DK2603138T3 - Anordninger og fremgangsmåder til monitorering af respirationsvariation ved måling af respirationsvolumener, bevægelse og variabilitet - Google Patents
Anordninger og fremgangsmåder til monitorering af respirationsvariation ved måling af respirationsvolumener, bevægelse og variabilitet Download PDFInfo
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- DK2603138T3 DK2603138T3 DK11817179.2T DK11817179T DK2603138T3 DK 2603138 T3 DK2603138 T3 DK 2603138T3 DK 11817179 T DK11817179 T DK 11817179T DK 2603138 T3 DK2603138 T3 DK 2603138T3
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Claims (14)
1. Anordning (200) til vurdering af en patient (230), hvilken anordning omfatter: en signalkilde (205), der omfatter en funktionsgenerator (210) konfigureret til at generere et elektrisk signal; en sensor (230), der er konfigureret til at modtage det elektriske signal, efter at det har passeret gennem en patient, og til at frembringe en udlæsning, der er proportional med patientens impedans; en mikroprocessor (275), hvilken mikroprocessor er konfigureret til at styre både signalkilden og sensoren; en indlæsningsanordning (190), der er konfigureret til at kommunikere med mikroprocessoren (275), hvor mikroprocessoren er programmeret til at: opnå en kalibreringskoefficient baseret på en bioelektrisk impedansanalyse af patienten og endvidere på mindst én af: demografiske informationer om patienten, der er indlæst via indlæsningsanordningen, og anatomiske målinger af patienten, der er indlæst via indlæsningsanordningen; styre signalkilden (205) til at frembringe et andet elektrisk signal efter opnåelse af kalibreringskoefficienten, hvorved det andet signal modtages af sensoren (235), efter af det andet signal har passeret gennem patienten; og analysere det modtagne andet signal for at tilvejebringe mindst én af patientens minutventilation, tidal-volumen og respirationsrate baseret på det modtagne andet signal og kalibreringskoefficienten.
2. Anordning (200) ifølge krav 1, hvor kalibreringskoefficienten endvidere er baseret på mindst én af: patientens målte EKG-signaler, patientens baseline-impedansniveauer, målinger fra et spirometer og målinger fra en ventilator.
3. Anordning (200) ifølge et hvilket som helst af kravene 1-2, hvor analysen af det modtagne andet signal tilvejebringer én eller flere af patientens respirationstryk, patientens respirationsflow, patientens sluttidal-CCh, patientens sublinguale CO2 og patientens respirationsintensitet, formen af patientens respirationskurve, ændring i formen af patientens respirationskurve, en respirationskurve baseret på patientens inhalerede volumen, en respirationskurve baseret på patientens ekshalerede volumen, en respirationskurve baseret på patientens inhalerede tryk, en respirationskurve baseret på patientens ekshalerede tryk, en respirationskurve baseret på patientens inhalerede flow, en respirationskurve baseret på patientens ekshalerede flow, en respirationskurve baseret på bevægelse af patientens bryst målt ved billeddannelse, en respirationskurve baseret på bevægelse af patientens bryst målt med kontaktsensorer placeret på brystet, en respirationskurve baseret på bevægelse af patientens abdomen målt ved billeddannelse, en respirationskurve baseret på bevægelse af patientens abdomen målt med kontaktsensorer placeret på abdomen, en respirationskurve baseret på bevægelse af både patientens bryst og abdomen målt ved billeddannelse, en respirationskurve baseret på bevægelse af patientens bryst og abdomen målt med kontaktsensorer placeret på brystet og abdomen, variation af patientens indåndingsintervaller, faseforsinkelse mellem patientens impedans- og volumensignal, variation af faseforsinkelse mellem patientens impedans- og volumensignal eller kombinationer deraf.
4. Anordning (200) ifølge krav 1 eller krav 2, hvor analysen af det modtagne andet signal tilvejebringer en variabilitet, variation eller kompleksitet i mindst én af patientens respirationsrate, patientens respirationstryk, patientens respirationsflow, en patients sluttidal-C02, patientens sublinguale CO2 og patientens respirationsintensitet, en måling, der vurderer variabilitet, variation eller kompleksitet af mindst én af formen af patientens respirationskurve, ændring i formen af patientens respirationskurve, en respirationskurve baseret på patientens inhalerede volumen, en respirationskurve baseret på patientens ekshalerede volumen, en respirationskurve baseret på patientens inhalerede tryk, en respirationskurve baseret på patientens ekshalerede tryk, en respirationskurve baseret på patientens inhalerede flow, en respirationskurve baseret på patientens ekshalerede flow, en respirationskurve baseret på bevægelse af patientens bryst målt ved billeddannelse, en respirationskurve baseret på bevægelse af patientens bryst målt med kontaktsensorer placeret på brystet, en respirationskurve baseret på bevægelse af patientens abdomen målt ved billeddannelse, en respirationskurve baseret på bevægelse af patientens abdomen målt med kontaktsensorer placeret på abdomen, en respirationskurve baseret på bevægelse af både patientens bryst og abdomen målt ved billeddannelse, en respirationskurve baseret på bevægelse af patientens bryst og abdomen målt med kontaktsensorer placeret på brystet og abdomen, variation af patientens indåndingsintervaller, faseforsinkelse mellem personens impedans- og volumensignal, variation af faseforsinkelse mellem personens impedans- og volumensignal, eller kombinationer deraf.
