US20150265833A1 - Transvascular diaphragm pacing systems and methods of use - Google Patents
Transvascular diaphragm pacing systems and methods of use Download PDFInfo
- Publication number
- US20150265833A1 US20150265833A1 US14/410,022 US201314410022A US2015265833A1 US 20150265833 A1 US20150265833 A1 US 20150265833A1 US 201314410022 A US201314410022 A US 201314410022A US 2015265833 A1 US2015265833 A1 US 2015265833A1
- Authority
- US
- United States
- Prior art keywords
- breath
- stimulation
- diaphragm
- patient
- ventilator
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Abandoned
Links
- 238000000034 method Methods 0.000 title claims abstract description 83
- 230000000638 stimulation Effects 0.000 claims abstract description 249
- 210000003105 phrenic nerve Anatomy 0.000 claims abstract description 81
- 210000001321 subclavian vein Anatomy 0.000 claims abstract description 10
- 210000002620 vena cava superior Anatomy 0.000 claims abstract description 9
- 230000000241 respiratory effect Effects 0.000 claims description 32
- 230000007115 recruitment Effects 0.000 claims description 23
- 230000004936 stimulating effect Effects 0.000 claims description 23
- 230000008859 change Effects 0.000 claims description 15
- 210000004072 lung Anatomy 0.000 claims description 11
- 230000007383 nerve stimulation Effects 0.000 claims description 9
- 230000033001 locomotion Effects 0.000 claims description 5
- 230000000284 resting effect Effects 0.000 claims description 4
- 238000002347 injection Methods 0.000 claims description 3
- 239000007924 injection Substances 0.000 claims description 3
- 230000005540 biological transmission Effects 0.000 claims description 2
- 238000006073 displacement reaction Methods 0.000 claims description 2
- 230000001960 triggered effect Effects 0.000 claims description 2
- 210000004204 blood vessel Anatomy 0.000 claims 5
- 210000004731 jugular vein Anatomy 0.000 claims 3
- 230000029058 respiratory gaseous exchange Effects 0.000 abstract description 19
- 208000020538 atrophic muscular disease Diseases 0.000 abstract description 16
- 230000003519 ventilatory effect Effects 0.000 abstract description 15
- 210000003205 muscle Anatomy 0.000 abstract description 10
- 208000028399 Critical Illness Diseases 0.000 abstract description 8
- 238000002627 tracheal intubation Methods 0.000 abstract description 5
- 230000006735 deficit Effects 0.000 abstract description 4
- 210000003462 vein Anatomy 0.000 abstract description 4
- 206010028289 Muscle atrophy Diseases 0.000 abstract description 3
- 208000014674 injury Diseases 0.000 abstract description 3
- 238000003780 insertion Methods 0.000 abstract description 3
- 230000037431 insertion Effects 0.000 abstract description 3
- 230000020763 muscle atrophy Effects 0.000 abstract description 3
- 201000000585 muscular atrophy Diseases 0.000 abstract description 3
- 208000012902 Nervous system disease Diseases 0.000 abstract description 2
- 208000025966 Neurological disease Diseases 0.000 abstract description 2
- 208000002193 Pain Diseases 0.000 abstract description 2
- 206010040047 Sepsis Diseases 0.000 abstract description 2
- 230000036407 pain Effects 0.000 abstract description 2
- 238000002644 respiratory therapy Methods 0.000 abstract description 2
- 230000008733 trauma Effects 0.000 abstract description 2
- 238000002560 therapeutic procedure Methods 0.000 description 41
- 230000004044 response Effects 0.000 description 29
- 238000009423 ventilation Methods 0.000 description 25
- 206010016256 fatigue Diseases 0.000 description 22
- 238000004422 calculation algorithm Methods 0.000 description 17
- 230000006870 function Effects 0.000 description 14
- 230000003434 inspiratory effect Effects 0.000 description 14
- 238000012545 processing Methods 0.000 description 14
- 238000001514 detection method Methods 0.000 description 13
- 238000012544 monitoring process Methods 0.000 description 13
- 230000001105 regulatory effect Effects 0.000 description 13
- 230000008602 contraction Effects 0.000 description 10
- 239000000835 fiber Substances 0.000 description 10
- 238000010586 diagram Methods 0.000 description 9
- 210000005036 nerve Anatomy 0.000 description 9
- 238000004891 communication Methods 0.000 description 8
- 238000005399 mechanical ventilation Methods 0.000 description 8
- 230000001419 dependent effect Effects 0.000 description 7
- 230000000694 effects Effects 0.000 description 7
- 210000002345 respiratory system Anatomy 0.000 description 7
- 206010039897 Sedation Diseases 0.000 description 6
- 208000010285 Ventilator-Induced Lung Injury Diseases 0.000 description 6
- 230000008901 benefit Effects 0.000 description 6
- 230000036461 convulsion Effects 0.000 description 6
- 230000008569 process Effects 0.000 description 6
- 230000036280 sedation Effects 0.000 description 6
- 230000002269 spontaneous effect Effects 0.000 description 6
- 230000003068 static effect Effects 0.000 description 6
- 230000003247 decreasing effect Effects 0.000 description 5
- 238000005259 measurement Methods 0.000 description 5
- 210000001087 myotubule Anatomy 0.000 description 5
- CURLTUGMZLYLDI-UHFFFAOYSA-N Carbon dioxide Chemical compound O=C=O CURLTUGMZLYLDI-UHFFFAOYSA-N 0.000 description 4
- 208000035873 Ventilator-induced diaphragmatic dysfunction Diseases 0.000 description 4
- QVGXLLKOCUKJST-UHFFFAOYSA-N atomic oxygen Chemical compound [O] QVGXLLKOCUKJST-UHFFFAOYSA-N 0.000 description 4
- 229910052760 oxygen Inorganic materials 0.000 description 4
- 239000001301 oxygen Substances 0.000 description 4
- 230000035790 physiological processes and functions Effects 0.000 description 4
- 208000020431 spinal cord injury Diseases 0.000 description 4
- 210000000779 thoracic wall Anatomy 0.000 description 4
- 206010035664 Pneumonia Diseases 0.000 description 3
- 230000004913 activation Effects 0.000 description 3
- 210000003050 axon Anatomy 0.000 description 3
- 230000009286 beneficial effect Effects 0.000 description 3
- 239000008280 blood Substances 0.000 description 3
- 210000004369 blood Anatomy 0.000 description 3
- 238000004364 calculation method Methods 0.000 description 3
- 210000000038 chest Anatomy 0.000 description 3
- 230000007423 decrease Effects 0.000 description 3
- 238000002955 isolation Methods 0.000 description 3
- 210000002161 motor neuron Anatomy 0.000 description 3
- 230000009467 reduction Effects 0.000 description 3
- 230000001360 synchronised effect Effects 0.000 description 3
- 238000012360 testing method Methods 0.000 description 3
- 230000036962 time dependent Effects 0.000 description 3
- 206010002091 Anaesthesia Diseases 0.000 description 2
- 206010066131 Congenital central hypoventilation syndrome Diseases 0.000 description 2
- 208000003443 Unconsciousness Diseases 0.000 description 2
- 208000009470 Ventilator-Associated Pneumonia Diseases 0.000 description 2
- 230000003044 adaptive effect Effects 0.000 description 2
- 230000002411 adverse Effects 0.000 description 2
- 230000037005 anaesthesia Effects 0.000 description 2
- 230000033228 biological regulation Effects 0.000 description 2
- 229910002092 carbon dioxide Inorganic materials 0.000 description 2
- 230000006378 damage Effects 0.000 description 2
- 230000003111 delayed effect Effects 0.000 description 2
- 238000011161 development Methods 0.000 description 2
- 230000018109 developmental process Effects 0.000 description 2
- 201000010099 disease Diseases 0.000 description 2
- 208000037265 diseases, disorders, signs and symptoms Diseases 0.000 description 2
- 230000002496 gastric effect Effects 0.000 description 2
- 238000002513 implantation Methods 0.000 description 2
- 238000002690 local anesthesia Methods 0.000 description 2
- 238000007726 management method Methods 0.000 description 2
- 238000004519 manufacturing process Methods 0.000 description 2
- 230000003278 mimic effect Effects 0.000 description 2
- 239000000203 mixture Substances 0.000 description 2
- 230000036961 partial effect Effects 0.000 description 2
- 230000001830 phrenic effect Effects 0.000 description 2
- 230000006461 physiological response Effects 0.000 description 2
- 238000004088 simulation Methods 0.000 description 2
- 210000002027 skeletal muscle Anatomy 0.000 description 2
- 238000003860 storage Methods 0.000 description 2
- 238000010200 validation analysis Methods 0.000 description 2
- 210000005166 vasculature Anatomy 0.000 description 2
- 206010011409 Cross infection Diseases 0.000 description 1
- 208000000782 Intrinsic Positive-Pressure Respiration Diseases 0.000 description 1
- 206010049565 Muscle fatigue Diseases 0.000 description 1
- 206010028347 Muscle twitching Diseases 0.000 description 1
- 208000037581 Persistent Infection Diseases 0.000 description 1
- 208000027418 Wounds and injury Diseases 0.000 description 1
- 230000001133 acceleration Effects 0.000 description 1
- 230000036982 action potential Effects 0.000 description 1
- 238000003491 array Methods 0.000 description 1
- 238000000418 atomic force spectrum Methods 0.000 description 1
- 230000002051 biphasic effect Effects 0.000 description 1
- 239000001569 carbon dioxide Substances 0.000 description 1
- 238000006243 chemical reaction Methods 0.000 description 1
- 230000001143 conditioned effect Effects 0.000 description 1
- 230000003750 conditioning effect Effects 0.000 description 1
- 230000009989 contractile response Effects 0.000 description 1
- 238000011217 control strategy Methods 0.000 description 1
- 230000001276 controlling effect Effects 0.000 description 1
- 238000007796 conventional method Methods 0.000 description 1
- 230000002939 deleterious effect Effects 0.000 description 1
- 238000011156 evaluation Methods 0.000 description 1
- 238000001914 filtration Methods 0.000 description 1
- 238000001595 flow curve Methods 0.000 description 1
- 239000007789 gas Substances 0.000 description 1
- 230000014509 gene expression Effects 0.000 description 1
- 238000002695 general anesthesia Methods 0.000 description 1
- 230000007407 health benefit Effects 0.000 description 1
- 238000001727 in vivo Methods 0.000 description 1
- 208000015181 infectious disease Diseases 0.000 description 1
- 230000000977 initiatory effect Effects 0.000 description 1
- 238000007918 intramuscular administration Methods 0.000 description 1
- 230000007774 longterm Effects 0.000 description 1
- 230000001537 neural effect Effects 0.000 description 1
- 230000007658 neurological function Effects 0.000 description 1
- 230000002232 neuromuscular Effects 0.000 description 1
- 244000144985 peep Species 0.000 description 1
- 230000000737 periodic effect Effects 0.000 description 1
- 230000002028 premature Effects 0.000 description 1
- 230000007425 progressive decline Effects 0.000 description 1
- 230000000750 progressive effect Effects 0.000 description 1
- 230000002035 prolonged effect Effects 0.000 description 1
- 230000017854 proteolysis Effects 0.000 description 1
- 239000003642 reactive oxygen metabolite Substances 0.000 description 1
- 238000011084 recovery Methods 0.000 description 1
- 230000002829 reductive effect Effects 0.000 description 1
- 230000008672 reprogramming Effects 0.000 description 1
- 230000036387 respiratory rate Effects 0.000 description 1
