Methods and apparatus for detecting and treating respiratory insufficiency

• US 9,827,388 B2
• Filed: 03/31/2010
• Issued: 11/28/2017
• Est. Priority Date: 04/29/2009
• Status: Active Grant

• Current Assignee: ResMed Pty Ltd. (ResMed Incorporated)
• Original Assignee: Resmed Limited (ResMed Incorporated)
• Inventors: Schindhelm, Klaus Henry, Bassin, David John, Richards, Glenn
• Primary Examiner(s): Vasat, Peter S
• Application Number:
  US12/751,174
• Publication Number:
  US 20100275921A1
• Time in Patent Office: 2,799 Days
• Field of Search: 12820423, 12820421, 12820323, 12820324, 12820419, 12820418, 12820024, 34053912, 3405731, 600533
• CPC Class Codes: A61B 5/08 Detecting, measuring or recording devices for evaluating the respiratory organs A61B5/0205 takes precedence
• CPC Class Codes: A61B 5/7264 Classification of physiological signals or data, e.g. using neural networks, statistical classifiers, expert systems or fuzzy systems neural networks per se G06N3/00; expert systems per se G06N5/00
• CPC Class Codes: A61B 5/7275 Determining trends in physiological measurement data; Predicting development of a medical condition based on physiological measurements, e.g. determining a risk factor
• CPC Class Codes: A61M 16/0006 with means for creating vibrations in patients' airways
• CPC Class Codes: A61M 16/0051 with alarm devices
• CPC Class Codes: A61M 16/0069 the speed thereof being controlled by respiratory parameters, e.g. by inhalation
• 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 2016/0027 pressure meter
• CPC Class Codes: A61M 2016/0036 in the breathing tube and used in both inspiratory and expiratory phase
• CPC Class Codes: A61M 2205/3375 Acoustical, e.g. ultrasonic, measuring means
• CPC Class Codes: A61M 2205/3569 sublocal, e.g. between console and disposable
• CPC Class Codes: A61M 2205/3592 using telemetric means, e.g. radio or optical transmission
• CPC Class Codes: A61M 2205/502 User interfaces, e.g. screens or keyboards
• CPC Class Codes: A61M 2230/04 Heartbeat characteristics, e.g. ECG, blood pressure modulation
• CPC Class Codes: A61M 2230/205 partial oxygen pressure (P-O2)
• CPC Class Codes: A61M 2230/42 Rate
• CPC Class Codes: A61M 2230/46 Resistance or compliance of the lungs
• CPC Class Codes: G16H 20/40 relating to mechanical, radiation or invasive therapies, e.g. surgery, laser therapy, dialysis or acupuncture
• CPC Class Codes: G16H 40/67 for remote operation
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems
• CPC Class Codes: G16H 50/30 : for calculating health indices; for individual health risk assessment

Abstract

Devices and systems provide methods of detecting a severity change in respiratory insufficiency (RI) or chronic obstructive pulmonary disease (COPD) condition of a patient. In an example embodiment, a detection monitoring device determines one or more severity change indicators based on a measure of supplied pressure or other representative measure determined by the device. The supplied pressure may optionally be determined during pressure treatment that satisfies a target ventilation. The supplied pressure or representative data may be compared to one or more thresholds that are selected to represent a change in the condition of the RI or COPD patient such as an exacerbation of a prior condition. Results of the comparisons may trigger one or more warnings or messages to notify a patient or physician of a pending change to the patient'"'"'s RI or COPD condition so that the patient may more immediately seek medical attention to treat the condition.

Claims

1. A device for monitoring a patient to evaluate a respiratory insufficiency condition of the patient comprising:

a transducer to generate a signal representative of a pressure delivered by a flow generator; and

a processor, coupled with the transducer, the processor configured to control an evaluation of a severity change indicator based on detecting, using a measure of determined pressure from the signal, a change in the measure of determined pressure from a plurality of treatment sessions, the evaluation comprising a detection of a continuous rise in the measure of determined pressure successively through the plurality of treatment sessions, the indicator representing information about a change in severity of a respiratory insufficiency condition of the patient,

wherein the respiratory insufficiency condition is attributable to an insufficiency condition of the patient'"'"'s lungs.

2. The device of claim 1 further comprising the flow generator configured to generate a flow of breathable gas at a pressure above atmospheric pressure to a patient interface, wherein the processor is configured to control the flow generator.

3. The device of claim 2 wherein the flow generator is configured to generate the flow of breathable gas at a pressure above atmospheric pressure to maintain a target ventilation, and wherein the measure of determined pressure comprises a measure of pressure generated by the flow generator in order to maintain the target ventilation.

4. The device of claim 3 wherein the target ventilation is a minute ventilation and the measure of determined pressure is an average pressure.

5. The device of claim 3 wherein the target ventilation is an estimate of alveolar ventilation.

6. The device of claim 3 wherein the evaluation of the severity change indicator comprises a threshold comparison of the continuous rise in the measure of determined pressure successively through the treatment sessions.

