CN102056538B - 用于在换气系统中确定患者努力及/或呼吸参数的系统及方法 - Google Patents
用于在换气系统中确定患者努力及/或呼吸参数的系统及方法 Download PDFInfo
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Abstract
本发明的各种实施例提供用于呼吸支持的系统、方法及装置。作为一个实例,描述一种用于呼吸支持的方法,所述方法包含:测量压力、提供所测量压力;测量入口流量及出口流量,并提供所测量净流量。使用与所述所测量压力有关的第一值、与所述所测量净流量有关的第二值和与患者努力有关的第三值之间的关系来提供患者努力的预测。至少部分地基于所述患者努力的所述预测而更新中间值。
Description
技术领域
本发明涉及换气机,且更特定来说涉及用于在动态换气系统中识别时间相依信号及/或呼吸参数的系统及方法。
背景技术
换气机经设计以用气体给患者的肺换气且借此在患者依靠自身呼吸的能力由于某种原因而受损时对患者起辅助作用。换气是通过根据规定的换气形态向患者提供所定义的气体混合物实现的。由于每一患者可能需要不同的换气策略,因此现代的换气机可针对个别患者的特定需要定制。
现代的换气机为动态系统,其动态行为及输出(例如递送到患者的压力及流量)由例如气体流量的输入信号来驱动。此类换气机的正确操作依赖于对多种呼吸参数的某一理解,包含患者气道的阻力及肺的顺应性。这些参数可因不同的换气系统及因不同的患者而显著变化。在许多情况下,换气系统的正确操作受到定义或估计此类参数的准确度的限制。
已开发用于识别特定个人或特定换气情形的换气参数的方法。可将此类方法分成两个不同的类别:静态方法及动态方法。在静态方法中,通常仅使用与所估计参数有关的几个数量测量而在系统的诱发平衡状态(即,操纵)的短周期期间估计呼吸参数。相比之下,动态方法操作以描述患者在换气下的动态行为且通常基于对换气机条件的连续测量或分段式连续测量。历史上,在由未知输入信号驱动的换气系统的情况下,识别呼吸参数提出了挑战。此为关于涉及主动呼吸的患者及泄漏的换气系统的情况,且许多现有方法不能提供充分准确的结果,因为通常无法测量驱动系统的这些信号但在识别算法中必须计及所述信号。举例来说,用于估计患者呼吸努力的各种方法不准确,且因此依赖于所估计的患者努力的动态算法通常为不适当的。
在一些情况下,已使用运动方程式并仅依赖于对进出于患者的肺的气体流量的测量连同压力测量估计患者呼吸努力。此方法的可靠性受到可测量到的流入和流出患者的肺的气体流量的准确度的限制。然而,此测量为固有地不准确的,因为其依赖于插入于患者的气管中的管处或附近的流量传感器。所述流量传感器的准确度由于从肺呼出的气体的湿度而显著减小。此外,接近患者的气管的此流量传感器通常不存在于现有换气系统中。
因此,此项技术中存在对高级换气系统及用于使用所述高级换气系统的方法的需要。
发明内容
本发明涉及换气机,且更特定来说涉及用于识别动态换气系统中的时间相依信号及/或呼吸参数的系统及方法。
本发明的各种实施例提供用于呼吸支持的方法。此类方法中的一些方法包含:测量压力、提供所测量压力;测量入口流量及出口流量并提供所测量净流量。使用与所述所测量压力有关的第一值、与所述所测量净流量有关的第二值和与患者努力有关的第三值之间的关系来提供患者努力的预测。至少部分地基于所述患者努力的所述预测而更新中间值。在前述实施例的一些实例中,所述方法进一步包含至少部分地基于所述中间值而计算所述患者努力。在一些情况下,计算所述与患者努力有关的第三值包含基于以下各项中的一者或一者以上的组合而估计患者努力:所估计的经正规化预测误差(ε)、经滤波压力值(z)及/或回归向量所述第一值可以是(但不限于)所测量压力的经滤波版本或实际所测量压力。所述第二值可以是(但不限于)所测量净流量的经滤波版本或实际所测量净流量。所述第三值可以是(但不限于)实际患者努力或患者努力导数。
在一些情况下,所述中间值包含时间相依信号及/或呼吸参数。所述呼吸参数可以是(但不限于)肺顺应性(CL)、患者阻力(RP)、管道顺应性(CT)及泄漏量(λLEAK)。在前述实施例中的特定实例中,所述中间值包含所述患者努力的时间相依估计量。所述患者努力的所述时间相依估计量可为所述患者努力的估计。所述患者努力的此估计可基于以下各项中的任一者:所估计的经正规化预测误差(ε)、经滤波压力值(z)、回归向量及/或前述变量的某一组合。
上述关系可以是从转移函数导出的线性回归在一种情况下,从系统的以下动态模型导出所述转移函数:
在一些情况下,使用以下近似来计算所述经滤波患者努力的预测:
本发明的其它实施例提供换气系统,其包含可以通信方式耦合到计算机可读媒体的处理器。所述计算机可读媒体包含可由所述处理器执行以进行以下操作的软件或固件:接收压力;接收入口流量;及接收出口流量。所述指令进一步可执行以:至少部分地基于所述入口流量及所述出口流量而计算净流量;及使用与所述压力有关的第一值、与所述净流量有关的第二值和与患者努力有关的第三值之间的关系来提供患者努力的预测。至少部分地基于所述患者努力的所述预测而更新中间值。在一些实施例中,至少部分地基于所述中间值而计算患者努力。
又一些实施例提供用于呼吸支持的方法,其包含:接收一个或一个以上参数的参数集;测量压力并提供所测量压力;测量入口流量及出口流量并提供所测量净流量。使用与所述所测量压力有关的第一值、与所述所测量净流量有关的第二值和所述参数集之间的关系来提供患者努力的预测。至少部分地基于所述患者努力的所述预测而更新中间值。在一些实施例中,所述参数集包含回路阻力、回路顺应新或者其它患者或回路有关参数。
本发明的又一实施例提供一种患者换气机,其包含:气体入口;气体出口;管,其耦合所述气体入口与所述气体出口;压力传感器,其可操作以提供指示所述管中的压力的所测量压力值;及两个流量传感器。所述流量传感器中的一者可操作以提供指示与所述气体入口相关联的流量的入口流量值;且另一流量传感器可操作以提供指示与所述气体出口相关联的流量的出口流量值。所述患者换气机进一步包含处理器,其以可通信方式耦合到计算机可读媒体。所述计算机可读媒体包含可由所述处理器执行以进行以下操作的软件或固件:接收压力;接收入口流量;及接收出口流量。所述指令进一步可执行以:至少部分地基于所述入口流量及所述出口流量而计算净流量;及使用与所述压力有关的第一值、与所述净流量有关的第二值和与患者努力有关的第三值之间的关系来提供患者努力的预测。可至少部分地基于所述患者努力的所述预测而更新中间值。