- 230000002441 reversible effect Effects 0.000 description 1
- 210000005245 right atrium Anatomy 0.000 description 1
- 238000012216 screening Methods 0.000 description 1
- 238000001228 spectrum Methods 0.000 description 1
- 238000001356 surgical procedure Methods 0.000 description 1
- 230000002459 sustained effect Effects 0.000 description 1
- 208000011580 syndromic disease Diseases 0.000 description 1
- 230000001225 therapeutic effect Effects 0.000 description 1
- 210000001364 upper extremity Anatomy 0.000 description 1
- 230000002747 voluntary effect Effects 0.000 description 1
Images
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/3605—Implantable neurostimulators for stimulating central or peripheral nerve system
- A61N1/3606—Implantable neurostimulators for stimulating central or peripheral nerve system adapted for a particular treatment
- A61N1/3611—Respiration control
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/08—Detecting, measuring or recording devices for evaluating the respiratory organs
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
- A61M16/0057—Pumps therefor
- A61M16/0066—Blowers or centrifugal pumps
- A61M16/0069—Blowers or centrifugal pumps the speed thereof being controlled by respiratory parameters, e.g. by inhalation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
- A61M16/021—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes operated by electrical means
- A61M16/022—Control means therefor
- A61M16/024—Control means therefor including calculation means, e.g. using a processor
- A61M16/026—Control means therefor including calculation means, e.g. using a processor 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
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/02—Details
- A61N1/04—Electrodes
- A61N1/05—Electrodes for implantation or insertion into the body, e.g. heart electrode
- A61N1/0551—Spinal or peripheral nerve electrodes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/02—Details
- A61N1/04—Electrodes
- A61N1/05—Electrodes for implantation or insertion into the body, e.g. heart electrode
- A61N1/056—Transvascular endocardial electrode systems
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/3601—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation of respiratory organs
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/3605—Implantable neurostimulators for stimulating central or peripheral nerve system
- A61N1/36128—Control systems
- A61N1/36135—Control systems using physiological parameters
- A61N1/36139—Control systems using physiological parameters with automatic adjustment
-
- H—ELECTRICITY
- H03—ELECTRONIC CIRCUITRY
- H03M—CODING; DECODING; CODE CONVERSION IN GENERAL
- H03M9/00—Parallel/series conversion or vice versa
-
- H—ELECTRICITY
- H04—ELECTRIC COMMUNICATION TECHNIQUE
- H04J—MULTIPLEX COMMUNICATION
- H04J3/00—Time-division multiplex systems
- H04J3/02—Details
- H04J3/06—Synchronising arrangements
- H04J3/0635—Clock or time synchronisation in a network
- H04J3/0638—Clock or time synchronisation among nodes; Internode synchronisation
- H04J3/0658—Clock or time synchronisation among packet nodes
- H04J3/0661—Clock or time synchronisation among packet nodes using timestamps
- H04J3/0664—Clock or time synchronisation among packet nodes using timestamps unidirectional timestamps
-
- H—ELECTRICITY
- H04—ELECTRIC COMMUNICATION TECHNIQUE
- H04J—MULTIPLEX COMMUNICATION
- H04J3/00—Time-division multiplex systems
- H04J3/02—Details
- H04J3/06—Synchronising arrangements
- H04J3/0635—Clock or time synchronisation in a network
- H04J3/0638—Clock or time synchronisation among nodes; Internode synchronisation
- H04J3/0658—Clock or time synchronisation among packet nodes
- H04J3/0661—Clock or time synchronisation among packet nodes using timestamps
- H04J3/067—Details of the timestamp structure
-
- H—ELECTRICITY
- H04—ELECTRIC COMMUNICATION TECHNIQUE
- H04J—MULTIPLEX COMMUNICATION
- H04J3/00—Time-division multiplex systems
- H04J3/02—Details
- H04J3/06—Synchronising arrangements
- H04J3/0635—Clock or time synchronisation in a network
- H04J3/0685—Clock or time synchronisation in a node; Intranode synchronisation
- H04J3/0697—Synchronisation in a packet node
-
- H—ELECTRICITY
- H04—ELECTRIC COMMUNICATION TECHNIQUE
- H04L—TRANSMISSION OF DIGITAL INFORMATION, e.g. TELEGRAPHIC COMMUNICATION
- H04L5/00—Arrangements affording multiple use of the transmission path
- H04L5/22—Arrangements affording multiple use of the transmission path using time-division multiplexing
- H04L5/24—Arrangements affording multiple use of the transmission path using time-division multiplexing with start-stop synchronous converters
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
- A61M16/0003—Accessories therefor, e.g. sensors, vibrators, negative pressure
- A61M2016/0015—Accessories therefor, e.g. sensors, vibrators, negative pressure inhalation detectors
- A61M2016/0018—Accessories therefor, e.g. sensors, vibrators, negative pressure inhalation detectors electrical
- A61M2016/0024—Accessories therefor, e.g. sensors, vibrators, negative pressure inhalation detectors electrical with an on-off output signal, e.g. from a switch
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M2205/00—General characteristics of the apparatus
- A61M2205/05—General characteristics of the apparatus combined with other kinds of therapy
- A61M2205/054—General characteristics of the apparatus combined with other kinds of therapy with electrotherapy
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M2230/00—Measuring parameters of the user
- A61M2230/60—Muscle strain, i.e. measured on the user
Definitions
- PPMV positive pressure mechanical ventilation
- VDD Ventilator-Induced Diaphragmatic Dysfunction
- PPMV Central Hypoventilation Syndrome
- SCI Spinal Cord Injury
- CCHS Congenital Central Hypoventilation Syndrome
- phrenic nerve stimulation and diaphragmatic pacing use electrical stimulation to induce contraction of the diaphragm using an electrode and an external pacing control box or an implanted pacemaker device.
- the two phrenic nerves which control activation of the diaphragm, run through the thorax, along the left and right sides of the heart, and then to the diaphragm.
- Phrenic nerve stimulation is performed by electrically stimulating the phrenic nerve to control the patient's diaphragm, which may induce a respiratory cycle.
- Conventional techniques include surgically implanting a nerve cuff around the phrenic nerve (at the neck or chest level), and then delivering an electrical stimulus from an externally located controller through the cuff to the phrenic nerve. This procedure is quite invasive, requiring incisions when deploying the nerve cuffs, and quite expensive, so it is only selectively used in patients with a life-long requirement for assisted ventilation.
- the direct placement of the nerve cuffs around the phrenic nerves may damage the phrenic nerves.
- diaphragmatic pacing Another method for electrically stimulating the diaphragm is known as diaphragmatic pacing.
- diaphragmatic pacing is performed by laparoscopically implanting four electrodes directly on the diaphragm (two on each side), with electrical leads connected to a controller residing external to the body.
- Conventional diaphragmatic pacing procedures are also quite time consuming and relatively invasive, requiring incisions during implantation, presenting risk during the implantation procedure and risk of chronic infection at the lead entrance sites to the body. Accordingly, these diaphragmatic pacing systems have not heretofore been prescribed for temporary use in critically ill ICU patients.
- the diaphragmatic pacing system of the '215 Patent is employed to administer therapy to convert Type IIa (fast-type) muscle fibers to Type I (slow-type) muscle fibers in patients who have been ventilated for prolonged periods, whose muscle fibers have all atrophied and converted to Fast-type (VIDD).
- VDD Fast-type
- the therapy described in the '215 Patent will not be desirable in the treatment of critical care patients that still have both Type IIa (fast-type) muscle fibers and Type I (slow-type) and will need to have both types to successfully wean off of PPMV.
- Examples of systems and methods disclosed herein address this need and others by providing a minimally invasive nerve stimulation system that paces the phrenic nerves transvascularly via disposable endovascular electrodes that can be percutaneously placed under local anesthesia.
- pacing systems and methods can be employed to provide short periods of electrical stimulation for preventing diaphragm disuse atrophy in patients at risk of becoming ventilator-dependent and/or to rehabilitate diaphragm disuse atrophy in ventilator-dependent patients.
- the system is designed to work either in conjunction with a mechanical ventilator, causing diaphragmatic contractions in synchrony with each ventilator administered breath, intermittently synchronized to some ventilator breaths, or as a stand-alone system.
- the systems and methods may be employed just minutes or hours after first intubation of the subject.
- Such diaphragm pacing therapy is expected to prevent, reduce or reverse diaphragm disuse atrophy that typically occurs in patients who are on PPMV or are expected to require PPMV and sedation for prolonged periods and by extension, the adverse effects associated with PPMV will be avoided or reduced.
- patients may be successfully weaned from PPMV earlier than currently known methods, providing drastic health benefits to patients not to mention substantial reductions in total in-patient costs.
- a method for administering a treatment plan designed for preventing or reversing diaphragm disuse atrophy in a patient receiving respiratory assistance from a ventilator.
- the ventilator is employed to provide a breath cycle to the patient, the patient having a prescribed assist level.
- the method comprises monitoring the breath cycle of the ventilator, administering a pre-programmed stimulation signal to the patient to recruit the phrenic nerve of the patient, and regulating the diaphragm output of the patient for each breath cycle.
- the stimulation signal is administered via one or more endovascular electrodes.
- the administration of the stimulation signal can occur within a time period, such as 1 hour, 3 hours, 6 hours, 12 hours, 1 day, 3 days, and 1 week, of the patient's first reception of respiratory assistance from the ventilator.
- the method also includes obtaining data indicative of at least one of: one or more ventilator breath parameters; one or more pacing parameters; and a prescribed assist level for the patient.
- the one or more ventilator breath parameters includes timing data indicative of the duration of a ventilated breath.
- the method also includes maintaining synchrony between the delivery of the stimulation signal and the ventilator breath cycle.
- maintaining synchrony includes determining the current breath cycle via data from one or more sensors, and comparing the current breath cycle with the timing data from at least one previous breath cycle.
- recruitment of the diaphragm provides at least a portion of the prescribed assist level.