7. The device of claim 6 wherein the threshold comparison involves the measure of determined pressure from one of the plurality of treatment sessions and a prior measure of determined pressure used to maintain the target ventilation during a prior treatment session of the plurality of treatment sessions.

8. The device of claim 6 wherein the threshold comparison represents an indication of a repeated rise in the measure of determined pressure over a period of days.

9. The device of claim 6 wherein the threshold comparison involves a difference between the measure of determined pressure from one of the plurality of treatment sessions and a prior measure of determined pressure used to maintain the target ventilation during a prior treatment session of the plurality of treatment sessions.

10. The device of claim 6 wherein the threshold comparison includes a ratio of the measure of determined pressure from one of the plurality of treatment sessions and a prior measure of determined pressure used to maintain the target ventilation during a prior treatment session of the plurality of treatment sessions.

11. The device of claim 6 wherein the evaluation of the severity change indicator further comprises a further threshold comparison involving a determined respiratory rate and a prior respiratory rate.

12. The device of claim 11 wherein the further threshold comparison represents an indication of a repeated rise in the determined respiratory rate over a period of days.

13. The device of claim 6 wherein the processor is configured to activate a warning based on the severity change indicator.

14. The device of claim 13 wherein the warning comprises an activated light.

15. The device of claim 13 wherein the warning comprises a message.

16. The device of claim 1 wherein the processor is configured to control transmitting of an electronic message including data representing a result of the evaluation of the severity change indicator.

17. The device of claim 3 further comprising a transmitter coupled with the processor, wherein the processor is further configured to control transmitting of a message including data representing the severity change indicator.

32. The device of claim 1,

wherein, in the evaluation, a level of the change between first and second measures of determined pressure from successive treatment sessions of the plurality of treatment sessions is compared with at least one threshold related to a continuous rise successively in the measure of determined pressure.

18. A system for monitoring a patient to evaluate a respiratory insufficiency condition of the patient comprising:

a pressure means to generate a signal representative of the pressure delivered by a flow generator; and

processing means for controlling an evaluation of a severity change indicator based on detecting, using a measure of determined pressure from the signal, a change in the measure of determined pressure from a plurality of treatment sessions, the evaluation comprising a detection of a continuous rise in the measure of determined pressure successively through the plurality of treatment sessions, the indicator representing information about a change in severity of a respiratory insufficiency condition of the patient,

wherein the respiratory insufficiency condition is attributable to an insufficiency condition of the patient'"'"'s lungs.

19. The system of claim 18 further comprising means for transmitting a message representing the indicator.

20. The system of claim 18 further comprising means for warning a user of the system based on the indicator.

21. The system of claim 18 further comprising the flow generator configured to generate a flow of breathable gas at a pressure above atmospheric pressure to a patient interface to satisfy a target ventilation.

22. The system of claim 21 wherein the target ventilation is an estimate of alveolar ventilation.

23. A device for monitoring a patient to evaluate a respiratory insufficiency condition of a patient comprising:

a sensor to generate a signal associated with a pressure therapy treatment of the respiratory system of a patient; and

a processor configured to control an evaluation of a severity change indicator based on detecting, using a measure of determined pressure from the signal, a change in the measure of determined pressure from the signal of the sensor from a plurality of treatment sessions, the evaluation comprising a detection of a continuous rise in the measure of determined pressure successively through the plurality of treatment sessions, the severity change indicator representing information about a change in severity of a respiratory insufficiency condition of the patient,

wherein the respiratory insufficiency condition is attributable to an insufficiency condition of the patient'"'"'s lungs.

24. The device of claim 23 wherein the measure of determined pressure represents a degree of respiratory assistance therapy determined from the signal of the sensor.

25. The device of claim 24 wherein the control of the evaluation of the severity change indicator includes assessing detected data associated with inspiratory flow limitation to rule out upper airway obstruction.

26. The device of claim 23 wherein the control of the evaluation of the severity change indicator includes assessing a measure representing a respiratory rate.

27. The device of claim 23 wherein the control of the evaluation of the severity change indicator includes assessing a measure representing a respiratory duty cycle determined from the signal of the sensor.

28. The device of claim 23 wherein the control of the evaluation of the severity change indicator includes assessing a measure representing an intrinsic positive end expiratory pressure.

29. The device of claim 23 wherein the control of the evaluation of the severity change indicator includes assessing a measure representing an expiratory flow limitation.

30. The device of claim 23 wherein the measure of determined pressure represents a magnitude of a measured flow in a later portion of expiration that is determined from the signal of the sensor and wherein the control of the evaluation further assesses a change in respiratory rate or ventilation.

31. The device of claim 23 wherein the evaluation of the processor comprises determining a change of one or more earlier measures of the signal compared to one or more subsequent measures of the signal.