本发明的额外实施例提供用于呼吸支持的方法,其包含:测量压力以产生所测量压力;测量流量以产生所测量流量;及使用以下动态模型:
来提供患者努力的预测。
本发明的再一些额外实施例提供用于呼吸支持的方法,其包含:测量压力以产生所测量压力;测量流量以产生所测量流量;使用线性回归以提供患者努力的预测;及至少部分地基于所述患者努力的所述预测而更新患者努力估计。
此发明内容仅提供对本发明的一些实施例的一般概述。依据以下详细说明、所附权利要求书及附图,本发明的许多其它目标、特征、优点及其它实施例将变得更加显而易见。
附图说明
可通过参考在说明书的其余部分中描述的图来认识对本发明的各种实施例的进一步理解。在所述图中,可在所述图中的数个图中使用相似的参考编号来指代类似的组件。在一些实例中,由小写字母组成的子标签与指示多个类似组件中的一者的参考编号相关联。当在未规定现有子标签的情况下参考一参考编号时,其既定指代所有此类多个类似组件。
图1描绘根据本发明的各种实施例的换气系统,其尤其包含能够提供自适应性地估计的呼吸参数及患者努力的自适应计算模块;
图2展示根据本发明的一些实施例的可用于确定患者努力的患者换气机系统及相关联参数化模型;
图3提供与其它信号相关的患者努力的图形实例,其可通过本发明的特定实施例的实施方案实现;
图4是描绘根据本发明的一些实施例的用于确定患者努力的方法的流程图;
图5展示根据本发明的各种实施例的用于确定患者努力的基于微处理器的系统;
图6是描绘根据本发明的一些实施例的用于触发换气循环的方法的流程图;
图7是展示根据本发明的各种实施例的基于所估计患者努力信号而触发换气循环的时序图;
图8是根据本发明的一个或一个以上实施例的比较压力传感器的触发的过程对所估计患者努力信号的触发的过程的时序图;
图9是展示根据本发明的各种实施例的用于与患者努力成比例地提供换气的方法的流程图;
图10图解说明根据本发明的一个或一个以上实施例的以图形描绘与患者努力成比例地提供换气的一群组时序图;
图11展示根据本发明的一些实施例的实例性图形接口,其展示对应于主动呼吸的患者的患者努力的显示;且
图12展示根据本发明的一些实施例的实例性图形接口,其展示对应于主动呼吸的患者的呼吸参数的显示。
具体实施方式
本发明涉及换气机,且更特定来说涉及用于基于患者的呼吸努力控制气体递送的系统及方法。
需要使换气循环的开始及结束同步到患者可能依靠其自身呼吸所正做的努力(即,患者努力)。举例来说,需要具有准确的换气机触发器,借此患者一尝试吸入所述换气机就起始呼吸。一些换气机使用感测由患者尝试吸入所导致的换气回路压力的改变的压力触发器,而其它换气机使用感测由患者尝试吸入所导致的流量的改变的流量触发器。在任一情况下,可由于多种原因而发生患者的努力与换气机响应之间的延迟。举例来说,换气回路中的泄漏可允许空气在患者吸入时进入所述回路。由于换气机流量传感器并不测量患者呼吸的全部且换气机可能正监视流量的改变以检测吸入(流量触发器),因此所述换气机可在起始呼吸上延迟。本发明的一些实施例通过提供对患者努力的相当准确的估计(其可单独使用或相对于其它信号使用以触发换气循环的开始及结束)来促进经改进的同步。在本发明的一个或一个以上实施例中,可另外相对于控制患者的成比例换气使用所估计患者努力。此成比例换气操作以与患者接收气体的努力成比例地向患者递送所述气体。在本发明的各种实施例中,可使用所估计患者努力及/或呼吸参数来驱动可由临床医生用于患者监视及/或诊断目的的图形显示器。
本发明的各种实施例提供用于以合理的准确度估计一个或一个以上呼吸参数及驱动换气系统的至少一个未测量输入信号的系统及方法。在一些实施例中,可从例如所测量压力及所测量流量导出至少一个未测量输入信号并使用其来估计呼吸参数。所述未测量输入信号可以是(但不限于):患者努力及/或患者努力导数、换气系统气体泄漏(即,在将换气机连接到患者的管道或患者接口中出现的泄漏)、患者气体泄漏(例如,患者的肺中的泄漏)及/或流量及压力感测误差。所述呼吸参数可包含(但不限于):肺顺应性(CL)、患者阻力(RP)及管道顺应性(CT)。在一些情况下,对呼吸参数及未测量输入信号两者的估计是同时的。在一些实施例中,未测量输入信号具有与患者努力的强相关性且因此可在后续换气机动作中用作患者努力的代理。在其它实施例中,本发明的方法允许连续地提供呼吸参数。以此方式,可确定患者努力以及呼吸或换气系统参数,例如患者阻力、泄漏等。
在本发明的一些实施例中,利用可测量压力、可测量流量与未知患者努力之间的关系以提供对患者努力连同多种呼吸参数的连续估计。在特定实例中,将所述关系定义为尤其关于所测量压力、所测量流量及患者努力的转移函数。在此类情况下,可使用线性回归技术产生又可用于估计患者努力的一个或一个以上中间值来减小所述转移函数。在一实施例中,将所测量压力及所测量流量的正在进行的输入插入到所述转移函数中以估计患者努力且视需要估计一个或一个以上呼吸参数。在另一实施例中,可递归地使用患者努力的估计在随后的计算周期中导出患者努力的较准确估计。因此,通过使用递归,可连续地改进所估计患者努力值的准确度。
在一些情况下,所测量流量为组合从系统中出来的净气体流量与到系统中的净气体流量的净流量值。在一个特定情况下,到系统中的净气体流量包含与到系统中的空气流量组合的氧气流量。此类流量相当容易测量且不经受通常伴随着接近肺的气体流量的测量的不准确度的影响。
在一些情况下,可使用如上文所描述的计算的患者努力信号或其某一代表来触发换气循环。使用此类信号可允许换气系统较准确地将机械换气与患者依靠自身呼吸所正做的努力同步。
值得注意,呼吸参数及患者努力导数可为同一模型的输入且可使用从所述同一模型导出的相依方程式计算。由于从相依方程式中的一些相依方程式计算的值用作其它相依方程式的输入,因此其可通常称为中间值。如本文中所使用,短语“中间值”以其最广泛意义用于意指从用作另一方程式的输入的一个方程式导出的值。基于阅读本发明,将注意可相对于本发明的各种实施例利用多种中间值。