- the method further comprises determining a diaphragm contribution level attributable to the administration of the stimulation signal, wherein the prescribed assist level is the sum of the diaphragm contribution level and a ventilator contribution level.
- the simulation signal includes stimulation signal characteristics that cause the stimulation signal, when delivered to the patient, to satisfy the diaphragm contribution level.
- the diaphragm contribution level is measured in tidal volume or pressure, individually, in combination, and including components thereof.
- the prescribed diaphragm contribution level is dependent on the condition of the patient and the contractile capacity and/or functional status of the diaphragm.
- determining the contractile capacity includes measuring strength and endurance from the response of the diaphragm to test stimulation patterns.
- the condition of the patient and contractile capacity of the diaphragm and/or functional status of the phrenic nerves are assessed prior to the administration of the treatment plan and/or during administration of the treatment plan.
- determining the strength and endurance of the patient's diaphragm includes measuring maximum diaphragm output and fatigue characteristics of the diaphragm.
- monitoring the breath cycle includes sensing breath cycle data via a breath sensor discrete from and interfaced with a breathing circuit of the ventilator and the patient airway, and determining the inspiration phase and the expiration phase of the breath cycle and the duration of each phase from the sensed breath cycle data.
- monitoring the breath cycle further includes determining at least one of the amplitude and rate of change of ventilator output signals for each breath.
- administering a stimulation signal includes generating a stimulation signal in accordance with one or more pacing parameters; and delivering the stimulation signal in relation to a ventilator breath cycle.
- regulating the diaphragm output of the patient for each breath cycle includes monitoring the diaphragm output in response to the last administered stimulation signal; and comparing the diaphragm output of the last administered stimulation signal to a preset target range.
- the method can skip pacing for one breath cycle (MV-Only), but stimulate the at the next breath cycle (i.e., mechanical ventilation and diaphragm pacing. The method can then compare both of these values and regulate the next paced breath.
- monitoring the diaphragm output in response to the last administered stimulation signal includes sensing diaphragm output data via one or more sensors, wherein the diaphragm output data is indicative of one or more of: air flow, tidal volume, pressure, and/or parameters derived from combinations of flow, tidal volume and/or pressure; and processing the sensed diaphragm data to determine the diaphragm output.
- regulating the diaphragm output of the patient for each breath cycle further includes modifying the stimulation signal to be administered with the next ventilator breath if the diaphragm output of the last administered stimulation signal is outside of the preselected target range.
- the preselected target range includes a diaphragm contribution level.
- the method further comprises determining a cause if the diaphragm output of the last administered stimulation signal is outside of the preselected target range.
- the condition of the patient's diaphragm and respiratory system during administration of the treatment plan is assessed.
- the method further comprises reprogramming the stimulation signal based on the condition of the assessed diaphragm.
- assessing the diaphragm includes monitoring data indicative of flow and pressure of the ventilator breath cycle to determine timing of the end expiration delay; progressively stimulating the diaphragm with stimulating signals based on the monitored data of the ventilator breath cycle; and determining one or more functional characteristics of the diaphragm and respiratory system, wherein the one or more functional characteristics includes one or more of Maximum Static Inspiratory Pressure, Inspiratory Capacity, Work of Breathing, Pressure-Time Product, Pressure-Time Index, Electromyogram (EMG), Maximum Relaxation Rate, and Expiration Time Constant.
- EMG Electromyogram
- the diaphragm stimulation is targeted to take place during each ventilator breath in order to reduce positive pressure and reduce the risk of Ventilator Induced Lung Injury (VILI).
- VIP Ventilator Induced Lung Injury
- monitoring the breath cycle of the ventilator includes sensing signals indicative of ventilator inspiration and expiration; and calculating one or more of: inspiration phase; expiration phase; inspiration pause; expiration pause.
- administering the stimulation signal includes delivery of the stimulation signal contemporaneously with inspiration phase.
- a transvascular diaphragm pacing system for preventing or reversing diaphragm disuse atrophy in a patient receiving respiratory assistance from a ventilator.
- the system comprises at least one endovascular electrode configured to transmit a stimulation signal delivered thereto.
- the stimulation signal in some embodiments is configured to recruit a phrenic nerve of the patient, the stimulation signal in some embodiments have one or more stimulation parameters.
- the system also includes one or more sensors configured to sense breath cycle signals from an associated ventilator and diaphragm response from recruitment of the phrenic nerve, and a pulse generator coupled in electrical communication with the at least one endovascular electrode, and at least one input device configured to input data indicative of one or more aspects of a therapy plan.
- the system further includes a controller coupled in electrical communication with the one or more sensors, the at least one input device, and the pulse generator.
- the controller is some embodiments is programmed to: receive input data indicative of one or more aspects of the therapy plan, wherein the input data includes sensed signals indicative of ventilator operation and one or more pacing parameters; monitor the breath cycle signals and determine the inspiration phase and expiration phase of the breath cycle; generate the stimulation signal according to the one or more pacing parameters and delivering the generated stimulation signal to the at least one transvascular electrode at a preselected time of the ventilator breath cycle; and regulate the diaphragm output of the patient for each breath cycle.
- the controller is further programmed to regulate the diaphragm output of the patient to satisfy a prescribed assist level of the patient.
- the controller is further programmed to maintain synchrony of the delivery of the stimulation signal with the ventilator breath cycle.
- the controller is further programmed to: monitor the diaphragm output in response to the last administered stimulation signal; and compare the diaphragm output of the last administered stimulation signal to a preselected target range.
- the controller is programmed to monitor the diaphragm output by sensing diaphragm output data via one of said one or more sensors and processing the sensed diaphragm data to determine the diaphragm output, wherein the diaphragm output includes flow, tidal volume and/or pressure and/or parameters derived from combinations of flow, tidal volume and/or pressure.
- the controller is further programmed to modify the stimulation signal to be administered with the next ventilator breath if the diaphragm output of the last administered stimulation signal is outside a preselected range.
- the signal could be modified and administered at the next breath with programmed pacing (i.e., a combined breath) as some ventilator breaths may be skipped between stimulations.
- the controller is further programmed to determine a cause if the diaphragm output of the last administered stimulation signal is outside of the preselected target range.
- the controller determines that the cause is due to a variation in the respiratory mechanics of the patient, then the controller is further programmed to assess the condition of the patient's diaphragm and respiratory system during administration of the treatment plan.
- the controller is further programmed to reprogram the stimulation signal based on the condition of the assessed diaphragm.
- the controller is further programmed to assess the diaphragm by monitoring data indicative of flow and pressure of the ventilator breath cycle to determine timing of the end expiration delay, progressively stimulating the diaphragm with stimulating signals based on the monitored data of the ventilator breath cycle, and determining one or more functional characteristics of the diaphragm and respiratory system.
- the one or more functional characteristics includes one or more of Maximum Static Inspiratory Pressure, Inspiratory Capacity, Work of Breathing, Pressure-Time Product, Pressure-Time Index, EMG, Maximum Relaxation Rate, and Expiration Time Constant.
- the controller is further programmed to determine the readiness to wean from the ventilator based on the assessment of the diaphragm.
- the stimulation signal includes a doublet or triplet pulse at the beginning of the stimulation train or in the middle of the simulation train.
- a method for preventing respiratory disuse atrophy in a patient who is attached to a mechanical ventilator and receiving artificial breath cycle respiratory assistance and sedation.
- the method comprises placing a first electrode in the patient's vasculature in proximity to the left phrenic nerve, placing at second electrode in the patient's vasculature in proximity to the right phrenic nerve, and within hours of attaching the patient to the ventilator, delivering a pre-programmed stimulation signal to the first and second electrodes in order to stimulate the diaphragm in synchrony with the ventilator breath cycle.
- within hours includes one of the following: within twelve hours; within six hours, within five hours; within four hours, within three hours; and within one hour.
- a method for administering a treatment plan for preventing or speeding up reversal of diaphragm disuse atrophy in a patient receiving respiratory assistance from a ventilator.
- the ventilator provides a breath cycle to the patient and the patient has a prescribed assist level.
- the method comprises storing a measurement value indicative of a preselected range of diaphragm output, wherein the diaphragm output is at least a portion of the prescribed assist level, monitoring the breath cycle of the ventilator, administering a stimulation signal to the patient in synchrony with the breath cycle of the ventilator to recruit the diaphragm of the patient, the recruitment of the diaphragm causing a level of diaphragm output, and regulating the diaphragm output of the patient attributable to phrenic recruitment for each stimulated breath cycle in order to fall within the preselected range of diaphragm output.
- regulating the diaphragm output of the patient for each breath cycle includes monitoring the diaphragm output in response to the last administered stimulation signal, and comparing the diaphragm output of the last administered stimulation signal to the preselected range of diagram output.
- monitoring the diaphragm output in response to the last administered stimulation signal includes sensing diaphragm output data via one or more sensors, and processing the sensed diaphragm output data to determine the diaphragm output.
- the diaphragm output includes one or more of: air flow, tidal volume, pressure, and/or parameters derived from combinations of flow, tidal volume and/or pressure.
- regulating the diaphragm output of the patient for each breath cycle further includes comparing the determined diaphragm output to the preselected range of diagram output, and modifying the stimulation signal to be administered with the next ventilator breath if the diaphragm output from the last administered stimulation signal fell outside of the preselected range of diagram output.
- modifying the stimulation signal includes increasing the intensity of the stimulation signal.
- increasing the intensity includes one or more of: increasing the frequency of stimulation signal pulses; increasing the amplitude of stimulation signal pulses; and/or increasing the duration of stimulation signal pulses.
- diaphragm output includes tidal volume, pressure, or combinations thereof.
- a method for preventing diaphragm disuse atrophy in a critically ill patient.
- the method comprises attaching a patient to a ventilator, monitoring the breath cycle of the ventilator; administering, within one of twelve hours or six hours of attaching the patient to the ventilator, a pre-programmed stimulation signal to the patient to recruit the diaphragm of the patient for outputting a level of diaphragm output, and regulating the level of diaphragm output of the patient for each breath cycle based on the administration of the stimulation signal to match or exceed a preselected threshold.
- a method for constructing a therapy plan for a patient.
- the therapy plan attempts to prevent disuse atrophy or rehabilitate the patient's diaphragm.
- the method comprises assessing the diaphragm for maximum diaphragm output and fatigue characteristics, and determining one or more stimulation signals that cause diaphragm output to be a preselected percentage of the maximum diaphragm output.
- the method further comprises creating a stimulation administration plan including a series of discrete stimulation signals, wherein the series of stimulation signals can vary by rate, duration, pulse width, frequency, and amplitude.
- a method for assessing a diaphragm.
