Methods and systems for exhalation control and trajectory optimization

• US 9,629,971 B2
• Filed: 04/29/2011
• Issued: 04/25/2017
• Est. Priority Date: 04/29/2011
• Status: Active Grant

• Current Assignee: Covidien LP (Medtronic Plc)
• Original Assignee: Covidien LP (Medtronic Plc)
• Inventors: Masic, Milenko, Doyle, Peter, Kimm, Gardner
• Primary Examiner(s): Yu, Justine
• Assistant Examiner(s): SUL, DOUGLAS YOUNG
• Application Number:
  US13/098,130
• Publication Number:
  US 20120272961A1
• Time in Patent Office: 2,188 Days
• Field of Search: 12820418, 12820421, 12820423, 12820426, 600529, 600533, 600538
• CPC Class Codes: A61M 16/0003 Accessories therefor, e.g. sensors, vibrators, negative pressure
• CPC Class Codes: A61M 16/0051 with alarm devices
• CPC Class Codes: A61M 16/0057 Pumps therefor
• CPC Class Codes: A61M 16/0063 Compressors
• CPC Class Codes: A61M 16/024 including calculation means, e.g. using a processor
• CPC Class Codes: A61M 16/0833 T- or Y-type connectors, e.g. Y-piece
• CPC Class Codes: A61M 2016/0039 in the inspiratory circuit
• CPC Class Codes: A61M 2016/0042 in the expiratory circuit
• CPC Class Codes: A61M 2205/502 User interfaces, e.g. screens or keyboards
• CPC Class Codes: A61M 2205/505 Touch-screens; Virtual keyboard or keypads; Virtual buttons; Soft keys; Mouse touches
• CPC Class Codes: A61M 2230/202 partial carbon oxide pressure, e.g. partial dioxide pressure (P-CO2)
• CPC Class Codes: A61M 2230/40 Respiratory characteristics
• CPC Class Codes: A61M 2230/42 Rate
• CPC Class Codes: A61M 2230/432 partial CO2 pressure (P-CO2)
• CPC Class Codes: A61M 2230/46 Resistance or compliance of the lungs

Abstract

The systems and methods include controlling pressure and/or flow during exhalation. The systems and methods include novel exhalation for ventilating a patient. The systems and methods decrease the amount of time it takes the patient to passively expire an inspired volume of gas. For example, the systems and method may determine one or more pressure profiles based on one or more criterion and may select and utilize the pressure profile that provides for the fastest rate of lung emptying.

Claims

1. A method for controlling an exhalation phase during ventilation of a patient on a ventilator, the method comprising:

determining with the ventilator a plurality of potential pressure profiles for an exhalation that will provide a faster rate of lung emptying for the exhalation than a previously provided rate based on at least one received criterion by the patient being ventilated on the ventilator;

selecting a pressure profile for delivery to the patient from the plurality of potential pressure profiles; and

controlling at least one of airway pressure and flow with the ventilator based on the selected pressure profile during the exhalation by the patient.

2. The method of claim 1, wherein the at least one criterion is a nonlinear relationship between airway resistance and lung pressure and the airway pressure.

3. The method of claim 1, wherein the at least one criterion is an exhalation pressure fall time parameter.

4. The method of claim 1, wherein the at least one criterion is an actual rate of pressure decay.

5. The method of claim 4, wherein the actual rate of pressure decay is defined by an exhalation pressure fall time parameter.

6. The method of claim 1, wherein the at least one criterion is an amount of time that the patient takes to exhale a delivered volume of gas inspired by the patient.

7. The method of claim 1, wherein the at least one criterion is a measured end inspiratory pressure.

8. The method of claim 1, wherein the at least one criterion is a trajectory for the plurality of potential pressure profiles calculated with an equation of

p_y=PEEP+(EIP−

PEEP)e<sup>−

α

t</sup>,

wherein the α

is greater than zero and denotes an exhalation fall time parameter,

wherein the PEEP is a set PEEP,

wherein the EIP is a measured end expiratory pressure,

wherein the t is an exhalation time, and

wherein the P_y is a pressure at a wye-fitting.

9. The method of claim 1, wherein the at least one criterion is a predetermined pressure profile that comprises:

allowing pressure to fall below a set PEEP by a predetermined amount;

increasing the pressure after the pressure falls below the set PEEP to another pressure above the set PEEP by a set amount; and

subsequently allowing the another pressure above the set PEEP to fall to the set PEEP at a predetermined rate.

10. The method of claim 1, wherein the plurality of potential pressure profiles is a family of pressure profiles.

11. The method of claim 10, wherein the step of determining the plurality of potential pressure profiles is further based on a received PEEP.

12. The method of claim 1, further comprising:

delivering a volume of gas to the patient for inspiration during ventilation on the ventilator,

wherein the exhalation by the patient includes exhaling an amount of the volume of gas delivered to the patient that was inspired by the patient.

13. The method of claim 1, wherein the at least one criterion is an operator determined pressure profile.

14. A method for optimizing a pressure profile delivered to a patient during an exhalation phase on a ventilator, the method comprising:

delivering at least one of airway pressure and flow based on the pressure profile during a current exhalation to the patient during ventilation on the ventilator;

monitoring at least one parameter during the current exhalation by the patient;

modifying the pressure profile for an exhalation to provide a faster rate of lung emptying during the exhalation than a previously provided rate based at least in part on the monitored at least one parameter to form a modified pressure profile; and

delivering at least one of a modified airway pressure and a modified flow based on the modified pressure profile to the patient during at least one of the current exhalation and a next exhalation,

wherein the modified pressure profile maintains a received PEEP.

15. The method of claim 14, wherein the modified pressure profile is based on a nonlinear relationship between airway resistance and lung pressure and the airway pressure.

16. The method of claim 14, wherein the step of delivering at least one of the modified airway pressure and the modified flow based on the modified pressure profile to the patient is during the next exhalation, and

wherein the monitored at least one parameter is an exhalation time.

17. The method of claim 14, wherein the monitored at least one parameter is an exhalation pressure fall time parameter.

18. The method of claim 14, wherein the monitored at least one parameter is an actual rate of pressure decay.

19. The method of claim 14, wherein the monitored at least one parameter is a measured end inspiratory pressure.

20. The method of claim 14, wherein the monitored at least one parameter is a trajectory determined by an equation of p_y=PEEP+(EIP−

PEEP)e<sup>−

α

t</sup>,

wherein the α

is greater than zero and denotes an exhalation fall time parameter,

wherein the PEEP is a set PEEP,

wherein the EIP is a measured end expiratory pressure,

wherein the t is an exhalation time, and

wherein the P_y is a pressure at a wye-fitting.

21. A non-transitory computer-readable medium having a controller with computer-executable instructions executed by a processor of an exhalation module for controlling an exhalation phase during ventilation of a patient on a ventilator, the controller comprising:

a pressure profile module that determines at least one potential pressure profile for an exhalation based on at least one received criterion to provide a faster rate of lunge emptying for the exhalation than a previously provided rate by the patient being ventilated on the ventilator and selects a pressure profile for delivery to the patient from the at least one potential pressure profile to provide a fastest rate of lung emptying; and

a parameters module that repeatedly controls at least one of airway pressure and flow based on the selected pressure profile during the exhalation by the patient.