转到图1,其展示根据本发明的各种实施例的换气系统1。换气系统1包含换气机10、自适应计算模块20、图形用户接口40以及成比例及触发控制模块30。换气机10可以是此项技术中已知的能够提供所测量压力65、所测量入口流量70及所测量出口流量75的任何换气机。自适应计算模块20接收压力65、入口流量70及出口流量75并计算所估计患者努力55及所估计呼吸参数60。患者努力55可以是患者努力自身或与患者努力强相关的某一信号。下文更全面地论述与患者努力相关的信号。呼吸参数60可包含下文更全面论述的多种参数。在一实施例中,由自适应计算模块20执行的计算在性质上可为自适应的,从而依赖于先前中间值产生经更新的呼吸参数60及患者努力55估计。在一些实施例中,此类中间值可包含患者努力55及/或如图1中的虚线所展示的呼吸参数估计60。或者(未展示),由自适应计算模块20使用的先前中间值可为不直接对应于任何可识别呼吸参数(例如,下文更详细论述的协方差矩阵及参数向量)的复合参数。
在所图解说明的实施例中,患者努力55提供到成比例及触发控制模块30。基于患者努力55,成比例及触发控制模块30产生提供到换气机10的一个或一个以上控制信号80。在一些实施例中,控制信号80控制到患者的气体递送的定时。在各种实施例中,控制信号80控制递送到患者的气体量,其中所述气体量与患者努力55成比例。
换气机10提供驱动图形用户接口40的控制信号90。图形用户接口40可经包含作为换气机10的一部分以允许与用户的相互作用,包含(但不限于)接收用户命令及/或显示与换气机操作有关的数据。在一些实施例中,换气机10可引导图形用户接口40显示由自适应计算模块20提供的信息85。此信息可包含(但不限于)如下文更全面地论述的呼吸参数60及/或患者努力55。
本发明的各种实施例利用患者换气机系统的参数化动态模型来确定患者努力。图2中描绘换气机系统100的模型。换气机系统100包含入口空气流量105(qAIR)、入口氧气流量110(qO2)及出口气体流量115(qE)。应注意,尽管换气机系统100展示两个气体源(空气与氧气),但可相对于本发明的不同实施例使用更多或更少的入口气体源。举例来说,其可以是仅使用一个空气源或除了入口空气源及入口氧气源以外,还可包含氦气及/或氦氧混合气体源。基于本文中所提供的揭示内容,所属领域的技术人员将认识到可相对于本发明的不同实施例使用的多种其它气体源。
所述系统中所包含的管道、流量阀及/或压力监视器将某一阻力引入到换气机系统100中的气体流量。特定来说,可能有空气阻力120(Rair)、氧气阻力125(RO2)、呼出阻力130(REV)及患者阻力135(RP)(即,气管阻力与气管内管中的阻力的某一组合)。压力传感器150测量入口处其中空气流与氧气流组合的位置处的压力(pI),且压力传感器155测量呼出输出中的压力(pE)。应注意,压力传感器150可由与相应入口线路相关联的个别压力传感器替换。将其中入口与出口气体组合的位置处的压力(pY)表示为折流板140(例如,Y形管气体压力),且由另一折流板表示患者的肺中的压力(pL)。在本发明的一些实施例中,通过使用安装于对应于pY的特定位置处或附近的压力测量装置来确定所述压力。在本发明的其它实施例中,将pY设定为等于pI或pE,而在本发明的其它实施例中,将pY设定为pI与pE的平均值。在前述三种情况中的任一者中,认为pY是“直接测量的”,因为其是测量或其它直接测量的平均值。还识别与管道中的泄漏量160(qTleak)相关联的气体流量及与患者中的泄漏量165(qPleak)相关联的气体流量。患者努力值195(pP)展示为与进出于患者的肺的移动气体的力相互作用的力。
可使用各种方程式来描述换气机系统100的操作。举例来说,使用质量守恒原理,可组合各种流量值(即,qAIR、qO2、qT、qTleak、qP、qPleak、qLUNG、ql)以产生以下三个方程式:
qLUNG=qp-qPleak;
q1-qp-qE=0;及
qAIR+qO2=q1+qTleak+qT。
此外,使用力平衡原理,可将压力pY、pL及pp以及流量qT及qL组合成以下关系:
最后,可基于换气机系统100使用压力与流量之间的关系导出以下方程式:
pY-pL=RP·qP。
通过对从换气机系统100导出的前述方程式进行代数操纵并将所述方程式重算成矩阵形式,形成以下参数化模型190以表征图2的换气机系统100的操作:
其中是在管道分支处测量的压力的一阶导数,是患者的肺中的压力的一阶导数,是患者努力的一阶导数,CT表示管道顺应性,且CL表示肺顺应性。应注意,在利用更多或更少入口气体的情况下,可根据本发明的其它实施例修改参数化模型190以计及不同气体。
本发明的各种实施例利用参数化模型190来确定患者努力pP。在本发明的不同实施例中,可做出假设以简化计算。在本发明的一个特定实施例中,可假设泄漏量160展现出管道泄漏流量与跨越开口的压力降之间的以下线性关系:
应注意,在本发明的其它实施例中,可使用关于管道泄漏流量与跨越开口的压力降之间的关系的其它假设。依赖于针对管道泄漏流量的前述线性假设,可将参数化模型190约简为以下模型:
基于前述参数化模型,针对pY的转移函数定义如下:
其中所测量流量中的每一者的瞬时和(例如,qAIR+qO2-qE)指示为针对净流量的qN。表示从净流量(qN)到输出(pY)的转移函数,表示从患者努力导数到输出(pY)的转移函数,且表示从患者泄漏量(qPleak)到输出(pY)的转移函数。应注意,前述转移函数中的第一项(即,qN项)为与已知的所测量值有关的转移函数,且前述转移函数中的第二项(即,pp项)为与未知的自适应性地估计的值相关的转移函数。在本发明的一些实施例中,为简化起见假设第三项(即,qPleak项)为零。同样,使用上述参数化模型,转移函数系数与系统参数之间的关系如下:
依据前文,有可能以线性回归形式导出参数化输出模型。在定义参数化线性回归输出模型时的第一步骤包含定义例如以下的未知参数向量:
ΘT=[a0 a1 bq0 bq1]。