- the method comprises monitoring data indicative of flow and pressure of a ventilator breath cycle, stimulating the diaphragm with stimulating signals based on the monitored data of the ventilator breath cycle, and determining one or more functional characteristics of the diaphragm from the response generated from the stimulation of the diaphragm with the stimulation signals.
- the one or more functional characteristics including one or more of Maximum Static Inspiratory Pressure, Inspiratory Capacity, Work of Breathing, Pressure-Time Product, Pressure-Time Index, EMG, Maximum Relaxation Rate, and Expiration Time Constant.
- a transvascular diaphragm pacing system for constructing a therapy plan for a patient.
- the therapy plan in some embodiments prevents diaphragm disuse atrophy or rehabilitates the patient's diaphragm.
- the system includes at least one endovascular electrode configured to transmit a stimulation signal delivered thereto.
- the stimulation signal in some embodiments is configured to recruit a phrenic nerve of the patient and the stimulation signal has one or more stimulation parameters.
- the system also includes one or more sensors configured to sense breath cycle signals from an associated ventilator and diaphragm response from recruitment of the phrenic nerve, a pulse generator coupled in electrical communication with the at least one endovascular electrode, and at least one input device configured to input data indicative of one or more aspects of a therapy plan.
- the system further includes a controller coupled in electrical communication with the one or more sensors, the at least one input device, and the pulse generator.
- the controller is some embodiments is programmed to assess the diaphragm for maximum diaphragm output and fatigue characteristics, and determine one or more stimulation signals that cause diaphragm output to be a preselected percentage of the maximum diaphragm output.
- a transvascular diaphragm pacing system for assessing a diaphragm.
- the system includes at least one endovascular electrode configured to transmit a stimulation signal delivered thereto.
- the stimulation signal in some embodiments is configured to recruit a phrenic nerve of the patient and the stimulation signal has one or more stimulation parameters.
- the system also includes one or more sensors configured to sense breath cycle signals from the ventilator and the diaphragm response from recruitment of the phrenic nerve, a pulse generator coupled in electrical communication with the at least one endovascular electrode, and at least one input device configured to input data indicative of one or more aspects of a therapy plan.
- the system further includes a controller coupled in electrical communication with the one or more sensors, the at least one input device, and the pulse generator.
- the controller is some embodiments is programmed to: monitor data indicative of flow and pressure of a ventilator breath cycle; stimulate the diaphragm with stimulating signals based on the monitored data of the ventilator breath cycle; and determine one or more functional characteristics of the diaphragm from the response generated from the stimulation of the diaphragm with the stimulation signals.
- the one or more functional characteristics include one or more of Maximum Static Inspiratory Pressure, Inspiratory Capacity, Work of Breathing, Pressure-Time Product, Pressure-Time Index, EMG, Maximum Relaxation Rate, and Expiration Time Constant.
- FIG. 1 is a schematic diagram of one example of a transvascular diaphragm pacing system formed in accordance with aspects of the present disclosure
- FIG. 2 is a schematic diagram of the location of the left and right phrenic nerves in a patient in relation to the heart and diaphragm of the patient;
- FIG. 3A is one example of one pair of catheter-mounted phrenic nerve stimulating electrodes positioned within the left subclavian vein of the patient;
- FIG. 3B is one example of one pair of catheter-mounted phrenic nerve stimulating electrodes positioned within the superior vena cava of the patient;
- FIG. 4 is a block diagram of the components of one embodiment of the system of FIG. 1 ;
- FIG. 5 illustrates the shift in force generated when stimulating with a train that begins with a doublet/triplet
- FIG. 6 illustrates one example of the programmable parameters of each stimulation pulse as well as the ratiometric relationship between the charge injection pulse and charge balance pulse when exemplifying net-charge;
- FIG. 7 illustrates one example of three stimulation trains, in each of which the pulse width and frequency are modulated to increase from the start to end of the stimulation train to cause graded contraction of the diaphragm;
- FIG. 8 illustrates one example of three stimulation trains, in each of which the pulse width and frequency are modulated to first increase and then decrease from the start to end of the stimulation train to cause graded contraction of the diaphragm;
- FIG. 9 illustrates examples of representative ramp envelopes where the ramp slopes represent the modulations in pulse width and/or pulse frequency within a train
- FIG. 10 illustrates examples of representative pulse width ramp envelopes and stimulus frequency envelopes, which can be combined together to form a single pacing ramp
- FIG. 11 illustrates examples of timing for the start time and end time of stimulation trains generated and delivered to the phrenic nerves, relative to a ventilator breath;
- FIG. 12 illustrates other examples of timing for the stimulation trains generated and delivered to the phrenic nerves
- FIG. 13 illustrates yet other examples of timing as well as amplitude modulations for the stimulation trains generated and delivered to the phrenic nerves
- FIG. 14 illustrates one example of a process configured to carry out one or more functions of the system 20 , including but not limited to the Ventilator Initiated Pacing Mode;
- FIG. 15 illustrates one feedback scheme that may be practiced by the process of FIG. 14 and the system of FIG. 1 ;
- FIG. 16 illustrates one example of a change in respiratory mechanics during pacing in synchrony with a volume controlled mechanical ventilator
- FIG. 17A-B illustrate examples of maintaining the diaphragm output at a prescribed level despite a time dependent fatiguing and drop-out of stimulated Type IIb fibers
- FIG. 17C illustrates a process for using doublets to enhance force in fatiguing muscle
- FIG. 18 illustrates one example of progressive recruitment of nerve axons across the cross-section of the phrenic nerve and their associated motor units by increasing the pacing intensity
- FIG. 19 is a graphical representation for scaling the contribution of the system of FIG. 1 to prescribed assist level and determining one or more initial pacing parameters using, for example, a binary algorithm;
- FIG. 20A is a schematic representation of one example of scaling the contribution of the system of FIG. 1 to diaphragm response;
- FIG. 20B is a schematic representation of another example of scaling the contribution of the system of FIG. 1 to diaphragm response;
- FIG. 21 is a graphical representation of one example of calculating the Work of Breathing (WOB), the calculation in turn used to regulate diaphragm contribution;
- WOB Work of Breathing
- FIG. 22 is one example of a routine for assessing the diaphragm without disconnecting the patient from the ventilator
- FIGS. 23 and 24 illustrate examples of the timing of administered stimulus in relation to the phases of the breath cycle
- FIG. 25 is a graphical representation of airway pressure data obtained from a volume controlled ventilator with and without stimulation
- FIG. 26 is a graphical representation of one example of calculating the Pressure-Time Product, the calculation in turn used to regulate diaphragm contribution.
- FIG. 27 is one example of an assessment routine carried out by the system of FIG. 1 ;
- FIG. 28 is a graphical representation of end expiratory pauses, sometimes referred to as quiet periods
- FIG. 29 is one example of a routine for determining the duration of the end-expiratory pause
- FIG. 30 is a schematic diagram showing one example of a Pacer-Initiated Ventilation Mode that can be carried out by one or more embodiments of the system shown in FIG. 1 ;
- FIG. 31 illustrates the relationship between the pacing system and the ventilator in Pacer-Initiated Ventilation Mode
- FIG. 32 is a schematic diagram showing one example of a pacing system operating in an Autonomous Mode.
- FIG. 33A-C graphically represent the benefits of examples of the system of FIG. 1 in preventing diaphragm disuse atrophy or rehabilitating the diaphragm for successful weaning from respiratory assistance.
- TDPS transvascular diaphragm pacing systems
- Some examples of the TDPS provide rapid insertion and deployment of endovascular pacing electrodes in critically ill patients who require intubation and invasive PPMV in order to support the physiological requirements of the human ventilatory system.
- Examples described herein make best use of the contractile properties of the diaphragm muscle and prevent muscle disuse and muscle atrophy. This can be carried out by engaging the phrenic nerves using patterned functional electrical stimulation applied to endovascular electrodes that are temporarily and reversibly inserted in central veins of the patient, such as the left subclavian vein and the superior vena cava.
- the TDPS is designed to seamlessly interface with any commercially available positive-pressure ventilatory assistance/support equipment such as is commonly in use in hospital intensive care units (ICU) for treating critically ill patients with breathing insufficiencies, pain, trauma, sepsis or neurological diseases or deficits.
- ICU hospital intensive care units
- Rapid insertion and deployment of the disclosed systems can be effected via employment of minimally invasive central line catheter-based electrodes, such as those described in U.S. application Ser. No. 12/524,571, filed Jul. 25, 2009, which can be quickly installed in the patient under local anesthesia and rapidly activated, such that a pacing therapy can be initiated within one or a few hours of admission/intubation.
- pacing via electrical stimulation can proceed in synchrony with ventilator breaths provided by virtually any brand or model of commercially available positive-pressure ventilator operating in typical modes such as Control Mode, Support Mode or Assist Mode.
- the pacing catheter electrodes can be easily removed.
- system pacing follows the operation of a ventilator while in other embodiments, the ventilator initiates and/or assists a breath cycle based on physiological responses generated by the pacing system.
- FIG. 33A-C illustrate examples of employing the TDPS to prevent diaphragm disuse atrophy or rehabilitate the diaphragm for successful weaning from respiratory assistance. As a result, early and successful weaning from the ventilator can be realized.
- each phrenic nerve may be recruited using a single channel of stimulation or two or more channels of stimulation per nerve.
- An example showing one embodiment employing two channels of stimulation per phrenic nerve is shown in FIG. 3 .
- the stimulation pulses can be delivered 180 degrees out of phase.
- the system 20 includes a stimulator 24 coupled in electrical communication (e.g., wired or wireless) with one or more transvascular electrodes 28 suitable for placement in-vivo near the left and/or right phrenic nerves.
- the stimulator 24 is configured to transmit a stimulatory signal in the form of stimulation pulses to one or more of the electrodes 28 .
- the electrodes 28 emit the stimulatory signal in the vicinity of a left and/or right phrenic nerve. Stimulation of the left and/or right phrenic nerve, in turn, aims to cause recruitment of the subject's diaphragm.
- the parameters (amplitude, duration, frequency, etc.) of stimulation pulses affect the amount of diaphragm recruitment, and the resulting output (such as tidal volume, pressure) therefrom.
- sensors 48 configured to sense various physiological parameters of the patient, some indicating diaphragm output, can provide feedback to the stimulator 24 for regulation of the administered therapy.
- the system 20 can be the sole respiratory aid for the patient.
- the system 20 operates in conjunction with a positive pressure mechanical ventilator 32 (“ventilator 32 ”) in order to satisfy the respiratory needs of the patient.
- a positive pressure mechanical ventilator 32 (“ventilator 32 ”) in order to satisfy the respiratory needs of the patient.
- signals sensed from a breath sensor 50 that monitors the breath cycle of the ventilator 32 can be employed to synchronize the delivery of the stimulation signals with the ventilator breath cycle.
