Methods and systems for triggering with unknown base flow

• US 8,844,526 B2
• Filed: 03/30/2012
• Issued: 09/30/2014
• Est. Priority Date: 03/30/2012
• Status: Active Grant

• Current Assignee: Covidien LP (Medtronic Plc)
• Original Assignee: Covidien LP (Medtronic Plc)
• Inventors: Jafari, Mehdi M., Jimenez, Rhomere S., Aviano, Jeffrey K.
• Primary Examiner(s): MATTER, KRISTEN CLARETTE
• Application Number:
  US13/435,968
• Publication Number:
  US 20130255685A1
• Time in Patent Office: 914 Days
• Field of Search: 128/204.18, 128 2021-20423, 128/204.26
• US Class Current: 128/204.23
• CPC Class Codes: A61M 16/0003 Accessories therefor, e.g. sensors, vibrators, negative pressure
• CPC Class Codes: A61M 16/0063 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 16/204 used for inhalation control
• CPC Class Codes: A61M 16/205 used for exhalation control
• CPC Class Codes: A61M 2016/0021 with a proportional output signal, e.g. from a thermistor
• CPC Class Codes: A61M 2016/0036 in the breathing tube and used in both inspiratory and expiratory phase
• CPC Class Codes: A61M 2016/0039 in the inspiratory circuit
• CPC Class Codes: A61M 2016/0042 in the expiratory circuit
• CPC Class Codes: A61M 2205/16 with back-up system in case of failure
• CPC Class Codes: A61M 2205/505 Touch-screens; Virtual keyboard or keypads; Virtual buttons; Soft keys; Mouse touches
• CPC Class Codes: A61M 2205/70 with testing or calibration facilities

Abstract

This disclosure describes systems and methods for providing novel back-up ventilation that allows the patient to trigger or initiate the delivery of breath. Further, this disclosure describes systems and methods for triggering ventilation when base flow is unknown or undeterminable by the ventilator.

Claims

1. A method for ventilating a patient with a ventilator, comprising:

delivering a fixed base flow that is undeterminable;

monitoring a windowed differential lung volume during exhalation;

determining that the windowed differential lung volume is at about zero after a decreasing trend toward zero; and

triggering inspiration based on the first of at least one of the following events to occur;

a net negative change in lung volume with increasing magnitude is detected that is greater than an inspiratory trigger threshold directly after the step of determining that the windowed differential lung volume is about zero; and

a predetermined amount of time expires.

2. The method of claim 1, wherein the fixed base flow is undeterminable because of at least one of the following conditions:

an absence of an inspiratory flow sensor;

a malfunction of the inspiratory flow sensor;

a malfunction that prevents utilization of the inspiratory flow sensor

an inspiratory module malfunction; and

a malfunction that deactivates at least one of a data measurement subsystem and a data acquisition subsystem.

3. The method of claim 1, further comprising:

determining a stable portion of exhalation;

monitoring an exhalation flow during the stable portion of exhalation;

estimating a base flow based on the exhalation flow monitored during the stable portion of exhalation;

wherein the events further include;

a flow derivation based on the estimated base flow is detected that is greater than the inspiratory trigger threshold during the stable portion of exhalation.

4. The method of claim 3, wherein the stable portion of exhalation is a time during exhalation when a slope of patient exhalation flow is about zero.

5. The method of claim 3, wherein the stable portion of exhalation occurs when

(Max(P_e)−

Min(P_e)<

1.5 cm H₂O) and (Max(Q_e)−

Min(Q_e)<

1.5 LPM) for each computation cycle,

wherein Max(P_e) is a maximum exhalation pressure, Min(P_e) is a minimum exhalation pressure, Max(Q_e) is a maximum exhalation flow, and Min(Q_e) is a minimum exhalation flow.

6. The method of claim 1, wherein the predetermined amount of time is one of 100 ms, 150 ms, and 200 ms.

7. The method of claim 1, wherein the net negative change in lung volume is calculated utilizing a following equation:

Δ

LV=WDLV*Δ

T,

wherein Δ

LV is a differential lung volume, WDLV is a differential lung volume over a window, and Δ

T is a sampling period.

8. The method of claim 7, wherein a window in the WDLV is 5 cycles for a 25 ms period.

9. The method of claim 1, wherein the inspiratory trigger threshold is a change in flow rate.

10. The method of claim 9, wherein the net negative change in lung volume is converted into flow rate for comparison to the inspiratory trigger threshold.

11. The method of claim 9, wherein the inspiratory trigger threshold is a change of at least 5 LPM.

12. A method for ventilating a patient with a ventilator, comprising:

delivering a fixed base flow that is undeterminable;

determining a stable portion of exhalation;

monitoring an exhalation flow during the stable portion of exhalation;

estimating a base flow based on the exhalation flow monitored during the stable portion of exhalation; and

triggering inspiration based on the first of at least one of the following events to occur;

a flow derivation based on the estimated base flow is detected that is greater than an inspiratory trigger threshold during the stable portion of exhalation; and

expiration of a predetermined amount of time.

