Ventilator-initiated prompt regarding auto-PEEP detection during volume ventilation of triggering patient exhibiting obstructive component

• US 8,607,788 B2
• Filed: 06/30/2010
• Issued: 12/17/2013
• Est. Priority Date: 06/30/2010
• Status: Active Grant

• Current Assignee: Covidien LP (Medtronic Plc)
• Original Assignee: Covidien LP (Medtronic Plc)
• Inventors: Milne, Gary, Hensley, Kirk, Doyle, Peter R., Kimm, Gardner
• Primary Examiner(s): Yu, Justine
• Assistant Examiner(s): SKORUPA, VALERIE LYNN
• Application Number:
  US12/826,828
• Publication Number:
  US 20120000467A1
• Time in Patent Office: 1,266 Days
• Field of Search: 128/200.24, 128/202.22, 12820418-20526, 715/700
• US Class Current: 128/204.21
• CPC Class Codes: A61M 16/0051 with alarm devices
• CPC Class Codes: A61M 16/0063 Compressors
• 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 16/0833 T- or Y-type connectors, e.g. Y-piece
• CPC Class Codes: A61M 2016/0021 with a proportional output signal, e.g. from a thermistor
• 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 2205/502 User interfaces, e.g. screens or keyboards
• CPC Class Codes: A61M 2205/584 having a color code
• CPC Class Codes: A61M 2210/1014 Diaphragm
• CPC Class Codes: A61M 2230/20 Blood composition characteristics
• CPC Class Codes: A61M 2230/43 Composition of exhalation

Abstract

This disclosure describes systems and methods for monitoring and evaluating ventilatory parameters, analyzing those parameters and providing useful notifications and recommendations to clinicians. That is, modern ventilators monitor, evaluate, and graphically represent multiple ventilatory parameters. However, many clinicians may not easily recognize data patterns and correlations indicative of certain patient conditions, changes in patient condition, and/or effectiveness of ventilatory treatment. Further, clinicians may not readily determine appropriate ventilatory adjustments that may address certain patient conditions and/or the effectiveness of ventilatory treatment. Specifically, clinicians may not readily detect or recognize the presence of Auto-PEEP during volume ventilation of a triggering patient exhibiting an obstructive component. According to embodiments, a ventilator may be configured to monitor and evaluate diverse ventilatory parameters to detect Auto-PEEP and may issue notifications and recommendations suitable for a triggering patient to the clinician when Auto-PEEP is implicated. The suitable notifications and recommendations may further be provided in a hierarchical format.

Claims

1. A ventilatory system for issuing a smart prompt when Auto-PEEP is implicated during volume ventilation of a triggering patient exhibiting an obstructive component, comprising:

at least one processor; and

at least one memory, communicatively coupled to the at least one processor and containing instructions that, when executed by the at least one processor, issue a smart prompt when Auto-PEEP is implicated, the ventilatory system comprising;

an Auto-PEEP module for detecting that Auto-PEEP is implicated for the triggering patient exhibiting the obstructive component upon detecting that parameter data breaches one or more predetermined thresholds;

a smart prompt module for;

determining a list of entries for mitigating Auto-PEEP, wherein the list of entries is determined based at least in part on determining that the triggering patient exhibits an obstructive component;

issuing a smart prompt when Auto-PEEP is implicated, the smart prompt displaying;

a notification that Auto-PEEP is implicated; and

the list of entries for mitigating Auto-PEEP, the list of entries including one or more primary entries comprising one or more of;

 

increase flow;

 

adjust ventilatory settings until end-expiratory flow (EEF) approximates zero;

investigate reasons for an elevated patient respiratory drive;

increase set PEEP; and

 

investigate reasons for increased obstruction.

2. The ventilatory system of claim 1, further comprising:

the smart prompt module for determining the notification, wherein the notification is based at least in part on the parameter data that implicated Auto-PEEP.

3. The ventilatory system of claim 2, wherein the notification comprises information regarding the parameter data that implicated Auto-PEEP.

4. The ventilatory system of claim 1, wherein the list of entries further includes one or more secondary entries.

5. The ventilatory system of claim 4, wherein the secondary entries include increasing expiratory time (T_E) by one or more of:

decreasing tidal volume (V_T); and

changing to a square flow waveform.