依据所述未知参数模型,一旦经估计,换气机系统100的所有集总参数(例如,CT、CL、RP及λLEAK)就可恢复。通过对针对pY的转移函数的代数操纵,其可表示为:
在此情况下,压力表示在通过适当滤波器进行滤波之后的压力pY(s)。此适当滤波器依赖于与s2(例如,s2、s3、s4…)相同的次或具有比其高的次的多项式Λ(s)。通过假设患者泄漏量(qPleak)为零,将对应于换气系统100的参数化模型190的输入对输出关系的紧线性回归形式表示为:
ΘT=[a0 a1 bq0 bq1]
其中z为输出压力值,为表示已知信号的集合的回归向量,且为经滤波的患者努力。
在此情况下,使用标准线性回归来估计系统参数ΘT=[a0 a1 bq0 bq1]是不可能的,因为是未知的。通过检验未知项
并理解患者努力导数为有界信号,滤波器(Λ(s))为稳定多项式且为适当线性滤波器,显而易见未知的经滤波患者努力(即,)为平滑信号。基于此理解,未知的经滤波患者努力在任何时间t时的值可由其在时间t-dt时的值来近似,其中dt表示无穷小或有限但小的时间量:
在本发明的一些实施例中,dt为5毫秒或小于5毫秒。前述近似表示对在时间t时未知的经滤波患者努力信号的合理猜测或预测,其可在计算呼吸参数时且此后在计算患者努力时使用。此合理猜测可用于确定系统输出(z)的所预测值其可根据以下方程式来定义:
依据此定义,可通过以下问题的公式化来解决参数识别问题:假定z(t),求出其中J()为Θ的凸(例如,O2)函数。依据此观点,可应用若干种数学解决方案中的一种来解决所述问题。作为一个实例,可使用修改型递归最小平方方法。关于此方法的非修改型数学实施方案的更多细节更全面地描述于以下各项中的一者或两者中:(1)里纳特 卢詹克,“系统识别,用户的理论”,第二版,普伦蒂斯·霍尔出版社,1999年(ISBN 0-13-656695-2)(Lennart Ljung,“System Identification,Theory for the User”,Second Edition,Prentice Hall,1999(ISBN 0-13-656695-2));及(2)佩卓斯 艾奥安努与孙京,稳健自适应控制,普伦蒂斯·霍尔出版社,1995年(ISBN9780134391007)(Petros loannou and Jing Sun,Robust Adaptive Control,Prentice Hall,1995(ISBN 9780134391007))。前述参考文献两者均出于所有目的而以引用的方式并入本文中。
在实施修改型递归最小平方方法时,首先正规化预测误差(ε)且选用信号来成为经正规化信号,如以下方程式中所阐述:
其中ε为经正规化预测误差,及为输出与回归量的分别对应于时间间隔dt的差,且m为正规化信号。另外,根据以下方程式选用修改型函数J()(称为成本函数):
其中β>0及Q0≥0称为遗忘因子及罚矩阵。基于此,必须在解Θ处满足以下固定条件:
因此,可非递归地求出Θ为:
其中:
矩阵P及向量Θ满足以下两个微分方程式,所述方程式完成可用于解决参数识别问题的递归算法的定义:
P(0)=P0=Q0 -1,
其中ε为最后所测量值与当前所测量值之间的经正规化误差或差。
在以下论述中,描述可用于实时间接地估计患者努力的当前值的方法。另外,证明上文所解释的上述中间值(例如,转移函数内部的信号)的各种组合如何与未测量患者努力拥有显著等级的相关性。由于所述相关性,可使用所述中间值以合理的准确度来表征患者努力。
依据上文所建立的关系,很清楚:
通过选择产生的恰当滤波器患者努力实导数的患者努力导数的估计可计算如下:
基于以下方程式,显而易见预测误差信号与患者努力信号及其经滤波版本相关:
使用上文所定义的转移函数及参数向量Θ的当前估计,管道中的当前压力(py)的预测由以下方程式表示:
依据此,预测误差可由以下方程式描述:
其为患者努力导数的经滤波版本。此外,如果通过管道泄漏的不存在(即,假设λLEAK=0)来表征换气系统,那么预测误差类似于患者努力信号(pP),因为转移函数为积分函数。
前述方程式描述患者努力(即,pp及/或)与可准确获得的流量及压力测量之间的关系。图3以图形描绘患者努力(即,pp及/或)与在先前所描述的算法内部的实例性信号之间的实例性相关性。如所展示,时序图210描绘作为时间的函数的患者努力(pp)。时序图205描绘作为时间的函数的患者努力一阶导数时序图215描绘且时序图220描绘pp、及中的每一者的量值以H2O的厘米表示。如基于上文所提供的分析将预期,在图示210中所描绘的患者努力(pp)与图示215中所描绘的信号之间存在强相关性。类似地,图示205及220证明患者努力的一阶导数与信号之间的强相关性。因此,可使用经重构信号来预测原本未知的信号及pp。应注意所述结果仅为实例性且基于本文中所提供的揭示内容,所属领域的技术人员将认识到可通过使用本发明的不同实施例实现以表征未知的患者努力信号及其导数的多种不同信号及其经延迟版本。
转到图4,流程图300描绘根据本发明的一些实施例的用于确定患者努力的方法。提供包含换气机的换气机系统,所述换气机使用各种管道耦合到受治疗者。所述换气机接收一个或一个以上入口气体流量且除了到受治疗者的入口/出口以外还包含出口气体流量。遵循流程图300,测量管道中的压力(py)连同入口流量及出口流量以产生净流量(qn)(框305)。对所述压力值(py)进行滤波并提供其作为输出(z)(框310),且对压力(py)及净流量值(qn)进行滤波并将其组合于回归向量中(框315)。计算前述值(即,z及)的差及/或导数以产生输出m2、及(框320)。另外,创建z的经时间延迟版本(即,ze-sdt)及的经时间延迟版本(即,)(框317、318)。组合m2、及ΘT以产生所估计的经正规化预测误差(ε)(框325);且使用m2、及ε连同先前所计算的协方差(P0)来计算经更新的协方差矩阵(P)(框330)。存储新计算的协方差矩阵(P)并维持其作为先前所计算的协方差(P0)以供在对所述协方差矩阵的稍后更新中使用(框335)。使用经更新的协方差矩阵(P)连同先前所计算的ε及值以计算经更新的系统参数向量(Θ)(框340)。另外,产生Θ的经时间延迟版本(即,Θe-sdt)(框319)。如上文所论述,系统参数向量(Θ)并入有各种系统参数,包含(例如)管道顺应性(CT)、肺顺应性(CL)、集总阻力(RP)及泄漏量(λLEAK)。