- the respiratory needs of the patient are sometimes referred to as the patient's prescribed assist level.
- the prescribed assist level is generally quantified as the amount of tidal volume or pressure (or a combination of the two) provided to the patient during one breath cycle that satisfies the minimum physiological functions of the patient.
- the prescribed assist level in terms of tidal volume is approximately 7-10 mL per Kg of patient weight.
- the prescribed assist level is satisfied solely via artificial means (e.g., via system 20 , via ventilator 32 , or a combination of the two). This may occur in patients that are heavily sedated and/or unconscious.
- the prescribed assist level may include some patient initiated respiratory effort.
- the clinician can program the system 20 in order to satisfy the prescribed assist level (i.e., in tidal volume, pressure, or both) via recruitment of the diaphragm.
- the clinician can program the system 20 to contribute only a percentage of the prescribed assist level (in volume, pressure, or both), referred to herein as the diaphragm contribution or diaphragm contribution level, via electrical recruitment of the phrenic nerve or nerves.
- the percentage can vary, and is patient-dependent based on a variety of factors, such as the condition of the patient, the ailment afflicting the patient, time elapsed preceding any stimulation therapy, etc.
- the remaining percentage of the prescribed assist level can then be satisfied by the ventilator 32 , which can be appropriately programmed by the clinician at the onset of or during administration of the therapy plan.
- the system 20 carries out one or more assessments of the patient in order to determine, for example, the current condition of the patient's diaphragm, the stimulation signal characteristics that relate to the recruitment of the diaphragm, such as threshold pulse width, pulse amplitude, pulse frequency, sub-maximal pulse width, and supra-maximal pulse width, etc.
- Threshold Pulse Width refers to a minimum pulse width at and above which there is a diaphragmatic response.
- Threshold Frequency refers to a minimum frequency at and above which partly or completely fused Tetanic contractions are produced, so as to generate useful diaphragmatic force and/or work.
- the left and right phrenic nerves run along the lateral and medial side of the heart to a diaphragm D.
- the left subclavian vein traverses in proximity to the left phrenic nerve and transmits blood from the upper extremities to the heart H.
- the superior vena cava traverses near the right phrenic nerve and carries deoxygenated blood from the upper half of the body to the heart's right atrium.
- FIG. 3 illustrates one embodiment showing two channels of transvascular stimulation delivered to the left phrenic nerve by endovascular electrodes placed in the left subclavian vein and two channels of transvascular stimulation delivered to the right phrenic nerve by endovascular electrodes placed along the lateral wall of the superior vena cava.
- Each phrenic nerve can be partially or fully recruited from more than one endovascular electrode combination. Partial nerve recruitment from more than one electrode combination is useful to reduce muscle fatigue over time.
- the system 20 includes a first electrode 28 A having anodal and cathodal electrode contacts 30 A, 32 A placed within the left subclavian vein and positioned in the vicinity of the left phrenic nerve.
- a second electrode 28 B having anodal and cathodal electrode contacts 30 B, 32 B may be also placed within the left subclavian vein and positioned in the vicinity of the left phrenic nerve.
- the system 20 further includes a third electrode 28 C having anodal and cathodal electrode contacts 30 C, 32 C placed within the superior vena cava and positioned in the vicinity of the right phrenic nerve.
- a fourth electrode 28 D having anodal and cathodal electrode contacts 30 D, 32 D may be also placed within the superior vena cava and positioned in the vicinity of the right phrenic nerve.
- Electrodes While two electrodes are shown and described for stimulating each of the left and right phrenic nerves, it will be appreciated that other numbers of electrodes may be practiced with embodiments of the present disclosure. For example, four electrodes can be used for stimulating each phrenic nerve.
- U.S. application Ser. No. 12/524,571 filed Jul. 25, 2009, the disclosure of which is hereby expressly incorporated in its entirety.
- electrodes with anodal and cathodal electrode contacts are utilized to emit the stimulation pulses into the phrenic nerves, other configurations are possible. For example, several cathodal electrode contacts may be used in conjunction with a single anodal electrode contact, and vice versa.
- Each electrode 28 is connected in electrical communication with the stimulator 24 .
- each electrode 28 is electrically connected to the stimulator 24 via lead(s) 40 .
- the system 20 further includes one or more sensors 48 configured to monitor the response to phrenic nerve stimulation and/or other physiological characteristics of the patient. As will be described in more detail below, the one or more sensors 48 can be part of a feedback control scheme for regulating the stimulation administered to the patient.
- the plurality of sensors 48 can transmit data to the stimulator 24 indicative of one or more of the following: electromyographic activity (intramuscular, surface, and/or intraesophageally monitored), central venous pressure (any specific component of this signal), heart rate, chest wall acceleration, blood oxygen saturation, carbon dioxide concentration, catheter position/depth within vein, mechanical movement (i.e., from accelerometers, length gauges, and/or strain gauges) resistance (.e., from impedance pneumographs, and/or piezoresistive sensors) and/or other physiological or mechanical parameters. It will be appreciated that the information can be appropriately processed (e.g., filtered, conditioned, amplified, etc.) prior to use by the stimulator 24 .
- volume includes, but is not limited to, Inspired Tidal Volume, Expired Tidal Volume or Minute Volume.
- pressure as used herein includes, but is not limited to, Airway Pressure, Alveolar Pressure, Ventilator Pressure, Esophageal Pressure, Gastric Pressure, Transdiaphragmatic Pressure, Intra-Thoracic Pressure Positive End-Expiratory Pressure or Pleural Pressure. Any pressure may be Peak Pressure, Mean Pressure or Baseline Pressure.
- flow as used herein includes, but is not limited to, Inspiratory Flow or Expiratory Flow.
- the electrodes 28 can also monitor physiological variables of the subject by virtue of their placement in the central veins.
- monitored physiological variables can include, but are not limited to: central venous pressure, electrocardiogram, and mixed venous oxygen saturation.
- one or more sensors discrete from the electrodes, such as one or more of the sensors 48 may be used to monitor such physiological variables.
- the system 20 can additionally or alternatively include a breath sensor 50 for sensing parameters of the ventilator 32 .
- the breath sensor 50 can be configured to interface with any standard breathing circuit used in critical care ventilators and therefore the pacing system is independent of the brand of ventilator used.
- the breath sensor 50 by virtue of its location in the breathing circuit, can monitor and/or measure several ventilation parameters and communicate such parameters to the stimulator 24 .
- the breath sensor 50 can be part of or used solely as a feedback control scheme for regulating the stimulation administered to the patient.
- the sensed ventilation parameters may include, but not limited to, airflow (inspired and/or expired), volume, pressure (airway, esophageal, gastric, and/or some combination/derivative of the former).
- other sensors may aid in the procurement of one or more ventilation parameters.
- the example parameters are being measured both to and from the ventilator 32 .
- the breath sensor 50 is external to the ventilator 32 so that the system is independent of ventilator model.
- the system 20 could also be integrated to use a ventilator's internal sensors or signals externally supplied by the ventilator can provide the information to the system 20 for proper operation so that an external breath sensor can be omitted.
- the stimulator 24 functions, in part, as a signal generator for providing therapy to the diaphragm in response to information received from the one or more of the sensors 48 and 50 and/or information programmed into the system 20 by the clinician.
- the stimulator 24 delivers pulses to the endovascular electrodes 28 in accordance with one or more protocols described herein.
- the pulses in some embodiments are generated by the stimulator 24 with characteristics that deliver a suitable charge to the phrenic nerves in order to provide enough diaphragm recruitment to satisfy the selected diaphragm contribution (e.g., in volume, pressure, both, or derived parameters from volume and pressure) of the prescribed assist level described above.
- the stimulator 24 is configured to deliver fully programmable stimulation, including, but not limited to, the following: any number of pulses, any combination of the defined pulses, any order of delivery of the defined pulses, multiple instances of any defined pulse(s), any frequency of stimulation, and/or any delay between pulses (interpulse delay).
- Each pulse can be independently programmable (e.g., frequency, amplitude, duration, etc.).
- the stimulation pulse(s) and/or train(s) may or may not generate a repeatable pattern.
- Each pulse includes a charge injection phase and a charge balance phase (biphasic).
- the balance phase duration and amplitude is programmable as a ratio of the charge phase duration and amplitude so that zero net charge is maintained, as shown in FIG. 6 .
- This ratio denominated as the Charge:Balance Ratio (C:B Ratio)
- C:B Ratio Charge:Balance Ratio
- each pulse is programmable via the following parameters: ratio of charge phase duration to balance phase duration; pulse width range; stimulation amplitude (current level); and delay between the charge phase and the balance phase.
- Stimulation amplitude may be changed during the same phase (i.e., generate a gradually decreasing current for the charge pulse width). While zero net change is preferred, non-netzero charges may be used.
- pacing may be accomplished by delivering one or more stimulation signals to produce a mechanically effective contraction of the diaphragm.
- the stimulation signals may include a plurality of pulses that are grouped in stimulation trains.
- a stimulation train is defined as a collection of stimulation pulses. This definition does not imply a specific composition, order of delivery, and/or shape profile or envelope.
- FIGS. 7 and 8 illustrate examples of stimulation trains generated by the stimulator 24 and delivered to the electrodes 28 for stimulating the phrenic nerves.
- the stimulation trains may start with a doublet (pair of pulses) or a triplet, which can be physiologically relevant; two or three pulses in quick succession at the beginning of recruitment has been shown to increase the overall force profile by shifting the baseline up during the initial onset of recruitment, as demonstrated in FIG. 5 .
- a doublet or triplet delivered part-way through a train can cause a sustained force increase.
- the upward shift in early force production infers that fewer stimulation pulses can be used to generate the same amount of force from the diaphragm in a comparable period of time.
- Stimulation or pulse trains are typically characterized by the rate, the duration, the pulse width, the frequency, and the amplitude of the signals.
- the rate of the stimulation train corresponds to the number of stimulation trains delivered per minute, which can correlate with the patient's respiratory rate or mechanical ventilator rate.
- the duration of the stimulation train refers to the length of time the stimulation train is delivered.
- the pulse width indicates the duration of each individual pulse creating the stimulation train.
- the frequency indicates the number of individual pulses delivered per second.
- the amplitude refers to the voltage of each pulse delivered. The parameters of amplitude, frequency, and pulse width determine the strength of the induced diaphragmatic pacing.
- the stimulation trains form ramp trains.
- ramp trains can be formed by linearly increasing (or decreasing) either the instantaneous frequency of consecutive pulses in a train, the durations (pulse widths) of consecutive pulses in a train, or both.
- Ramp trains indicate that a change in injected charge is induced by the programmed stimulation parameters and any applied modulation.
- ramp envelopes can be generated during a single pacing ramp in pulse width alone, frequency alone or both in pulse width and frequency.