13. A ventilator system comprising:

a pressure generating system adapted to generate a flow of breathing gas,

wherein the pressure generating system delivers an undeterminable fixed base flow;

a ventilation tubing system including a patient interface for connecting the pressure generating system to a patient;

at least one sensor operatively coupled to at least one of the pressure generating system, the patient, and the ventilation tubing system;

a lung volume module for monitoring a windowed differential lung volume during exhalation and for determining when the windowed differential lung volume is at about zero after a decreasing trend toward zero; and

a trigger module for triggering inspiration based on the first of at least one of the following events to occur;

a net negative change in lung volume with increasing magnitude is detected directly after the lung volume module determines that the windowed differential lung volume is about zero that is greater than an inspiratory trigger threshold, and

a predetermined amount of time expires.

14. The ventilator system of claim 13, further comprising:

a base flow estimator module for determining a stable portion of exhalation, monitoring an exhalation flow during the stable portion of exhalation, and for estimating a base flow based on the exhalation flow monitored during the stable portion of exhalation,

wherein the events further include;

a flow derivation based on an estimated base flow is detected that is greater than the inspiratory trigger threshold.

15. The ventilator system of claim 13, further comprising:

a display in communication with at least one of the lung volume module and the trigger module, the display displays at least one of a WDLV, the net negative change in lung volume, an estimated base flow, an exhalation flow, a restricted period, a trigger threshold, and a sampling period for the WDLV.

16. A ventilator system comprising:

a pressure generating system adapted to generate a flow of breathing gas;

wherein the pressure generating system delivers an undeterminable fixed base flow,

a ventilation tubing system including a patient interface for connecting the pressure generating system to a patient;

at least one sensor operatively coupled to at least one of the pressure generating system, the patient, and the ventilation tubing system, wherein the at least one sensor is capable of generating an output indicative of an exhalation flow;

a base flow estimator module for determining a stable portion of exhalation, monitoring the exhalation flow during the stable portion of exhalation based on the output, and for estimating a base flow based on the exhalation flow monitored during the stable portion of exhalation; and

a trigger module for triggering inspiration based on the first of at least one of the following events to occur;

a flow derivation based on an estimated base flow is detected that is greater than an inspiratory trigger threshold, and

a predetermined amount of time expires.

17. A computer-readable medium having computer-executable instructions for performing a method of ventilating a patient with a ventilator, the method comprising:

repeatedly delivering a fixed base flow that is undeterminable;

repeatedly monitoring a windowed differential lung volume during exhalation;

repeatedly determining that the windowed differential lung volume is at about zero after a decreasing trend toward zero; and

repeatedly triggering inspiration based on the first of at least one of the following events to occur;

a net negative change in lung volume with increasing magnitude is detected that is greater than an inspiratory trigger threshold directly after the step of determining that the windowed differential lung volume is about zero; and

a predetermined amount of time expires.

18. A ventilator system, comprising:

means for delivering a fixed base flow that is undeterminable;

means for monitoring a windowed differential lung volume during exhalation;

means for determining that the windowed differential lung volume is at about zero after a decreasing trend toward zero; and

means for triggering inspiration based on the first of at least one of the following events to occur;

a net negative change in lung volume with increasing magnitude is detected that is greater than an inspiratory trigger threshold directly after the step of determining that the windowed differential lung volume is about zero; and

a predetermined amount of time expires.

19. A computer-readable medium having computer-executable instructions for performing a method of ventilating a patient with a ventilator, the method comprising:

repeatedly delivering a fixed base flow that is undeterminable;

repeatedly determining a stable portion of exhalation;

repeatedly monitoring an exhalation flow during the stable portion of exhalation;

repeatedly estimating a base flow based on the exhalation flow monitored during the stable portion of exhalation; and

repeatedly triggering inspiration based on the first of at least one of the following events to occur;

a flow derivation based on the estimated base flow is detected that is greater than an inspiratory trigger threshold during the stable portion of exhalation; and

expiration of a predetermined amount of time.

20. A ventilator system, comprising:

means for delivering a fixed base flow that is undeterminable;

means for determining a stable portion of exhalation;

means for monitoring an exhalation flow during the stable portion of exhalation;

means for estimating a base flow based on the exhalation flow monitored during the stable portion of exhalation; and

means for triggering inspiration based on the first of at least one of the following events to occur;

a flow derivation based on the estimated base flow is detected that is greater than an inspiratory trigger threshold during the stable portion of exhalation; and

expiration of a predetermined amount of time.