessel of the patient such that the electrode recruits a phrenic nerve of the patient, wherein the stimulation signal is based on a stimulation parameter, the attribute of the breath cycle, and a desired value of a breath parameter, wherein the breath parameter is at least one of a tidal volume or a pressure; and wherein at least one of the stimulation signal and the respiratory assistance is adjusted between breath cycles of a same diaphragm stimulation treatment. - View Dependent Claims (13, 14, 15, 16, 17, 18, 19)
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20. A method of stimulating a diaphragm to provide a diaphragm assist level, comprising:
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(a) obtaining an attribute of a breath cycle of a patient, wherein the patient receives respiratory assistance from a ventilator during the breath cycle; (b) based on a stimulation parameter, the attribute of the breath cycle, and a desired value of a breath parameter, transmitting a stimulation signal to an electrode positioned within a blood vessel of the patient such that the electrode recruits a phrenic nerve of the patient, wherein the breath parameter is at least one of a tidal volume or a pressure; (c) after transmitting the stimulation signal, determining an actual value of the breath parameter from a breath; (d) comparing the actual value of the breath parameter to the desired value of the breath parameter; and (e) either (1) maintaining the stimulation parameter if the actual value of the breath parameter is within a selected range of the desired value of the breath parameter;
or (2) modifying the stimulation parameter if the actual value of the breath parameter is not within the selected range of the desired value of the breath parameter; and(f) repeating steps (b)-(e), wherein the blood vessel is at least one of a left jugular vein or a left subclavian vein, the phrenic nerve is a left phrenic nerve, and the method further includes transmitting a stimulation signal to a second electrode positioned within at least one of the left jugular vein or the left subclavian vein such that the second electrode recruits the left phrenic nerve, and transmitting stimulation signals to a third electrode and a fourth electrode positioned in the superior vena cava such that the third and fourth electrodes recruit a right phrenic nerve of the patient; and wherein transmitting the stimulation signal to the first electrode occurs at a different time as transmitting the stimulation signal to the second electrode, and transmitting the stimulation signal to the third electrode occurs at a different time as transmitting the stimulation signal to the fourth electrode.
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Specification