在上述处理(框305到340)期间,可单独地或以组合形式使用各种中间值来估计患者努力(框345)。例如,如以上图3中所描绘,z与患者努力相关。此外,由于可使用其它构成元素来计算z,因此还可使用所述构成元素来估计患者努力。基于本文中所提供的揭示内容,所属领域的技术人员将认识到构成元素用以预测患者努力的其它用途。
转到图5,其描绘根据本发明的各种实施例的用于确定患者努力的基于微处理器的系统400。系统400包含以可通信方式耦合到计算机可读媒体460的微处理器410。微处理器410可以是此项技术中已知的能够接收各种输入值且执行软件或固件指令以基于所述输入值提供输出的任何处理器。计算机可读媒体460可以是能够存储可由微处理器410执行的指令的任何媒体。基于本文中所提供的揭示内容,所属领域的技术人员将认识到可相对于本发明的不同实施例使用的多种处理器。仅作为一些实例,计算机可读媒体460可以是硬盘驱动器、磁带驱动器、便携式固态存储器、CD ROM、RAM、前述装置的组合或类似装置。基于本文中所提供的揭示内容,所属领域的技术人员将认识到可相对于本发明的不同实施例使用的多种媒体及所述媒体的组合。
指令450在被执行时致使微处理器410经由I/O接口420接收各种I/O。所接收的I/O包含所测量入口气体流量422、424及所测量出口气体流量426。在一些情况下,所测量入口气体流量分别测量空气及氧气的流量。应注意,取决于本发明的特定实施例,可测量多于或少于两个入口气体流量。
出口气体流量426测量正从系统400呼出的气体流量。此外,所接收的I/O包含与相应入口气体流量422、424相关联的所测量入口气体压力428、430。应注意,在存在更多或更少入口气体流量的情况下,所述I/O可包含更多或更少所测量气体压力输入。此外,在本发明的一些实施例中,可提供单一气体压力输入来替代入口气体压力428、430,其中将单一气体压力传感器放置于系统400中的允许其提供有效地组合入口气体压力428、430的压力值的位置处。此外,指令450在被执行时致使微处理器410实施使用经由I/O接口420接收的I/O并提供患者努力输出440的患者努力算法。此患者努力算法可以是(但不限于)上文相对于图2及图4所论述的患者努力算法。作为实施患者努力算法的一部分,指令450致使微处理器410计算多种原本未知的系统参数,包含(但不限于)管道顺应性412(CT)、肺顺应性414(CL)、集总阻力416(RP)及泄漏量418(λLEAK)。可在多种中间计算中使用前述系统参数,其中所述中间计算中的一者或一者以上的结果提供预测患者努力输出440的结果。
另外,基于微处理器的系统400可包含图形用户接口驱动器490及图形用户接口495。图形用户接口495可以是实现将来自基于微处理器的系统400的信息以图形描绘给用户的任何接口。因此,图形用户接口495可以是此项技术中已知的任何显示器。在一些情况下,图形用户接口495可进一步包含接收来自用户的输入的能力。接收输入的能力可由(例如)触摸屏能力、键盘、鼠标及/或与图形用户接口495相关联地部署的类似装置提供。图形用户接口驱动器490可以是此项技术中已知的能够将来自基于微处理器的系统400的信息转换成可经由图形用户接口495显示的图形信息的任何电路、系统或装置。
图6是描绘根据本发明的一些实施例的用于触发换气循环的方法的流程图500。遵循流程图500,测量压力(框505),测量入口流量(框510)且测量出口流量(框515)。在一些情况下,在将换气机连接到正被换气的人的管中测量所述压力。在一些情况下,在接近气体入口处及/或在接近气体出口处测量所述压力。在其它情况下,在接近气体入口与气体出口的会合处测量所述压力。在各种情况下,压力测量为单点压力测量,而在其它情况下,压力测量为多点压力测量且所测量压力为两个或两个以上压力测量的数学组合。测量入口流量可包含测量单一气体的流量或测量两种或两种以上气体的流量及聚合多个流量值。测量出口流量可包含(但不限于)测量换气系统的出口处的气体流量。从特定瞬间的入口流量减去出口流量以产生瞬时净流量(框520)。
使用给定瞬间的净流量及所测量压力来计算患者努力的经更新预测(框525)。可使用上文相对于图4所论述的方法来完成此过程。接着确定患者努力的经更新预测是否指示开始条件(框530)。在指示开始条件的情况下(框530),触发换气循环以使其开始(框535)。作为实例,患者努力的经更新预测可以是上文曾论述的经滤波患者努力信号经滤波患者努力信号是患者努力导数的函数,如以下方程式中所阐述:
因此,预期经滤波患者努力信号在实际患者努力(pp)正降低时为负。因此,当经滤波患者努力信号变为小于零(例如,展现负零交叉,其中所述信号从正值转变为负值)时,指示吸气的开始。可使用此指示符使换气循环的开始与患者努力同步。此同步性产生经改进的患者换气。在一些情况下,一旦经滤波患者努力信号小于零,就触发换气循环以使其开始。在其它情况下,一旦经滤波患者努力信号达到预定义的负阈值或正阈值,就触发换气循环以使其开始。应注意,尽管在前述实例中使用了经滤波患者努力信号,但可类似地使用一个或一个以上其它信号。举例来说,还可使用预测误差信号因为其与实际患者努力类似地相关。基于本文中所提供的揭示内容,所属领域的技术人员将认识到可用于起始换气循环的多种其它信号。
或者,确定患者努力的经更新预测是否指示结束条件(框540)。在指示结束条件的情况下(框540),触发先前所起动的换气循环以使其终止(框545)。作为实例,患者努力的经更新预测可以是用于触发吸气的开始的相同经滤波患者努力信号。由于经滤波患者努力信号是患者努力导数的函数,因此当经滤波患者努力信号变为大于零(例如,展现正零交叉,其中所述信号从负值转变为正值)时指示吸气的结束。可使用此指示符使换气循环的终止与患者努力同步且借此提供经改进的患者换气。在一些情况下,一旦经滤波患者努力信号大于零,就触发换气循环以使其结束。在其它情况下,一旦经滤波患者努力信号达到预定义的负阈值或正阈值,就触发换气循环以使其结束。同样,应注意尽管在前述实例中使用了经滤波患者努力信号,但可类似地使用一个或一个以上其它信号。举例来说,还可使用预测误差信号因为其与实际患者努力类似地相关。基于本文中所提供的揭示内容,所属领域的技术人员将认识到可用于终止换气循环的多种其它信号。
