System and method for closed-loop patient-adaptive hemodynamic management

• US 10,512,722 B2
• Filed: 04/07/2015
• Issued: 12/24/2019
• Est. Priority Date: 01/12/2011
• Status: Active Grant

• Current Assignee: Regents of the University of California (University of California)
• Original Assignee: Regents of the University of California (University of California)
• Inventors: Rinehart, Joseph B., Cannesson, Maxime
• Primary Examiner(s): Vu, Quynh-Nhu H.
• Application Number:
  US14/680,706
• Publication Number:
  US 20150209514A1
• Time in Patent Office: 1,722 Days
• CPC Class Codes: A61B 5/021 Measuring pressure in heart or blood vessels A61B5/0205 takes precedence
• CPC Class Codes: A61B 5/0245 by using sensing means generating electric signals, i.e. ECG signals
• 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 5/0295 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 5/14542 for measuring blood gases A61B5/14551 takes precedence
• CPC Class Codes: A61B 5/4833 Assessment of subject's compliance to treatment
• CPC Class Codes: A61B 5/7203 for noise prevention, reduction or removal
• CPC Class Codes: A61M 2202/0208 Oxygen
• CPC Class Codes: A61M 2205/502 User interfaces, e.g. screens or keyboards
• CPC Class Codes: A61M 2205/52 with memories providing a history of measured variating parameters of apparatus or patient
• CPC Class Codes: A61M 2230/00 Measuring parameters of the user
• CPC Class Codes: A61M 2230/04 Heartbeat characteristics, e.g. ECG, blood pressure modulation
• CPC Class Codes: A61M 5/142 Pressure infusion, e.g. using pumps
• CPC Class Codes: A61M 5/16877 Adjusting flow; Devices for setting a flow rate
• CPC Class Codes: A61M 5/1723 using feedback of body parameters, e.g. blood-sugar, pressure measurement of body parameters A61B5/00
• CPC Class Codes: G16H 20/17 delivered via infusion or injection

Abstract

A system and method for patient-adaptive hemodynamic management is described. One embodiment includes a system for hemodynamic management including transfusion, volume resuscitation with intravenous fluids, and medications, utilizing monitored hemodynamic parameters including the described dynamic predictors of fluid responsiveness, and including an intelligent algorithm capable of adaptation of the function of the device to specific patients.

Claims

1. An intelligent pump apparatus for delivering fluid to a patient, the apparatus comprising:

one or more bags of intravenous fluid free of vasoactive medication, the intravenous fluid constituting a fluid bolus a fluid pump device configured to control a rate of flow of intravenous fluid from said bag of intravenous fluid;

a physical housing;

computer memory and a circuit for storing bolus log information resulting from response to intravascular volume expansion caused by said bolus as an input signal in said memory;

a monitor device;

a controller disposed within the physical housing and communicatively coupled to the infusion pump device via an electrical communication interface, the controller having the circuit to;

receive, from the monitor device, the input signal indicating a physiologic parameter of a patient;

determine, based at least in part on the physiologic parameter, a predicted change in cardiac output of the patient in response to said intravascular volume expansion; and

the circuit to provide a pump control signal to the infusion pump device over the electrical communication interface based at least in part on the predicted change to cause the infusion pump device to provide an additional intravenous fluid bolus from another bag thereof, free of vasoactive medication, to the patient in order to effect intravascular volume expansion as a result of providing said intravenous fluid bolus to the patient.

2. The intelligent pump apparatus of claim 1 wherein the controller is further configured to determine the predicted change based at least in part upon information relating to an expected change in the physiologic parameter in a patient population resulting from response to infusion of a fluid bolus in patients included in the patient population.

3. The intelligent pump apparatus of claim 2 wherein the controller is further configured to receive information relating to a medical condition of the patient and determine the patient population based at least in part upon the medical condition.

4. The intelligent pump apparatus of claim 3 wherein the medical condition is included within state information associated with the patient, the controller being further configured to determine the patient population by selecting the patient population from among a plurality of patient populations based at least in part upon the state information.

5. The intelligent pump apparatus of claim 2 wherein the controller is further configured to determine the expected change in the physiologic parameter based at least in part upon a population reference table associated with the patient population.

6. The intelligent pump apparatus of claim 1 wherein the controller is further configured to determine the predicted change based at least in part upon results of prior administration of a different intravenous fluid bolus to the patient.

7. The intelligent pump apparatus of claim 1 further comprising a memory, the controller being configured to:

generate a bolus log entry associating the intravenous fluid bolus with an effect of the intravenous fluid bolus on the physiologic parameter of the patient; and

store the bolus log entry in the memory corresponding.

8. The intelligent pump apparatus of claim 1 further comprising a memory storing a bolus log, wherein the controller is further configured to:

determine an effect of the intravenous fluid bolus on a hemodynamic state of the patient;

generate a bolus log entry associated with the intravenous fluid bolus, the bolus log entry comprising information indicating the determined effect; and

storing the bolus log entry in the bolus log.

9. The intelligent pump apparatus of claim 8 wherein the controller is further configured to determine the predicted change based at least in part upon other log information obtained from the bolus log, wherein the other log information is associated with prior administration of fluid to the patient.

10. The intelligent pump apparatus of claim 1 wherein:

the controller is further configured to generate a bolus log containing log information relating to one or more effects on a hemodynamic state of the patient resulting from response to prior administration of intravenous fluid boluses to the patient; and

said determining the predicted change is based at least in part upon the log information.

11. The intelligent pump apparatus of claim 1 further including a user interface, wherein the controller is further configured to:

generate, on the user interface, an indication of an intervention command;

receive user input indicating an acceptance of the intervention command; and

generate the pump control signal at least partially in response to the user input.

12. The intelligent pump apparatus of claim 1 further comprising an interface port configured to receive pump status information indicative of a status of the infusion pump device, wherein the controller is further configured to determine whether the pump status information is consistent with an expected status associated with the pump control signal.

13. The intelligent pump apparatus of claim 1 further comprising a user interface, wherein the controller is further configured to cause the user interface to provide one or more recommendations for care of the patient based at least in part upon the predicted change in the physiologic parameter.

14. The intelligent pump apparatus of claim 1 further comprising a network interface configured to receive at least one population reference table comprising expected response information associated with expected responses of a patient population to fluid infusions, wherein the controller is further configured to determine the predicted change based at least in part upon the expected response information.

15. The intelligent pump apparatus of claim 14 wherein the controller is further configured to send, to a network server through the network interface, bolus log information relating to an effect of the administration of the intravenous fluid bolus on the physiologic parameter of the patient.