Systems and methods for ventilation with unknown exhalation flow

• US 9,925,346 B2
• Filed: 01/20/2015
• Issued: 03/27/2018
• Est. Priority Date: 01/20/2015
• Status: Active Grant

• Current Assignee: Covidien LP (Medtronic Plc)
• Original Assignee: Covidien LP (Medtronic Plc)
• Inventors: Dong, Nancy F., Sanchez, Gabriel
• Primary Examiner(s): Douglas, Steven
• Application Number:
  US14/600,261
• Publication Number:
  US 20160206837A1
• Time in Patent Office: 1,162 Days
• 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 16/0069 the speed thereof being controlled by respiratory parameters, e.g. by inhalation
• 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 16/04 Tracheal tubes catheters in general A61M25/00
• CPC Class Codes: A61M 16/06 Respiratory or anaesthetic masks
• CPC Class Codes: A61M 16/0833 T- or Y-type connectors, e.g. Y-piece
• CPC Class Codes: A61M 16/20 Valves specially adapted to medical respiratory devices
• CPC Class Codes: A61M 2016/0027 pressure meter
• CPC Class Codes: A61M 2016/003 with a flowmeter
• CPC Class Codes: A61M 2205/14 Detection of the presence or absence of a tube, a connector or a container in an apparatus
• CPC Class Codes: A61M 2205/18 with alarm
• CPC Class Codes: A61M 2205/3334 Measuring or controlling the flow rate
• CPC Class Codes: A61M 2205/52 with memories providing a history of measured variating parameters of apparatus or patient

Abstract

Systems and methods for ventilation that allows the patient to trigger or initiate the delivery of a breath are provided. Further, systems and methods for triggering ventilation when exhalation flow is unknown or unreliable by the ventilator are provided.

Claims

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

delivering a fixed base flow;

monitoring an exhalation flow, an exhalation pressure, and an exhalation auxiliary pressure during ventilation of the patient with the fixed base flow based on output from one or more sensors to determine a monitored exhalation flow, a monitored exhalation pressure, and a monitored exhalation auxiliary pressure;

detecting a first trigger condition based at least on the monitored exhalation flow;

triggering inspiration in response to the detecting of the first trigger condition;

determining an absence of the monitored exhalation flow with the ventilator based on the output from the one or more sensors; and

the ventilator in response to the determining;

ceasing to utilize the first trigger condition based at least on the exhalation flow;

estimating the exhalation flow based on the monitored exhalation pressure and the monitored exhalation auxiliary pressure to determine an estimated exhalation flow;

detecting a second trigger condition based at least on the estimated exhalation flow; and

triggering inspiration during the ventilation in response to the detecting of the second trigger condition.

2. The method of claim 1, wherein the second trigger condition is detection of a stable portion of exhalation flow at about zero.

3. The method of claim 1, wherein the second trigger condition is a negative change in base flow after a stable portion of exhalation is reached decreases below zero.

4. The method of claim 1, wherein the second trigger condition is a flow deviation based on the fixed base flow and the estimated exhalation flow that breaches a trigger threshold.

5. The method of claim 4, wherein the trigger threshold is a drop in the estimated exhalation flow of at least 1.5 LPM.

6. The method of claim 4, wherein the trigger threshold is a range of a change in flow of −

0.1 LPM to −

20 LPM.

7. The method of claim 1, further comprising:

monitoring an exhalation time during the ventilation of the patient with the ventilator;

detecting a third trigger condition based at least on a monitored exhalation time; and

triggering inspiration in response to the detecting of the third trigger condition.

8. The method of claim 7, wherein the third trigger condition is the exhalation time of at least 20 seconds.

9. The method of claim 1, wherein the absence of the monitored exhalation flow is because an exhalation flow sensor is removed from the ventilator.

10. The method of claim 1, wherein the absence of the monitored exhalation flow is because of a malfunction in an exhalation flow sensor.

11. The method of claim 1, further comprising:

determining an estimated exhaled tidal volume based at least on the estimated exhalation flow in response to the detecting of the absence of the monitored exhalation flow; and

displaying the estimated exhaled tidal volume.

12. The method of claim 1, further comprising:

in response to the absence of the monitored exhalation flow;

displaying at least one of a notification that an exhalation flow sensor is removed, a notification that the exhalation flow sensor is malfunctioning, the estimated exhalation flow, and the second trigger condition.

13. A ventilator system comprising:

a pressure generating system that generates a flow of breathing gas including a fixed base flow;

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

an exhalation valve connected to the ventilation tubing system;

a plurality of sensors operatively coupled to at least one of the pressure generating system, the patient, and the ventilation tubing system for monitoring inspiratory pressure, inspiratory flow, exhalation pressure, exhalation auxiliary pressure, and exhalation flow to determine a monitored inspiratory pressure, a monitored inspiratory flow, a monitored exhalation pressure, a monitored exhalation auxiliary pressure, and a monitored exhalation flow;

an exhalation flow estimation module, the exhalation flow estimation module estimates the exhalation flow based on the monitored exhalation pressure and the monitored exhalation auxiliary pressure to determine an estimated exhalation flow;

a driver, the driver controls the exhalation valve to deliver ventilation to the patient based at least on at least one of the monitored exhalation flow, and the estimated exhalation flow determined based on the monitored exhalation pressure and the monitored exhalation auxiliary pressure;

a main trigger module, the main trigger module triggers an inspiration based on a first of at least one of the following events to occur;

detection of a first trigger condition based at least on the monitored exhalation flow, and

expiration of a predetermined amount of exhalation time;

a backup trigger module, the backup trigger module triggers the inspiration based on a first of at least one of the following events to occur;

detection of a second trigger condition based at least on the estimated exhalation flow, and

expiration of the predetermined amount of exhalation time;

a controller, the controller determines an absence in the monitored exhalation flow and switches from the main trigger module to the backup trigger module.

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

a display that displays at least one of a notification that an exhalation flow sensor is removed, a notification that the exhalation flow sensor is malfunctioning, the estimated exhalation flow, and the second trigger condition.

15. The ventilator system of claim 13, wherein the controller detects the absence of the monitored exhalation flow because an exhalation flow sensor has been removed.

16. The ventilator system of claim 13, wherein the controller detects the absence of the monitored exhalation flow because an exhalation flow sensor is malfunctioning.

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

a display that displays the estimated exhalation flow and an estimated exhalation tidal volume, wherein the exhalation flow estimation module estimates an exhalation tidal volume based on the estimated exhalation flow.

18. The ventilator system of claim 13, wherein the second trigger condition is detection of a stable portion of exhalation.

19. The ventilator system of claim 13, wherein the second trigger condition is a flow deviation based on the fixed base flow and the estimated exhalation flow that breaches a trigger threshold.

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

monitoring an exhalation flow, an exhalation pressure, and an exhalation auxiliary pressure during ventilation of the patient with the ventilator based on output from one or more sensors to determine a monitored exhalation flow, a monitored exhalation pressure, and a monitored exhalation auxiliary pressure;

delivering ventilation based at least on the monitored exhalation flow;

determining an absence in the monitored exhalation flow with the ventilator based on the output from the one or more sensors;

in response to the absence of the monitored exhalation flow, estimating the exhalation flow based at least on the monitored exhalation pressure and exhalation auxiliary pressure to determine an estimated exhalation flow; and

in response to the absence of the monitored exhalation flow, ceasing to deliver the ventilation based at least on the monitored exhalation flow and instead delivering ventilation based at least on the estimated exhalation flow.