5. Anordning (200) ifølge et hvilket som helst foregående krav, hvor analysen af det modtagne andet signal tilvejebringer mindst én måling udvalgt fra gruppen bestående af en beregning eller estimering af patientens levedygtighed, af alvorsgraden af patientens læsion, en vurdering af patientens sandsynlighed for kollaps, en vurdering af patientens sandsynlighed for at lide af respirationsinsufficiens, en vurdering af patientens anæstesidybde, en vurdering af patientens lægemiddeldoseringsniveau, en vurdering af patientens sandsynlighed for kardiopulmonal insufficiens, en vurdering af sandsynligheden for udstyrsfejl for udstyr, der er forbundet med behandling af patienten, og kombinationer deraf.
6. Anordning (200) ifølge et hvilket som helst foregående krav, der endvidere omfatter mindst ét impedansmåleelement (220) med én eller flere fj emsonder, hvor mikroprocessoren (275) endvidere er programmeret til at analysere ét eller flere fj emsondedatasæt indsamlet fra den ene eller flere fj emsonder; eventuelt hvor mikroprocessoren endvidere er programmeret eller konfigureret til at forbedre mindst én af flerheden af fj emsondedatasæt, eller til at stabilisere mindst ét af flerheden af fj emsonde datasæt, eller til at analysere hvert af flerheden af fj emsondedatasæt ud fra værdier for dynamisk interval og si gnal-til-støj-forhold (SNR).
7. Anordning (200) ifølge krav 6, der endvidere omfatter én eller flere akustikfrembringende anordninger og én eller flere akustikregistreringsanordninger til indsamling af akustiske målinger, hvor de akustiske målinger sammenlignes med impedansdata for at øge si gnal-til-støj-forholdet.
8. Anordning (200) ifølge et hvilket som helst foregående krav, hvor den mindst ene af patientens minutventilation, tidal-volumen og respirationsrate endvidere analyseres ved hjælp af en fremgangsmåde udvalgt fra gruppen bestående af en lineær fremgangsmåde, en nonlineær fremgangsmåde, en entropifremgangsmåde, en fremgangsmåde med fordelingslighed og ffaktaldimensioner, en variabilitetsanalysemetode, en kompleksitetsanalysemetode eller kombinationer deraf; og/eller hvor den yderligere analyse af det mindst ene respirationsparameter omfatter korrelering af det mindst ene respirationsparameter med en foruddefmeret respirationstilstand.
9. Anordning (200) ifølge et hvilket som helst foregående krav, hvor analysen af det modtagne andet signal tilvejebringer et indeks for respirationsinsufficiens, der anvendes som et diagnostisk eller monitoreringsredskab.
10. Anordning ifølge et hvilket som helst foregående krav, hvor et registreringskredsløb inde i mikroprocessoren kan justeres ved anvendelse af én eller flere af demografiske, impedans- og anatomiske data, således at patientens vurderede respirationsvolumen ligger inden for én af 20 %, 10 %, 5 % eller 2% af et målt respirationsvolumen for en patient, der anvender en ventilator eller et spirometer.
11. Anordning (200) ifølge et hvilket som helst foregående krav, hvor mikroprocessoren, baseret på det vurderede mindst ene respirationsparameter, hvoraf ét bestemmer effekten af ét eller flere lægemidler eller medicinske indgreb på patienten, tilvejebringer informationer, der understøtter extubering af patienten, foreslår extubering af patienten, tilvejebringer informationer, der understøtter justering af patientterapier eller -medicineringer, foreslår justering af patientterapier eller -medicineringer, tilvejebringer informationer, der understøtter justering af ventilatorindstillinger, foreslår justering af ventilatorindstillinger, tilvejebringer informationer, der understøtter justering af patientens afvænning fra ventilation, foreslår patientens afvænning ffa ventilation, tilvejebringer informationer til vurdering af en patients status før, under eller efter kirurgisk indgreb eller medicinsk procedure, monitorerer for luftlækager, monitorerer for ukorrekt ventilation, monitorerer udfoldelse, monitorerer stressniveauer og monitorerer sygdoms- eller medicinsk tilstand.
12. Anordning (200) ifølge et hvilket som helst foregående krav, der endvidere omfatter to demodulatorer, hvor den første demodulator filtrerer et signal med et generatorsignal som en bærer og den anden demodulator filtrerer signalet med 90-graders faserotationskredsløb før demodulering.
13. Anordning (200) ifølge et hvilket som helst foregående krav, hvor sensoren (230) er en bipolær eller tetrapolær impedanssensor med én eller flere målekanaler placeret på patientens abdomen eller thorax; fortrinsvis hvor kalibreringskoefficienten er afledt af én eller flere af følgende patientspecifikke målinger: total kropsimpedans, bioelektriske impedansmålinger, gennemsnitlig eller baseline-impedans på målekanalen, EKG-signal opfanget på forskellige steder, antropomorfe målinger.
14. Anordning (200) ifølge et hvilket som helst foregående krav, der endvidere omfatter adaptiv elektronik styret af mikroprocessoren (275) og forskellige forstærkere (240, 270), hvor den adaptive elektronik bevarer forstærkningerne på de forskellige forstærkere for at forhindre, at signalet kommer uden for rækkevidde; fortrinsvis hvor mikroprocessoren sporer og justerer de indstillede forstærkninger ved hver af forstærkerne.
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