转到图7,时序图600展示基于患者努力的代表触发多个换气循环的过程。在此情况下,患者努力的代表为经滤波患者努力信号610。展示实际患者努力信号(Pp)620以证明可使用本发明的不同实施例实现的同步性。应注意,尽管将经滤波患者努力信号610展示为循环触发器,但可类似地使用一个或一个以上其它信号。举例来说,还可使用预测误差信号因为其与实际患者努力类似地相关。基于本文中所提供的揭示内容,所属领域的技术人员将认识到可用于实现触发的多种其它信号。
如所展示,经滤波患者努力信号610通过负零交叉点612a的转变对应于实际患者吸气努力的开始622a。后续正零交叉点614a对应于呼出开始624a。此过程描绘达若干个换气循环。按照时序图600,经滤波患者努力信号610的正零交叉可用于触发换气循环的开始,且经滤波患者努力信号610的负零交叉可用于触发换气循环的结束。
图8包含:展示对应于py的压力传感器的触发的过程的时序图710、展示所估计患者努力信号的触发的过程的时序图720及展示与患者努力相关的另一信号的触发的过程的时序图730。如时序图710所展示,所述压力传感器展现噪声电平711,其中触发器阈值713将噪声缓冲器量712设定为低于预期噪声电平711以避免假触发。如所展示,对应于py的压力最终会降到低于触发器阈值713,从而导致检测到的吸气开始714(以垂直虚线表示)。检测到的吸气阈值714在实际吸气开始716(由垂直虚线表示)之后的延迟周期715内发生。如从时序图710可看出,延迟周期715的量值是噪声电平711及噪声缓冲器量712的函数。
与压力测量相关联的噪声未必和与流量测量相关联的噪声相关。在与仅使用单一测量时预期的噪声相比时,通过在所估计患者努力信号的形成中组合从压力测量及流量测量两者导出的信息,预期的噪声量通常减小。噪声缓冲器量通常是基于预期噪声的量值来选择。因此,在本发明的一些实施例中,预期噪声电平及噪声缓冲器量两者小于在单一测量系统中所展现的预期噪声电平及噪声缓冲器量。这些变量的减小允许与实际吸气开始在时间上更紧密相关的检测到的吸气。时序图720、730以图形描绘此减小的触发器延迟。
遵循时序图720,所估计患者努力信号展现相对小的噪声电平721,其中触发器阈值723将噪声缓冲器量722设定为高于预期噪声电平721以避免假触发。如所展示,所估计患者努力信号最终会超过触发器阈值723,从而导致检测到的吸气开始724(以垂直虚线表示)。检测到的吸气开始724在实际吸气开始726(由垂直虚线表示)之后的延迟周期725内发生。延迟周期725小于在仅使用单点测量时产生的延迟周期。类似地,遵循时序图730,所估计患者努力信号展现相对小的噪声电平731,其中触发器阈值733将噪声缓冲器量732设定为高于预期噪声电平731以避免假触发。如所展示,所估计患者努力信号最终会超过触发器阈值733,从而导致检测到的吸气开始734(以垂直虚线开始)。检测到的吸气开始734在实际吸气开始736(由垂直虚线表示)之后的延迟周期735内发生。延迟周期735小于在仅使用单点测量时产生的延迟周期。
转到图9,流程图800展示根据本发明的各种实施例的用于与患者努力成比例地提供换气的方法。遵循流程图800,测量压力(框805),测量入口流量(框810),且测量出口流量(框815)。在一些情况下,在将换气机连接到正被换气的人的管中测量所述压力。在一些情况下,在接近气体入口处及/或在接近气体出口处测量所述压力。在其它情况下,在接近气体入口与气体出口的会合处测量所述压力。在各种情况下,压力测量为单点压力测量,而在其它情况下,压力测量为多点压力测量且所测量压力为两个或两个以上压力测量的数学组合。测量入口流量可包含测量单一气体的流量或测量两种或两种以上气体的流量及聚合多个流量值。测量出口流量可包含(但不限于)测量换气系统的出口处的气体流量。从特定瞬间的入口流量减去出口流量以产生瞬时净流量(框820)。
使用给定瞬间的净流量及所测量压力来计算患者努力的经更新预测(框825)。可使用上文相对于图4所论述的方法来完成此过程。接着计算在瞬间将由换气机递送的气体(对应于所计算的患者努力)的所要气体递送参数(框840)。在本发明的一些实施例中,气体递送参数为流量及/或压力。在此情况下,所要的气体递送压力及流量各自为患者努力的函数。举例来说,在患者努力被确定为在由函数f(x)描述的瞬间x的值的情况下,则可使用函数g(f(x))描述在瞬间的所计算压力且可通过函数h(f(x))来描述在瞬间的所计算流量。在本发明的一个特定实施例中,函数g及函数h各自为常数乘子。在此情况下,在瞬间x的所计算压力为k1f(x)且在瞬间x的所计算流量为k2f(x),其中k1为对应于压力的常数且k2为对应于流量的常数。基于本文中所提供的揭示内容,所属领域的技术人员将认识到可相对于本发明的不同实施例使用的其它函数g、函数h。用作用于递送气体的度量的压力可以是(但不限于)Y形管压力或患者肺压力。用作用于递送气体的度量的流量可以是(但不限于)患者肺流量或入口气体流量。
接着确定患者努力的经更新预测是否指示吸气阶段(框830)。在本发明的一些实施例中,在患者努力导数大于零的情况下,指示吸气阶段。在指示吸气阶段的情况下(框830),根据先前所计算的气体递送参数将气体递送到接受者(框835)。同样,气体递送参数可包含(但不限于)将要递送到患者的气体或气体组分(例如,氧气、空气、氮气、氦气等)的压力及流量。否则,在未指示吸气阶段的情况下(框830),不提供气体递送。此方法实现以作为患者努力的函数的速率及/或压力进行气体递送。此方法实现增加的患者舒适度以及对患者自身的呼吸尝试的较小干扰。
转到图10,四个时序图910、920、930、940以图形描绘根据本发明的一个或一个以上实施例与患者努力成比例地提供换气。时序图910描绘作为时间的函数的患者努力,且时序图920描绘作为时间的函数的患者努力导数。如所展示,当患者努力导数大于零(对应于吸气阶段)时,将患者努力描述为函数f(x)。应注意,尽管时序图910将患者努力展示为随时间重复的相同函数,但取决于特定患者的呼吸模式,第一实例f1(x)912可显著不同于第二实例f2(x)914。
