AUTOMATIC PRESSURE TITRATION

• US 20110297156A1
• Filed: 01/22/2010
• Published: 12/08/2011
• Est. Priority Date: 02/25/2009
• Status: Active Grant

• Current Assignee: Koninklijke Philips N.V.
• Original Assignee: Koninklijke Philips Electronics N.V. (Koninklijke Philips N.V.)
• Inventors: Shelly, Benjamin Irwin, Kane, Michael T., Matthews, Gregory Delano, Ressler, Heather Dawn
• Granted Patent: US 9,056,172 B2
• Time in Patent Office: Days
• US Class Current: 128/204.23
• CPC Class Codes: A61M 16/0003 Accessories therefor, e.g. sensors, vibrators, negative pressure
• CPC Class Codes: A61M 16/0006 with means for creating vibrations in patients' airways
• CPC Class Codes: A61M 16/0069 the speed thereof being controlled by respiratory parameters, e.g. by inhalation
• CPC Class Codes: A61M 16/024 including calculation means, e.g. using a processor
• CPC Class Codes: A61M 16/06 Respiratory or anaesthetic masks
• CPC Class Codes: A61M 2016/0027 pressure meter
• CPC Class Codes: A61M 2016/003 with a flowmeter
• CPC Class Codes: A61M 2205/3334 Measuring or controlling the flow rate
• CPC Class Codes: A61M 2205/50 with microprocessors or computers
• CPC Class Codes: A61M 2205/52 with memories providing a history of measured variating parameters of apparatus or patient

Abstract

A pressure support methodology and system that utilizes at least two, and possibly all three, of information relating to (i) airway patency, i.e., the degree to which the patient'"'"'s airway is open, (ii) the primary cause of the current sleep disordered breathing event, and (iii) the patient'"'"'s response to previous pressure changes to automatically titrate pressure when presented with a sleep disordered breathing event. In another embodiment, pressure may be automatically titrated based solely on the primary cause of the sleep disordered breathing event.

Claims

1. A method of providing pressure support to a patient, comprising:

detecting an occurrence of a sleep disordered breathing event in the patient; and

in response to the detecting, titrating a pressure of a flow of gas provided to the patient based on at least two of;

(i) a determined patency of an airway of the patient, (ii) a determined cause of the sleep disordered breathing event, and (iii) a determined responsiveness of the patient to previous pressure changes in the flow of gas provided to the patient.

2. The method according to claim 1, wherein the titrating comprises titrating the pressure of the flow of gas provided to the patient based on (i) the determined patency of the airway of the patient, (ii) the determined cause of the sleep disordered breathing event, and (iii) the determined responsiveness of the patient to previous pressure changes in the flow of gas provided to the patient.

3. The method according to claim 2, wherein the titrating comprises (i) performing no titration of the pressure if the airway is determined to be open, (ii) increasing the pressure if the airway is determined to be closed and if the sleep disordered breathing event is determined to not be centrally-mediated, (iii) performing one of (a) decreasing the pressure or (b) not changing the pressure if the airway is determined to be closed, if the sleep disordered breathing event is determined to be centrally-mediated, and if the determined responsiveness is non-responsive to the previous pressure changes in the flow of gas provided to the patient, and (iv) increasing the pressure if the airway is determined to be closed, if the sleep disordered breathing event is determined to be centrally-mediated, and if the determined responsiveness is responsive to the previous pressure changes in the flow of gas provided to the patient.

4. The method according to claim 1, wherein the titrating comprises titrating the pressure of the flow of gas provided to the patient based only on the determined patency of the airway of the patient and the determined responsiveness of the patient to previous pressure changes in the flow of gas provided to the patient.

5. The method according to claim 4, wherein the titrating comprises (i) performing no titration of the pressure if the airway is determined to be open, (ii) performing one of (a) decreasing the pressure or (b) not changing the pressure if the airway is determined to be closed and if the determined responsiveness is non-responsive to the previous pressure changes in the flow of gas provided to the patient, and (iii) increasing the pressure if the airway is determined to be closed and if the determined responsiveness is responsive to the previous pressure changes in the flow of gas provided to the patient.

6. The method according to claim 1, wherein the titrating comprises titrating the pressure of the flow of gas provided to the patient based only on the determined patency of the airway of the patient and the determined cause of the sleep disordered breathing event.