- Pulse width and stimulus frequency envelopes can be modulated together or combined, as shown in the examples of FIG. 10 , during pacing to generate a desired ramp train.
- combination AF will cause a graded recruitment of the phrenic motoneurons at a constant frequency (no rate coding) and Combination BA will gradually recruit and de-recruit the motoneurons, with a steadily increasing rate coding; although any combination is possible.
- pulse width and frequency modulation can be defined mathematically as piecewise functions in time, thereby allowing any desired ramp envelope to be generated while remaining within the scope of the present disclosure.
- the ramp trains aim to achieve one or more of the following: 1) mimic physiological contraction of the diaphragm by independently controlling recruitment and rate coding by means of pulse width and frequency modulation, respectively; 2) delay the onset of neuromuscular fatigue; 3) maintain the native fiber composition of the healthy diaphragm; 4) condition the diaphragm towards a specific fiber type, for e.g. Type I (Slow Twitch, Fatigue Resistant).
- a therapy plan can be constructed by the clinician with or with the aid of the system 20 .
- the therapy plan constructed by the clinician is patient dependent in order to achieve various goals.
- the therapy plan may include one or more of the following: timing of delivery of pacing in relation to ventilator breaths (e.g., every breath, every other breath, every five breaths, etc.); intermittent stimulation segments (e.g., stimulation delivery for 15 minutes every hour), etc.
- timing of delivery of pacing in relation to ventilator breaths (e.g., every breath, every other breath, every five breaths, etc.); intermittent stimulation segments (e.g., stimulation delivery for 15 minutes every hour), etc.
- a therapy plan would take into consideration both major objectives of minimizing VIDD and minimizing risk of VILI.
- the therapy plan includes the ability to skip stimulation, sometimes referred to as skipped breaths, which allows for a ventilator breath to be delivered without being accompanied by stimulation from the system 20 .
- the therapy plan may include sigh breaths. Sigh breaths are characterized as intermittently programmable breaths that inject more charge than a normal breath (i.e. a higher magnitude stimulation train). Physiologically, this results in a more forceful contraction of the diaphragm. Both functions are programmable independently and can be repeatable. For sigh breaths only, the percentage increase in amplitude is programmable based on the amplitude of a typical paced breath. It is possible to implement these features independently or combined.
- FIG. 13A-C illustrate an example of skipped breaths, sigh breaths, and a combination of skipped breaths and sigh breaths, respectively.
- FIG. 13A is an example of skipped breaths, where the system 20 skips every 3rd breath. This means that during the skipped breath, the patient receives the ventilatory support entirely from the ventilator 32 . During the skipped breaths, respiratory mechanics such as tidal volume, compliance of the lungs, resistance to airflow or the recruitment of the lung regions may vary.
- FIG. 13B is an example of sigh breaths generated by the system 20 while operating in synchrony with the ventilator 32 . In this example, a sigh breath is delivered every 3 rd breath.
- FIG. 13C is an example of both skipped and sigh breaths being administered in a periodic manner by the system 20 .
- the stimulator 24 in some embodiments is configured to generate constant-amplitude current pulses with pulse duration in the range from 50-300 microsec, controllable in increments of 10 microsec.
- the amplitude and duration of each pulse in a train can be independently programmed.
- the amplitude of pulses can be selected between 0.1 and 10 mA in 0.1 mA increments.
- the stimulator 24 can produce pulses in the range from 5 nC to 3000 nC and the charge per pulse can be specified in increments of 1 nC.
- FIG. 4 shows a schematic diagram of one embodiment of the stimulator 24 .
- the stimulator 24 includes a controller 60 , which receives signals sensed from one or more sensors 48 and/or the breath sensor 50 .
- the stimulator 24 may also include a timer 64 coupled to controller 60 , and a power source 68 .
- the controller 60 is coupled to a pulse generation circuit 70 , which delivers stimulation signals to one or more of the electrodes 28 via leads 40 .
- the components described above are coupled via bus 72 .
- the power source 68 of the stimulator 24 includes one or more batteries.
- the power source 68 includes a power regulation section that receives power from standard “mains,” and transforms it into appropriate power for the circuitry of the stimulator 24 .
- controller 60 serves as the computational center of the stimulator 24 for carrying out logic or by supporting the execution of routines, instructions, etc., for providing functionality to the stimulator 24 .
- the logic, routines, instructions, etc., described herein may be implemented in hardware, in software, or a combination of hardware and software.
- the controller 60 includes one or more processors and memory.
- the logic, routines, instructions, etc. may include a set of control algorithms, including resident program instructions and calibrations stored, for example, in the memory and executed to provide a desired functionality of the system 20 .
- the algorithms may be executed during preset loop cycles such that each algorithm is executed at least once each loop cycle.
- Algorithms stored in non-volatile storage medium can be executed by the processor to: 1) monitor inputs from the sensors 48 , 50 and other data transmitting devices or polls such devices for data to be used therein; 2) cause the pulse generator to generate and transmit one or more pulses to the electrodes 28 ; and 3) regulate the diaphragm output of the patient, among other functions.
- Loop cycles are executed at regular intervals, for example each 3.125, 6.25, 12.5, 25 and 100 milliseconds during ongoing operation of the system 20 .
- algorithms may be executed in response to the occurrence of an event.
- the term processor is not limited to integrated circuits referred to in the art as a computer, but broadly refers to a microcontroller, a microcomputer, a microprocessor, a programmable logic controller, an application specific integrated circuit, other programmable circuits, such as programmable gate arrays, combinations of the above, among others.
- the controller 60 may include additional components including but not limited to a high speed clock, analog to digital (A/D) and digital to analog (D/A) circuitry, input/output circuitry and devices (I/O) and appropriate signal conditioning and buffer circuitry.
- the signals received from the sensors 48 , 50 may be processed by an optional signal processing section 80 prior to arriving at the controller 60 .
- the signal processing section 80 may include dedicated circuits, processors, such as digital signal processors (DSP), etc., for receiving, processing and filtering electrical signals sensed by the sensors associated with the subject and/or the ventilator 32 .
- Signal processing section 80 can include amplifiers and circuits to condition, filter and/or amplify the electrical signals supplied thereto.
- the signal processing section 80 carries out discrete tasks, such as the determination of one or more physiological states.
- One physiological state that can be determined by signal processing section 80 is a patient's minute volume or ventilation.
- Minute ventilation is a respiratory related parameter that is a measure of the volume of air inhaled and exhaled during a particular period of time.
- the minute ventilation is the product of respiration rate and tidal volume.
- Signal processing section 80 can also be used to receive and process signals representing other respiratory activity such as intrathoracic pressure, chest wall motion, etc.
- the determination of one or more physiological states, processing of signals, implementation of logic or processes, etc. can be carried out solely by the controller 60 .
- the stimulator 24 includes one or more input devices 86 .
- the input devices 86 may include switches, knobs, etc., supported by the housing of the stimulator, and/or computer style devices, such as a keyboard, a touchpad, etc.
- the input devices 86 provide for the input of data, such as the pacing parameters, ventilator parameters, etc., into the stimulator 24 .
- Output devices 92 such as a monitor, may also be provided.
- one or more embodiments of the system 20 can be operated in various pacing modes.
- the pacing modes may be alternatively employed by a clinician, depending on the clinical status and needs of each patient and on the operational properties of a ventilator, such as ventilator 32 , which may be available in a particular ICU.
- the pacing modes can include but are not limited to Ventilator-Initiated Pacing Mode, Pacer-Initiated Ventilation Mode, and Autonomous Pacing Mode.
- these modes may be engaged in many ways to generate different combinations of system functionality, but for reasons of brevity all possible combinations are not listed herein. Each of these modes will now be described in some detail.
- the first mode of the system 20 to be described herein is the Ventilator Initiated Pacing Mode.
- this mode operates the stimulator 24 in synchrony with the operation of the ventilator 32 .
- This mode can work with any mechanical ventilator in control mode, whereby the flow or pressure is controlled by the ventilator and delivered at a pre-determined frequency (breath rate). Delivery of stimulation ramp trains generated by the stimulator 24 , such as any of those shown in FIGS. 9 and 10 , can be synchronized with the ventilator 32 in several ways, some of which are shown in FIGS. 11 and 12 .
- stimulation can begin at any time before, during, or after the onset of the inspiratory phase of the ventilator 32 and/or can end at any time before, during, or after the end of the inspiratory phase of the ventilator 32 .
- routine 100 configured to carry out one or more functions of the system 20 , including the Ventilator Initiated Pacing Mode.
- the logic or routines described herein may represent one or more of any number of processing strategies such as event-driven, interrupt-driven, multi-tasking, multi-threading, and the like.
- various acts or functions illustrated may be performed in the sequence illustrated, in parallel, or in some cases omitted.
- the order of processing is not necessarily required to achieve the features and advantages, but is provided for ease of illustration and description.
- one or more of the illustrated acts or functions may be repeatedly performed depending on the particular strategy being used.
- the routine 100 begins at block 102 , where the system is initialized.
- Initialization allows a clinician to program the system 20 , for example, by inputting via input devices 86 various system parameters according to a therapy plan.
- the therapy plan can include a level of diaphragm contribution and the prescribed assist level if not already known by the system 20 or derivable from other data known by system 20 .
- the level of diaphragm contribution can be entered as either a percentage of prescribed assist level or as tidal volume, pressure or both volume and pressure, or as a parameter derived from volume and pressure.
- the clinician can input the prescribed assist level for the patient depending upon clinical status.
- the prescribed assist level in some embodiments is programmed as tidal volume. Alternatively, it can also be programmed as: (1) a desired amount of pressure generated by the diaphragm; (2) the product of pressure and volume, referred to as Work of Breathing (WOB) shown in FIG. 21 ; (3) the integral of pressure with respect to time, referred to as Pressure-Time Product (PTP); (4) indices derived from the monitored variables, such as Pressure-Time Index (PTI); or (5) a reduction in the airway pressure attained by PPMV plus Pacing, when compared to PPMV alone.
- the prescribed assist level can be set in terms of one of the parameters mentioned above or as a combination of one or more of these parameters, while remaining within the scope of the claimed subject matter.
- the clinician can program the system 20 with one or more stimulation parameters, such as amplitude, duration, frequency, etc., that are capable of recruiting the diaphragm in order to satisfy the diaphragm contribution level (e.g., in volume or pressure, or both).
- stimulation parameters such as amplitude, duration, frequency, etc.
- some of the stimulation parameters which correspond to the diaphragm contribution level may have been previously programmed into or obtained by the system 20 .
- the clinician may also enter the amount of therapy to be provided per 24 hour period. For example, the clinician may wish to administer therapy for eight (8) hours out of each 24 hour period.