时序图930描绘换气机为增加Y形管连接处的压力以抵消由患者努力导致的压力降低所做的努力。如所展示,在吸气阶段期间(即,当患者努力导数大于零时),换气机尝试提升Y形管连接处的作为患者努力的函数g(f1(x))932的压力。在后续呼吸时,换气机尝试提升Y形管处的作为患者努力的函数g(f2(x))934的压力。在此特定情况下,函数g为常数k1,然而,可根据本发明的不同实施例使用其它时间变化函数。
类似地,在吸气阶段期间,换气机增加作为患者努力的函数h(f1(x))942而流到患者的气体的流量。在后续呼吸时,换气机增加作为患者努力的函数h(f2(x))944而流到患者的气体的流量。在此特定情况下,函数h为常数k2,然而,可根据本发明的不同实施例使用其它时间变化函数。在一些情况下,函数g及h可与患者努力成正比或成反比。应注意,在气体递送作为患者努力的函数而提供的意义上,可直接基于患者努力(即,患者胸膜间压力)或基于患者努力的一阶或更高阶导数来确定患者努力。
转到图11,其为根据本发明的一些实施例的实例性图形接口1000,其展示对应于主动呼吸的患者的患者努力的显示。图形接口1000包含各自作为时间的函数的经滤波患者努力1010及患者努力(pp)1020的图形显示。应注意,除了所描绘的那些指示以外或替代所描绘的那些指示,取决于本发明的特定实施例,还可显示患者努力的其它指示。
在所描绘的实施例中,跨越水平轴显示时间且跨越左轴显示相应患者努力值的值。随着时间的进行,跨越水平轴的时间增量经更新以反映围绕当前时间的窗口。另外,两个用户可移动垂直条1012、1022安置于图形1010及图形1020上方。此允许用户将开始条1012及结束条1022放置于特定时间处以测量事件。开始条1012与结束条1022之间的时间差可连同在相应时刻的经滤波患者努力及患者努力的值显示给用户。在一些情况下,可经由键盘命令或鼠标命令使用开始条1012及结束条1022。基于本文中所提供的揭示内容,所属领域的技术人员将认识到可用于相对于图形1010、1020操纵开始条1012及结束条1022的多种I/O。
另外,可计算并经由图形接口1000显示关于以图形显示的患者努力的各种度量。举例来说,可计算并显示呼吸之间的中值时间1030。可基于所定义数目的呼吸计算此中值时间,其中所述呼吸中的每一者之间的时间是从呼气的结束计算到后续吸气的开始。基于本文中所提供的揭示内容,所属领域的技术人员将了解可根据本发明的不同实施例用于计算呼吸之间的中值时间的多种方法。作为另一实例,可显示峰值呼吸努力1040。取决于特定实施方案,峰值呼吸努力1040可为在所定义数目的呼吸的过程上记录于图形1010或图形1020上的最大值。作为又一实例,可显示每呼吸的峰值努力1050。每呼吸的峰值努力1050可针对最当前呼吸指示图形1010或图形1020的峰值。或者,其可针对由开始条1012识别的呼吸指示图形1010或图形1020的峰值。作为又一实例,可显示最后吸气的持续时间1060。最后吸气的持续时间106指示针对最近的呼吸从检测到吸气的开始时直到检测到吸气的结束的时间。在一种情况下,此可通过检测患者努力的一阶导数何时超过阈值直到其返回到低于所述阈值来实现。作为另一实例,可显示最后呼气的持续时间1070。在一些情况下,可通过检测患者努力的一阶导数何时降到低于阈值直到所述一阶导数返回到高于所述阈值时的时间来计算最后呼气的持续时间1070。作为另一实例,可显示吸气的平均持续时间1080及呼气的平均持续时间1090。此可通过对若干个先前所论述的呼气持续时间及吸气持续时间求平均来计算。
转到图12,其为根据本发明的一些实施例的实例性图形接口1100,其展示对应于主动呼吸的患者的呼吸参数的显示。特定来说,图形1110描绘作为时间的函数的患者阻力参数的所估计值。在一些实施例中,患者阻力参数称为“所估计Rp”,因为其是区别于患者阻力的实际值的计算结果。应注意,尽管将图形接口1100描述为展示所估计Rp,但可根据本发明的不同实施例显示其它呼吸参数。举例来说,图形接口1100可经扩充以显示肺顺应性或泄漏量参数,其中这些另外显示的参数是使用与本文中所描述的相同或类似的方程式集确定的。基于本文中所提供的揭示内容,所属领域的技术人员将认识到可显示的多种呼吸参数。在一些情况下,所显示的呼吸参数可由监视的临床医生用来对患者进行实时评估。另一选择为或另外,所显示的呼吸参数可用于确定潜在的系统故障或指示患者与换气机断开连接。作为一个特定实例,Rp的动态增加可指示部分阻塞。基于本文中所提供的揭示内容,所属领域的技术人员将认识到可根据本发明的一个或一个以上实施例实现的多种优点。
如所展示,跨越水平轴显示时间且跨越左轴显示所估计Rp的值。在一些实施例中,随着时间的进行,跨越水平轴的时间增量经更新以反映围绕当前时间的窗口。另外,在一些实施例中,两个用户可移动垂直条1112、1113安置于图形1110上方。此允许用户将开始条1112及结束条1113放置于特定时间处以测量事件。开始条1112与结束条1113之间的时间差可连同在相应时刻的经滤波患者努力及患者努力的值显示给用户。在一些情况下,可经由键盘命令或鼠标命令使用开始条1112及结束条1113。基于本文中所提供的揭示内容,所属领域的技术人员将认识到可用于相对于图形1110操纵开始条1112及结束条1113的多种I/O。
在此特定实例中,在初始周期1120内,以五(5)cmH2O/lps的值初始化所估计Rp。此时,Rp的实际值较接近于三十(30)cmH2O/lps。在一时间周期上,用于确定所估计Rp的值的算法自适应性地调整直到所估计值近似在周期1130期间Rp的实际值。在围绕五十(50)秒标记的某一时间,从换气系统移除阻塞,从而导致Rp的实际值的明显降低。此时,所述算法通过使所估计Rp的值降低来自适应性地调整直到所估计值近似实际值。在周期1140期间,所估计Rp的值保持近似地恒定而接近Rp的实际值。