7. The method according to claim 6, wherein the titrating comprises (i) performing no titration of the pressure if the airway is determined to be open, (ii) increasing the pressure if the airway is determined to be closed and if the sleep disordered breathing event is determined to not be centrally-mediated, and (iii) increasing the pressure to no more than a predetermined threshold if the airway is determined to be closed and if the sleep disordered breathing event is determined to be centrally-mediated.

8. The method according to claim 1, wherein the titrating comprises titrating the pressure of the flow of gas provided to the patient based only on the determined cause of the sleep disordered breathing event and the determined responsiveness of the patient to previous pressure changes in the flow of gas provided to the patient.

9. The method according to claim 8, wherein the titrating comprises (i) increasing the pressure if the sleep disordered breathing event is determined to not be centrally-mediated, (ii) performing one of (a) decreasing the pressure or (b) not changing the pressure if the sleep disordered breathing event is determined to be centrally-mediated and if the determined responsiveness is non-responsive to the previous pressure changes in the flow of gas provided to the patient, and (iii) increasing the pressure if the sleep disordered breathing event is determined to be centrally-mediated and if the determined responsiveness is responsive to the previous pressure changes in the flow of gas provided to the patient.

10. The method according to claim 1, further comprising, in response to the detecting, determining the determined patency of the airway of the patient by providing a test pressure increase of predetermined amplitude to the patient, evaluating a degree of flow response to the test pressure increase and comparing a volume of the flow response to a predetermined volume threshold, wherein if the volume is greater than the predetermined volume threshold the airway is determined to be open and if the volume is less than or equal to the predetermined volume threshold the airway is determined to be closed.

11. The method according to claim 1, further comprising, in response to the detecting, determining the determined patency of the airway of the patient by providing a pressure increase having an independently-controlled magnitude to the patient, measuring a flow response to the pressure increase, and determining whether the airway is open or closed based on the flow response to the pressure increase.

12. The method according to claim 11, wherein the determining whether the airway is open or closed based on the flow response to the pressure increase comprises computing a volume of the flow response, and comparing the volume to a predetermined volume threshold that is determined by a magnitude of the pressure increase, wherein if the volume is greater than the predetermined volume threshold the airway is determined to be open and if the volume is less than or equal to the predetermined volume threshold the airway is determined to be closed.

13. A pressure support system, comprising:

a pressure generating system adapted to produce a flow of gas;

a patient circuit operatively coupled to the pressure generating system to deliver the flow of gas to an airway of a patient; and

a controller operatively coupled to the pressure generating system, the controller being adapted to control a pressure of the flow of gas by;

detecting an occurrence of a sleep disordered breathing event in the patient; and

in response to the detecting, titrating the pressure of the flow of gas provided to the patient based on at least two of;

(i) a determined patency of an airway of the patient, (ii) a determined cause of the sleep disordered breathing event, and (iii) a determined responsiveness of the patient to previous pressure changes in the flow of gas provided to the patient.

14. The pressure support system according to claim 13, wherein the titrating comprises titrating the pressure of the flow of gas provided to the patient based on (i) the determined patency of the airway of the patient, (ii) the determined cause of the sleep disordered breathing event, and (iii) the determined responsiveness of the patient to previous pressure changes in the flow of gas provided to the patient.

15. The pressure support system according to claim 14, wherein the titrating comprises (i) performing no titration of the pressure if the airway is determined to be open, (ii) increasing the pressure if the airway is determined to be closed and if the sleep disordered breathing event is determined to not be centrally-mediated, (iii) performing one of (a) decreasing the pressure or (b) not changing the pressure if the airway is determined to be closed, if the sleep disordered breathing event is determined to be centrally-mediated, and if the determined responsiveness is non-responsive to the previous pressure changes in the flow of gas provided to the patient, and (iv) increasing the pressure if the airway is determined to be closed, if the sleep disordered breathing event is determined to be centrally-mediated, and if the determined responsiveness is responsive to the previous pressure changes in the flow of gas provided to the patient.

16. The pressure support system according to claim 13, wherein the titrating comprises titrating the pressure of the flow of gas provided to the patient based only on the determined patency of the airway of the patient and the determined responsiveness of the patient to previous pressure changes in the flow of gas provided to the patient.