- the therapy can be administered consecutively for 8 hours, or can be segmented into time period blocks (e.g., 2 hrs., 1 hr., 30 minutes, 15 minutes, etc.), which can be either constant or variable. If variable, the time period blocks can form a repeatable pattern, if desired.
- the therapy may also vary the diaphragm contribution throughout the period of administered stimulation.
- the clinician can program sigh breaths or skipped breaths, as described above with reference to FIG. 13A-C .
- the clinician can further enter one or more ventilation parameters, such as ventilator operating mode, breath cycle timing (i.e., breaths per minute), etc. It will be appreciated that other data may be entered by the clinician during the initialization stage for providing functionality to the system 20 .
- the routine 100 proceeds to block 104 , where the respiratory cycle of the patient and/or the ventilator are monitored.
- the routine 100 carries out a breath detection algorithm, which uses data from the breath sensor 50 and detects the different phases of ventilator breath or a spontaneous breath, such as inspiration phase, inspiration pause, expiration phase and expiration pause. Further, the breath detection algorithm can quantify the different attributes of a breath such as duration of any of the breath phases mentioned above.
- the breath detection algorithm can use any of the monitored signals, such as flow, volume or pressure to evaluate a series of conditional expressions to identify and/or calculate the attributes of a breath cycle.
- the method of identifying and/or calculating the attributes of a breath cycle may include, but is not limited to, Slope Threshold Detection, Amplitude Threshold Detection or a combination thereof.
- the breath detection algorithm can store and/or process waveform data of the current breath or any set of previous breaths.
- the breath detection algorithm may also facilitate the operation of the system in an event-predictive or in an event-triggered manner. In case of detection of a spontaneous breath, the system may either stop ongoing stimulation, continue stimulating so as to add to the spontaneous breath, or skip the next breath.
- synchrony between the ventilator 32 and the administration of pacing therapy is maintained. This ensures that diaphragm pacing by stimulation signals emitted by the electrodes is synchronized with each breath administered by the ventilator 32 . If an uncoupling is suspected, pacing may be skipped and resumed as soon as the ventilatory pattern stabilizes again. In other embodiments, the pacing can continue while synchrony is reestablished. In some embodiments, synchrony is determined by comparing the attributes of at least one previous breath cycle (e.g., 12 breaths per minute, etc.) with the attributes of the current breath cycle of the ventilator 32 as determined via processing of the signals from the breath sensor 50 and/or one or more of the sensors 48 .
- at least one previous breath cycle e.g., 12 breaths per minute, etc.
- the routine proceeds to block 108 .
- the diaphragm output e.g., tidal volume, pressure, or a combination of the two
- the system 20 monitors the data from one or more of the sensors 48 and/or sensor 50 for determining the diaphragm contribution (tidal volume, pressure, or both) for each ventilator breath. This may be calculated from the measured output (i.e., the sum of diaphragm contribution and ventilator contribution) of each ventilator breath or can be calculated directly from the sensor data. If the diaphragm output (or diaphragm contribution) from the previous administered stimulation signal is within a preselected range, the programmed stimulation parameters are maintained, and will be subsequently employed to generate the stimulation train for therapy administration at the next breath.
- the stimulation parameters may be modified (e.g., amplitude and/or duration are increased) so as to maintain the diaphragm output within a desired range.
- a difference between the calculated diaphragm contribution responsive to the last administered stimulation signal and the programmed diaphragm contribution value can be seen as a change in either the pressure (in Volume-Controlled Modes/Ventilators) or as a change in tidal volume (in Pressure-Controlled Modes/Ventilators) or as a change in any signal sensed by one or more of the sensor(s) 48 or sensor 50 .
- the modified stimulation parameters are then stored in memory.
- the system 20 operates in accordance with a “closed-loop” feedback scheme to regulate the diaphragm output during operation of the system 20 , one example of which is shown in FIG. 15 .
- an evaluation is carried out to determine the reason for such a drop in tidal volume or pressure.
- the discrepancy in reaching the diaphragm contribution target may be due to a displacement of a stimulation electrode away from an optimal position.
- the discrepancy or variability in tidal volume or pressure between breaths can be attributable to either changing respiratory mechanics of the patient or to time-dependent fatigue of the higher force producing fast-fatigable (Type IIb) fibers.
- Changes in respiratory mechanics may include changes in airway resistance and/or compliance of the lungs/chest wall.
- the tidal volume is controlled during all breaths, representing a ventilator operating in a Volume Controlled Mode. If any changes occur to the resistive load or the compliance load, these will be reflected as changes in the airway pressure represented in the plot below the tidal volume.
- the first two breaths illustrate the baseline level of airway pressure when pacing the diaphragm in synchrony with the ventilator 32 .
- the system encounters a change in compliance load, which can be inferred from the increased peak airway pressure and change in slope of the airway pressure waveform.
- the system 20 can validate the measured drop in compliance and assumes it is due, for example, to a reduction in force contribution of fast fatigable Type IIb fibers.
- the system 20 has adjusted its pacing parameters to restore the desired level of diaphragm contribution (negative pressure) to the overall ventilatory assist system, thereby returning the airway pressure to the prescribed assist level.
- the system 20 may be configured to adaptively modify the pacing parameters to return the tidal volume to the prescribed assist level.
- FIG. 17A illustrates a natural progressive decline in the percentage of Type IIb Fast Fatigable Motor Units contributing to force development.
- Type IIb Motor Units can produce much larger forces than Type I Motor Units and their larger diameter axons are also easiest to be recruited by electrical stimulation. Therefore, a low level of intensity of phrenic nerve stimulation is initially sufficient to produce the diaphragm contribution level, as illustrated by FIG. 17B .
- FIG. 18 As shown schematically in FIG. 18 , initially perhaps only 15% of all motor units in a phrenic nerve need to be recruited by the system 20 to meet the prescribed force/pressure levels of the diaphragm contribution.
- Type IIb Motor Units tend to fatigue and produce less force with the passage of time, leading to a decline in the force (Diaphragm Contribution) below the programmed level of diaphragm contribution.
- the intensity of stimulation can be progressively increased so as to recruit additional Type I and Type IIa Motor Units.
- the stimulation spreads across a higher cross-sectional area (e.g. 30%) of the phrenic nerve to recruit more Type I and Type II Motor Units and the prescribed force is produced.
- the force declines again as the Type IIb Motor Units present in the newly activated cross-section of the phrenic nerves, fatigue in turn.
- the pacing intensity is increased again by the pacing control system in order to activate an even larger cross-sectional area of the phrenic nerve, recruiting more Motor Units to reestablish the force output.
- This progressively increasing activation of the phrenic nerve continues and finally up to 100% of the phrenic nerve motor units may be recruited.
- the increase in the stimulation may be a simple linear equation or a complex equation with weights assigned to the proportion of available fibers and their fatigue resistant properties.
- the loss of force may be attributed specifically to the fatigue of the fast fatigable fibers, using parameters such as Maximum Relaxation Rate and half-relaxation time.
- the changes in slope of the first half of the diaphragm relaxation curve indicative of the relative contribution of Type I and Type II fibers to force development may also be used.
- Other parameters specific to fatigue such as Pressure-Time Index, Expiratory Time Constant, EMG (and any derived parameters thereof such as power spectrum), Ratio between slow and fast twitch amplitudes, may also be employed to infer the varying conditions and to determine the modified stimulation parameters.
- the closed-loop control strategy may include using doublets/triplets in response to contractile slowing accompanying fatigue of the diaphragm Motor Units.
- the stimulation pattern is automatically changed to include doublet/triplets and otherwise lower stimulation frequency, as this form of stimulation is known in the art to optimize force production in fatiguing/fatigued motor units.
- the stimulation pattern can again be changed to moderate stimulation frequency with or without doublets.
- This closed-loop scheme allows for continuous pacing of the diaphragm irrespective of the onset or progression of fatigue, also reduces the number of stimulation pulses delivered and protects the muscle from potential injury that could be caused by over-stimulation.
- the stimulation therapy is administered at block 110 .
- Administration of the stimulation therapy includes generation of a stimulation signal, such as a stimulation or ramp train.
- the stimulation signal is generated in accordance with either the original stimulation perimeters or the stimulation parameters as modified in block 108 described above.
- Delivery timing of the stimulation ramp train is also determined at block 110 .
- the routine can determine the appropriate timing for phrenic nerve stimulation in relation to the actual breath cycle of the ventilator 32 .
- the routine controls the timing of stimulation according to pre-defined rules, based on parameter estimates from the breath detection algorithm, etc.
- the pre-defined rules can include whether stimulation begins at any time before, during, or after the onset of the inspiratory phase of the ventilator 32 , which is shown in FIGS. 11 and 12 , or whether stimulation begins during the expiratory phase, as shown in FIG. 24 .
- the system 20 can trigger off pressure or airflow signals.
- the stimulation train can either be started by triggering off the start of the expiration phase followed by a delay or the start of the inspiration phase, as shown in FIG. 23 . Triggering off the start of the expiration phase allows stimulation to be generated prior to the start of the inspiration phase to maximize diaphragmatic force during the inspiration phase.
- stimulation during the expiration phase can be achieved by triggering off the start of the expiration phase or the start of the inspiration phase with a delay, as shown in FIG. 24 . While using the inspiration or expiration start is preferred, the end of the inspiration/expiration periods could conceivably be used as well. Furthermore, it is also possible to provide delayed stimulation such that stimulation would begin in the middle of the inspiration phase for example.
- the routine at block 110 delivers the stimulation pulses to the stimulating electrodes 28 at the appropriate time for transmission therefrom.
- the routine returns to block 104 until the time period for therapy has expired or a clinician halts operation of the system 20 .
- the system 20 may assist the clinician in determining the appropriate level of diaphragm contribution to be input into the system 20 .
- the diaphragm contribution can be dependent on the condition of the patient's diaphragm. For example, in a patient that has only a maximum diaphragm output of 750 mL and the clinician intends to target an assist level of 500 mL, the clinician may unknowingly choose a diaphragm contribution level that would require delivery of the maximum stimulation charge, which will cause premature fatigue, etc. Given this patient's present diaphragm condition, the clinician may wish to choose a much lower percentage so that the stimulation charge is in-between the threshold charge and the supra-maximal charge.
- the condition of the diaphragm and the respiratory system is first assessed by the system 20 .
- the system 20 is configured to run one or more assessments on the patient's diaphragm and/or respiratory mechanics.
- the assessment determines the maximum diaphragm output (in volume, pressure, or both) and other parameters such as the fatigue characteristics of the diaphragm, the resistance, compliance and relaxation characteristics of the respiratory system and its components, etc.
- the assessment can be also run in-between or during periods of the operation of the system 20 in synchrony with the ventilator 32 .
