Methods of measuring cardiac output using a non-invasively estimated intrapulmonary shunt fraction

• US 6,241,681 B1
• Filed: 12/16/1999
• Issued: 06/05/2001
• Est. Priority Date: 09/09/1998
• Status: Expired due to Term

• Current Assignee: RIC INVESTMENTS LLC (Respironics Incorporated)
• Original Assignee: NTC Technology, Inc. (Dixtal Medical, Inc.)
• Inventors: Orr, Joseph A., Kück, Kai, Jaffe, Michael B., Haryadi, Dinesh G.
• Primary Examiner(s): O'Connor, Cary
• Assistant Examiner(s): Natnithithadha, Navin
• Application Number:
  US09/464,589
• Time in Patent Office: 537 Days
• Field of Search: 600/481, 600/483, 600/484, 600/504, 600/526, 600/508, 600/538
• US Class Current: 600/504
• 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 5/083 Measuring rate of metabolism by using breath test, e.g. measuring rate of oxygen consumption
• CPC Class Codes: A61B 5/0836 Measuring rate of CO2 production
• CPC Class Codes: A61B 5/14551 for measuring blood gases

Abstract

A method of non-invasively estimating the intrapulmonary shunt in a patient. The method includes non-invasively measuring respiratory flow, respiratory carbon dioxide content, and arterial blood oxygen content. A re-breathing process is employed to facilitate an estimate of the patient'"'"'s pulmonary capillary blood flow. Any inaccuracies of the arterial blood oxygen content are corrected to provide a substantially accurate arterial blood oxygen content measurement. The respiratory flow, carbon dioxide content and arterial blood oxygen content measurements, and the pulmonary capillary blood flow estimate are employed to estimate an intrapulmonary shunt of the patient. The invention also includes a method of determining the total cardiac output of the patient which considers the estimated intrapulmonary shunt.

Claims

1. A method of estimating an intrapulmonary shunt of a patient, comprising:

determining a respiratory flow and a respiratory carbon dioxide fraction of respiration of the patient;

calculating a carbon dioxide elimination of the patient;

calculating an end capillary blood oxygen content of the patient;

determining an arterial blood oxygen saturation of the patient; and

calculating an intrapulmonary shunt fraction with said end capillary blood oxygen content, said arterial blood oxygen saturation, and said carbon dioxide elimination.

2. The method of claim 1, wherein said calculating said intrapulmonary shunt fraction also includes employing a respiratory quotient of the patient.

3. The method of claim 2, further comprising measuring said respiratory quotient.

4. The method of claim 2, further comprising estimating said respiratory quotient.

5. The method of claim 2, further comprising assuming said respiratory quotient.

6. The method of claim 1, wherein said determining said arterial blood oxygen saturation is effected by a technique comprising pulse oximetry.

7. The method of claim 1, further comprising correcting for an inaccuracy of said arterial blood oxygen saturation.

8. The method of claim 7, wherein said correcting for said inaccuracy comprises modifying said arterial blood oxygen saturation by a correction summand.

9. The method of claim 8, wherein said correction summand comprises an assumed value.

10. The method of claim 9, wherein said assumed value comprises about 2% to 3% of said arterial blood oxygen saturation.

11. The method of claim 8, further comprising determining said correction summand.

12. The method of claim 11, wherein said determining said correction summand comprises directly obtaining another arterial blood oxygen saturation measurement and comparing said another arterial blood oxygen saturation measurement to said arterial blood oxygen saturation.

13. The method of claim 7, wherein said correcting for said inaccuracy comprises generating an equation for converting said arterial blood oxygen saturation to a substantially accurate value.

14. The method of claim 13, further comprising directly obtaining another arterial blood oxygen saturation measurement and comparing said another arterial blood oxygen saturation measurement to said arterial blood oxygen saturation.

15. The method of claim 1, further comprising employing said arterial blood oxygen saturation to determine an arterial blood oxygen content of the patient.

16. The method of claim 1, further comprising determining an alveolar partial pressure of oxygen of the patient.

17. The method of claim 7, wherein said correcting for said inaccuracy comprises modifying alveolar partial pressure of oxygen.

18. The method of claim 1, wherein said calculating said end capillary blood oxygen content comprises determining an end tidal partial pressure of oxygen.

19. The method of claim 1, wherein said calculating said end capillary blood oxygen content comprises determining an end tidal partial pressure of carbon dioxide.

20. The method of claim 1, further comprising estimating a pulmonary capillary blood flow of the patient.

21. The method of claim 20, wherein said estimating said pulmonary capillary blood flow comprises re-breathing.

22. The method of claim 21, wherein said re-breathing comprises partial or total re-breathing.

23. The method of claim 20, wherein said estimating said pulmonary capillary blood flow comprises adjusting a respiratory rate.

24. The method of claim 20, wherein said estimating said pulmonary capillary blood flow comprises adjusting a period of inspiration or expiration.

25. The method of claim 20, wherein said estimating said pulmonary capillary blood flow comprises adjusting a tidal volume.

26. The method of claim 20, wherein said estimating said pulmonary capillary blood flow comprises adding a volume of carbon dioxide to ventilation of the patient.

27. The method of claim 20, wherein said pulmonary capillary blood flow is employed to determine an intrapulmonary shunt flow of the patient.

28. The method of claim 20, wherein said pulmonary capillary blood flow is employed to determine a cardiac output of the patient.

29. A method of determining an intrapulmonary shunt fraction of a patient, comprising:

non-invasively determining an oxygen saturation of arterial blood of the patient;

determining a fraction of inspired oxygen of the patient;

determining a pulmonary capillary blood flow of the patient; and

employing said oxygen saturation of arterial blood and said fraction of inspired oxygen to determine the intrapulmonary shunt fraction.

30. The method of claim 29, wherein said determining said pulmonary capillary blood flow comprises re-breathing.

31. The method of claim 29, wherein said employing comprises employing said oxygen saturation of arterial blood and said fraction of inspired oxygen with at least one of an iso-shunt equation and an iso-shunt plot.