17. The pressure support system according to claim 16, wherein the titrating comprises (i) performing no titration of the pressure if the airway is determined to be open, (ii) performing one of (a) decreasing the pressure or (b) not changing the pressure if the airway is determined to be closed and if the determined responsiveness is non-responsive to the previous pressure changes in the flow of gas provided to the patient, and (iii) increasing the pressure if the airway is determined to be closed and if the determined responsiveness is responsive to the previous pressure changes in the flow of gas provided to the patient.

18. The pressure support system according to claim 13, wherein the titrating comprises titrating the pressure of the flow of gas provided to the patient based only on the determined patency of the airway of the patient and the determined cause of the sleep disordered breathing event.

19. The pressure support system according to claim 18, wherein the titrating comprises (i) performing no titration of the pressure if the airway is determined to be open, (ii) increasing the pressure if the airway is determined to be closed and if the sleep disordered breathing event is determined to not be centrally-mediated, and (iii) increasing the pressure to no more than a predetermined threshold if the airway is determined to be closed and if the sleep disordered breathing event is determined to be centrally-mediated.

20. The pressure support system according to claim 13, wherein the titrating comprises titrating the pressure of the flow of gas provided to the patient based only on the determined cause of the sleep disordered breathing event and the determined responsiveness of the patient to previous pressure changes in the flow of gas provided to the patient.

21. The pressure support system according to claim 20, wherein the titrating comprises (i) increasing the pressure if the sleep disordered breathing event is determined to not be centrally-mediated, (ii) performing one of (a) decreasing the pressure or (b) not changing the pressure if the sleep disordered breathing event is determined to be centrally-mediated and if the determined responsiveness is non-responsive to the previous pressure changes in the flow of gas provided to the patient, and (iii) increasing the pressure if the sleep disordered breathing event is determined to be centrally-mediated and if the determined responsiveness is responsive to the previous pressure changes in the flow of gas provided to the patient.

22. A method of providing pressure support to a patient, comprising:

detecting an occurrence of a sleep disordered breathing event in the patient; and

in response to the detecting, titrating a pressure of a flow of gas provided to the patient based on a determined cause of the sleep disordered breathing event.

23. The method according to claim 22, further comprising determining whether the sleep disordered breathing event is centrally-mediated, wherein the titrating comprises titrating the pressure of the flow of gas in a first manner if the sleep disordered breathing event is determined to be centrally-mediated and titrating the pressure of the flow of gas in a second manner different than the first manner if the sleep disordered breathing event is determined to not be centrally-mediated.

24. The method according to claim 23, wherein the first manner includes not changing the pressure or not increasing the pressure above a predetermined threshold, and the second manner includes increasing the pressure.

25. The method according to claim 23, further comprising classifying the sleep disordered breathing event as being caused by one of sleep-onset central activity, Cheyne-Stokes Respiration, opioid-induced central activity, and primary obstructive apnea, wherein the titrating is based on the classification of the sleep disordered breathing event.

26. A pressure support system, comprising:

a pressure generating system adapted to produce a flow of gas;

a patient circuit operatively coupled to the pressure generating system to deliver the flow of gas to an airway of a patient; and

a controller operatively coupled to the pressure generating system, the controller being adapted to control a pressure of the flow of gas by;

detecting an occurrence of a sleep disordered breathing event in the patient; and

in response to the detecting, titrating the pressure of the flow of gas based on a determined cause of the sleep disordered breathing event.

27. The pressure support system according to claim 26, the controller being further adapted to determine whether the sleep disordered breathing event is centrally-mediated, wherein the titrating comprises titrating the pressure of the flow of gas in a first manner if the sleep disordered breathing event is determined to be centrally-mediated and titrating the pressure of the flow of gas in a second manner different than the first manner if the sleep disordered breathing event is determined to not be centrally-mediated.

28. The pressure support system according to claim 27, wherein the first manner includes not changing the pressure or not increasing the pressure above a predetermined threshold, and the second manner includes increasing the pressure.

29. The pressure support system according to claim 26, the controller being further adapted to classify the sleep disordered breathing event as being caused by one of sleep-onset central activity, Cheyne-Stokes Respiration, opioid-induced central activity, and primary obstructive apnea, wherein the titrating is based on the classification of the sleep disordered breathing event.