6. The ventilatory system of claim 1, further comprising:

the smart prompt module for identifying one or more ventilatory settings associated with the ventilatory treatment of the triggering patient;

wherein determining the list of entries for mitigating Auto-PEEP is further based at least in part on evaluating the one or more ventilatory settings.

7. A graphical user interface of a ventilator for displaying one or more smart prompts corresponding to a detected condition, the ventilator configured with a computer having a user interface including the graphical user interface for accepting commands and for displaying information, the graphical user interface comprising:

at least one window; and

one or more elements within the at least one window comprising at least one smart prompt element for communicating information regarding the detected condition, wherein the detected condition is Auto-PEEP, and wherein the at least one smart prompt element further comprises;

a notification that Auto-PEEP is implicated; and

a list of entries for mitigating Auto-PEEP, the list of entries determined based at least in part on determining that a triggering patient exhibits an obstructive component, the list of entries comprising one or more of;

increase flow;

adjust ventilatory settings until end-expiratory flow (EEF) approximates zero;

investigate reasons for an elevated patient respiratory drive;

increase set PEEP; and

investigate reasons for increased obstruction.

8. The graphical user interface of claim 7, wherein list of entries for mitigating Auto-PEEP further comprises one or more of:

decrease tidal volume (V_T); and

switch to a square flow waveform.

9. The graphical user interface of claim 7, wherein the ventilator determines that a triggering patient connected to the ventilator exhibits obstructive component by:

determining a predicted expiratory time (T_E);

determining an actual T_E for the triggering patient; and

determining that the actual T_E is greater than the predicted T_E.

10. The graphical user interface of claim 7, wherein the ventilator determines that a triggering patient connected to the ventilator exhibits obstructive component by:

determining a normal pulmonary time constant;

calculating a pulmonary time constant for the triggering patient; and

determining that the calculated pulmonary time constant is greater than the normal pulmonary time constant.

11. The graphical user interface of claim 7, wherein the ventilator detects that Auto-PEEP is implicated for a triggering patient by:

receiving one or more predetermined thresholds associated with end-expiratory flow (EEF);

detecting that EEF is positive when the EEF breaches the one or more predetermined thresholds; and

determining that Auto-PEEP is implicated for the triggering patient when EEF is positive for a predetermined number of breaths.

12. The graphical user interface of claim 7, wherein the ventilator detects that Auto-PEEP is implicated for a triggering patient by:

calculating a time required to reach functional residual capacity (FRC);

comparing the time required to reach FRC with an expiratory time (T_E);

determining that Auto-PEEP is implicated for the triggering patient when the time required to reach FRC is greater than T_E.

13. The graphical user interface of claim 7, wherein the ventilator detects that Auto-PEEP is implicated for a triggering patient by:

receiving a positive end-expiratory pressure (PEEP) setting, wherein the PEEP setting is about 0 cmH₂O or greater;

receiving one or more predetermined thresholds associated with end-expiratory pressure (EEP);

detecting that the EEP breaches the one or more predetermined thresholds when the EEP minus the PEEP setting is greater than the one or more predetermined thresholds; and

determining that Auto-PEEP is implicated for the triggering patient when the EEP breaches the one or more predetermined thresholds.

14. The graphical user interface of claim 7, wherein the ventilator detects that Auto-PEEP is implicated for a triggering patient by:

receiving one or more predetermined thresholds associated with respiratory resistance data;

detecting that respiratory resistance has increased when the respiratory resistance data breaches the one or more predetermined thresholds; and

determining that Auto-PEEP is implicated for the triggering patient when the respiratory resistance has increased.

15. The graphical user interface of claim 7, wherein the ventilator detects that Auto-PEEP is implicated for a triggering patient by:

comparing a pulmonary time constant to an expiratory time (T_E); and

determining that Auto-PEEP is implicated for the triggering patient when the T_E is less than three pulmonary time constants.

16. The graphical user interface of claim 7, wherein the ventilator detects that Auto-PEEP is implicated for a triggering patient by:

evaluating an expiratory flow curve;

detecting that inspiration was triggered prior to complete exhalation; and

determining that Auto-PEEP is implicated for the triggering patient when inspiration was triggered prior to complete exhalation for a predetermined number of breaths.