另外,可计算并经由图形接口1100显示关于以图形显示的阻力参数的各种度量。举例来说,可显示当前Rp值1150,且可显示平均Rp值1160。可通过对在特定时间周期上的若干个Rp值求平均来计算平均Rp值1160。另外,可显示视觉报警1170。每当检测到所估计Rp的值的预定义的增加或降低时,就可触发此视觉报警。应注意,图形接口1100可经扩充以显示多种其它信息。
本发明提供与患者努力成比例地递送气体的新颖系统、方法及装置。尽管上文已给出对本发明的一个或一个以上实施例的详细描述,但所属领域的技术人员将明了各种替代方案、修改形式及等效形式,此并不与本发明的精神不同。因此,以上描述不应视为限制本发明的范围,其由所附权利要求书界定。
Claims (24)
1.一种用于在动态换气系统中识别时间相依信号和/或呼吸参数的方法,所述方法包括:
测量压力并提供所测量压力;
测量入口流量及出口流量,并提供所测量净流量;
使用与所述所测量压力有关的第一值、与所述所测量净流量有关的第二值和所估计的经正规化预测误差之间的关系来提供患者努力的预测,其中所述所估计的经正规化预测误差至少部分地基于正规化信号m,输出对应于时间间隔dt的差回归量对应于时间间隔dt的差以及系统参数ΘT;及
至少部分地基于所述患者努力的所述预测而使用线性回归更新中间值。
2.根据权利要求1所述的方法,其中与患者努力有关的第三值为实际患者努力。
3.根据权利要求1所述的方法,其中与患者努力有关的第三值为患者努力的导数。
4.根据权利要求1所述的方法,其中所述方法进一步包括:
至少部分地基于所述中间值而计算所述患者努力。
5.根据权利要求4所述的方法,其中计算与患者努力有关的第三值包含基于选自由以下各项组成的群组的一个或多个值的组合而估计患者努力:所估计的经正规化预测误差(ε)、经滤波压力值(z)、回归向量()及参数向量(Θ)的当前所估计值。
6.根据权利要求1所述的方法,其中所述中间值包含来自选自以下各项的群组的一个或多个变量:时间相依信号及呼吸参数。
7.根据权利要求1所述的方法,其中所述中间值包含呼吸参数集,且其中所述呼吸参数集为包含选自以下各项的一个或多个参数的组合的向量:肺顺应性(CL)、患者阻力(RP)、管道顺应性(CT)及泄漏量(λLEAK)。
8.根据权利要求1所述的方法,其中所述中间值包含患者努力的时间相依估计量。
9.根据权利要求8所述的方法,其中所述患者努力的所述时间相依估计量为患者努力的估计。
10.根据权利要求9所述的方法,其中患者努力的所述估计基于选自由以下各项组成的群组的一个或多个值的组合:所估计的经正规化预测误差(ε)、经滤波压力值(z)、回归向量()及参数向量的当前所估计值。
11.根据权利要求1所述的方法,其中从由以下各项组成的群组选择所述第二值:所述所测量净流量的经滤波版本及所述所测量净流量。
12.根据权利要求1所述的方法,其中从由以下各项组成的群组选择所述第一值:所述所测量压力的经滤波版本及所述所测量压力。
13.根据权利要求1所述的方法,其中所述关系为参数化系统输入对输出关系。
14.根据权利要求13所述的方法,其中所述参数化系统输入对输出关系为以下回归形式:
其中:
z是系统输出,
ΘT是系统参数,
是患者努力,且
是未知的经滤波患者努力。
15.根据权利要求14所述的方法,其中从转移函数导出所述参数化系统输入对输出关系。
16.根据权利要求15所述的方法,其中从以下模型导出所述转移函数:
是在管道分支处测量的压力的一阶导数,
PY是在管道分支处测量的压力,
是患者的肺中的压力的一阶导数,
PL是患者的肺中的压力,
是患者努力的一阶导数,
CT表示管道顺应性,
CL表示肺顺应性,
Rp是患者阻力,
qAIR是入口空气流量,
qO2是入口氧气流量,
qE是出口气体流量,
qTleak是管道中的泄漏量,且
qPleak是患者中的泄漏量。
17.根据权利要求1所述的方法,其中使用近似来计算预测患者努力的估计:
其中:
是患者努力,
是未知的经滤波患者努力,
z是系统输出,且
ΘT是系统参数。
18.根据权利要求1所述的方法,其中提供所述所测量净流量包含:
对至少所述入口流量与所述出口流量进行数学组合以产生所述所测量净流量。
19.一种用于操作换气机的方法,包括:
接收压力;
接收入口流量;
接收出口流量;
至少部分地基于所述入口流量及所述出口流量而计算净流量;
使用与所述压力有关的第一值、与所述净流量有关的第二值和所估计的经正规化预测误差之间的关系来提供患者努力的预测,其中所述所估计的经正规化预测误差至少部分地基于正规化信号m,输出对应于时间间隔dt的差回归量对应于时间间隔dt的差以及系统参数ΘT;及
至少部分地基于所述患者努力的所述预测而使用线性回归更新中间值。
20.根据权利要求19所述的方法,其进一步包括:
至少部分地基于所述中间值而计算患者努力值。
21.一种用于在动态换气系统中识别时间相依信号和/或呼吸参数的方法,所述方法包括:
接收一个或多个参数的参数集;
测量压力并提供所测量压力;
测量入口流量及出口流量,并提供所测量净流量;
使用与所述所测量压力有关的第一值、与所述所测量净流量有关的第二值和至少部分地基于正规化信号m,输出对应于时间间隔dt的差回归量对应于时间间隔dt的差以及系统参数ΘT的所述参数集之间的关系来提供患者努力的预测;及
至少部分地基于所述患者努力的所述预测而使用线性回归更新中间值。
22.根据权利要求21所述的方法,其中所述参数集包括与回路阻力有关的参数。
23.根据权利要求21所述的方法,其中所述参数集包括与回路顺应性有关的参数。
24.一种换气机,所述换气机包括:
气体入口;
气体出口;
管,其耦合所述气体入口与所述气体出口;
压力传感器,其中所述压力传感器可操作以提供指示所述管中的压力的所测量压力值;
第一流量传感器,其中所述第一流量传感器可操作以提供指示与所述气体入口相关联的流量的入口流量值;
第二流量传感器,其中所述第二流量传感器可操作以提供指示与所述气体出口相关联的流量的出口流量值;
其中,所述换气机配置为根据如权利要求19所述的方法来操作。
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2009
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