- These tests can either be run by shortly disconnecting the patient from the ventilator 32 and pacing the diaphragm in isolation or can be run with the patient connected to the ventilator 32 by employing a sequence of pauses in the operation of the ventilator 32 during which the diaphragm is paced in isolation.
- the sequence of pauses may either be employed manually by the clinician, or natural pauses that are part of a regular ventilator breath cycle (such as an End-Inspiratory Pause or an End-Expiratory Pause) may be automatically identified and used by the system 20 .
- the maximal static pressures generated by the diaphragm in response to supramaximally stimulating the phrenic nerves to elicit twitch, ramp, or tetanic contractions of the diaphragm are measured as well as the diaphragm relaxation characteristics during the inspiration and expiration phases.
- the assessment can pace the diaphragm in isolation with a preset duty cycle to assess diaphragm function with regard to its strength and endurance properties.
- measures and/or indices can be derived that include, but are not limited to, Maximum Static/Dynamic Inspiratory Pressures, Inspiratory Capacity, Pressure-Volume loop relationships, Work of Breathing, Pressure-Time Product, Pressure-Time Index, EMG, Maximum Relaxation Rate, and Expiration Time Constant.
- Diaphragm fatigue can be induced by continuous or intermittent stimulation of the phrenic nerves to assess endurance limits and to detect the presence of low frequency and/or high frequency fatigue.
- serial measurements set apart in time ranging from a few minutes to days can be done on a patient by the pacing system to provide a complete picture of evolving changes in the diaphragm strength and endurance of the patient.
- a knowledge-based algorithm may be used to monitor instantaneous and/or trend data of the monitored signals. Such instantaneous and/or trend data may allow the assessment to predict weaning readiness of the patient and/or a time course for weaning. Such capability can also be extended to make the diaphragm assessment tests as a standalone screening and/or confirmatory tool by clinicians in the ICU, as the method of transvascular pacing of the diaphragm enables the clinician to assess the true status of the diaphragm in the absence of confounding factors (such as decreased central drive) usually associated with voluntary breathing maneuvers.
- confounding factors such as decreased central drive
- the diaphragm contribution level can be chosen with knowledge of the relationship between the prescribed assist level and the maximum diaphragm output.
- the controller 60 in some embodiments, via one or more subroutines, can recursively estimate the percentage of maximum diaphragm output required to generate 100% of the prescribed assist level.
- this and other calculations can be made on a separate computer system and imported or otherwise inputted into the controller 60 prior to operation of the system 20 .
- FIG. 19 One example of this recursive estimate is shown in FIG. 19 .
- the clinician has the option to adjust the diaphragm contribution during operation of the system 20 from 0 to 100% of the prescribed assist level, as illustrated by the dial of FIG. 20 , depending upon the status of the patient and the therapeutic goal.
- FIG. 20A illustrates an example of setting the desired diaphragm contribution to 75% of the prescribed assist level (i.e., the target diaphragm contribution level).
- the remaining 25% of the ventilatory work is carried out by the ventilator 32 .
- the clinician can therefore adjust the ventilator settings to contribute 25% of the ventilatory work, either as tidal volume or as pressure assist, as illustrated by the bottom plot of FIG. 20A .
- FIG. 20B illustrates another example of setting the desired diaphragm contribution to only 25% of the prescribed assist level (i.e., the target diaphragm contribution level).
- the remaining 75% of the ventilatory work is carried out by the ventilator 32 .
- the clinician can therefore adjust the ventilator settings to contribute 75% of the ventilatory work, either as tidal volume or as pressure assist, as illustrated by the bottom plot of FIG. 20B .
- the PPMV can be set to a mode where the remaining portion of the prescribed assist level is determined and adjusted automatically by the ventilator on an Inter-Breath or Intra-Breath basis (e.g. Pressure Regulated Volume Control Mode).
- the system 20 also calculates or otherwise obtains the stimulation characteristics that correspond to the diaphragm contribution.
- the clinician can enter data indicative of these stimulation characteristics.
- the condition of the diaphragm is periodically reassessed after the therapy has been administered for a period of time (e.g. 12 hours, 1 day, etc.).
- a period of time e.g. 12 hours, 1 day, etc.
- the variability in volume or pressure between breaths in some instances is attributable to changing respiratory mechanics of the patient, including changes to airway resistance and/or compliance of the lungs/chest wall.
- the diaphragm muscle, through the administration of the therapy has strengthened, and thus, the diaphragm contribution can be increased or the intensity of stimulation can be decreased to adjust the diaphragm contribution. In these cases, it may be beneficial to periodically reassess the diaphragm and optimize pacing therapy accordingly, after therapy has been initiated.
- FIG. 22 One example of a routine for measuring changes in the diaphragm condition without removing the patient from the ventilator 32 is shown in FIG. 22 . Similar to the diaphragm assessment described above, a successive approximation routine in some embodiments can be used to determine the optimal parameters of stimulation for the patient.
- the routine 200 begins with the clinician providing the initial system parameters, which may include maximum allowable stimulation parameters.
- Stimulation parameters can be provided either as a predefined stimulation train with fixed duration such that the stimulation train is fully defined by the user using methods as previously described or as a stimulation train in which the number of pulses and the train duration are based on the detected ventilator inspiration time.
- the routine carries out the breath detection algorithm to detect the inspiration and expiration phases using the flow/pressure data sensed by breath sensor 50 .
- the flow and pressure data for one or more breaths without stimulation are collected and stored.
- the system 20 can trigger off pressure or airflow signals.
- the stimulation train can either be started by triggering off the start of the expiration phase followed by a delay or the start of the inspiration phase, as shown in FIG. 23 . Triggering off the start of the expiration phase allows stimulation to be generated prior to the start of the inspiration phase to maximize diaphragmatic force during the inspiration phase.
- stimulation during the expiration phase can be achieved by triggering off the start of the expiration phase or the start of the inspiration phase with a delay, as shown in FIG. 24 . While using the inspiration and expiration start are preferred, the end of the inspiration/expiration periods could conceivably be used as well. Furthermore, it is also possible to provide delayed stimulation such that stimulation would begin in the middle of the inspiration phase for example.
- Flow, volume, and/or pressure data, or derived parameters thereof, for at least one breath with stimulation is recorded.
- the data with stimulation as well as without, if more than one breath of information has been recorded the data can be averaged together.
- the collected flow/volume/pressure data with stimulation is then subtracted from the collected flow/volume/pressure data without stimulation.
- the difference calculated as an area (and shown as the blacked-out area), can be used as a relative measurement of force generated by the diaphragm, and is shown in FIG. 26 .
- the difference in volume area under flow curve
- the area under the pressure graph would be used as the measurement.
- FIG. 27 is one example of another assessment routine 300 carried out by the system 20 .
- the assessment routine 300 can be used to guide the placement of endovascular electrodes during normal ventilator operation (i.e., without interference to the ventilator operation or disconnecting the ventilator), and can assess the diaphragm recruitment in response to varying (decreasing or increasing) stimulation charges.
- the system 20 can administer low-frequency stimulation (such as 1 Hz to 5 Hz), during one or more quiet expiratory periods, to elicit unfused diaphragm contractile responses in the form of single twitches.
- the charge delivered can be progressively increased to build a complete nerve recruitment curve for each endovascular location, and the operator can define across how many breath periods this stimulation is delivered.
- the system 20 can analyze this stimulation and response information to algorithmically estimate the best position of the electrodes to stimulate one or both phrenic nerves using minimal amounts of charge (highest degree of efficiency). During this assessment routine, the system 20 can also gather information regarding the relationship between the stimulation train profiles and the corresponding diaphragm response, including diaphragm output (in volume, pressure, or both). Some stimulation parameters that may be obtained include but are not limited to Threshold Pulse Width and Supra-maximal Pulse Width required to recruit each phrenic nerve from appropriate endovascular electrode locations.
- the stimulation charges in routine 300 can be programmed to periodically occur during periods of baseline flow/volume, which can occur at the end-expiratory pause of the ventilator breath cycle, which can also be referred to as the end-expiratory delay.
- the benefit of selective stimulation during the end-expiratory pause is that the length of the diaphragm muscle fibers is the same before each stimulus is delivered and thereby establishes standardized conditions for obtaining comparable results. This provides a standard baseline to compare the diaphragm twitch responses and can guide the placement of the endovascular electrodes.
- FIG. 29 illustrates one example of a routine 400 for determining the duration of the end-expiratory pause.
- this routine flow data is collected and the end expiratory pause is estimated.
- volume of the inspiration and expiration phases are calculated. The point at which the expired volume reaches a user-programmable percentage of the inspiration volume is used as the start time for the end-expiratory pause. In one embodiment, the percentage used as a default is 85% of the inspired volume. In some embodiments, volume is used as it is less influenced by noise than other measures.
- volume data in some embodiments is one technique, this does not preclude using other measures of the end expiratory phase such as a slope close to zero or simply using a fixed time interval at the end of the expiration phase as the end expiratory pause.
- the system 20 can compute relaxation characteristics of the respiratory system, such as Expiratory-Time Constant (i.e. time required to exhale a certain percentage of the air from the lungs) to determine the ideal end-expiratory pause duration and prompt the clinician to adjust the ventilator settings accordingly.
- Expiratory-Time Constant i.e. time required to exhale a certain percentage of the air from the lungs
- Routine 300 begins at block 302 with the clinician providing the initial system parameters or accepting internal default values, which may include the characteristics of a low-level starting stimulation signal, the maximum stimulation level, the estimated duration of the end-expiratory pause, one or more ventilator parameters, etc. In some embodiments, the characteristics of the low-level starting stimulation signal are based on the estimated duration of the end-expiratory pause.
- the breath detection algorithm described above can be employed to synchronize the administered stimulation with the end-expiratory pause period of the ventilator 32 .
- the breath detection algorithm can be employed to identify the period of interest during a breath cycle when stimulation can be delivered, as shown in FIG. 28 .
- the diaphragm being a skeletal muscle, its force output changes with its length, as described by its length-tension relationship. Therefore, it is beneficial to stimulate the diaphragm near its resting length, as it provides a standard baseline to compare the diaphragm twitch responses.
- the resting length of the diaphragm is reached at the end of every expiration phase, as the lungs reach their Functional Residual Capacity.
- signals from one or more of the sensors 48 and/or sensor 50 can be used to confirm that the lungs have reached Functional Residual Capacity.
- the system 20 administers a starting stimulation signal at block 308 and then monitors and measures the diaphragm response to the administered stimulation at block 310 .
- Signals that can be monitored and measured to quantify the diaphragm response may include, but are not limited to, EMG, Airway Pressure, Airway Flow, Intra-Thoracic Pressure, Pleural Pressure, Central Venous Pressure, Thoraco-abdominal motion, various patient impedances, etc.
- the system can also employ validation checks to confirm that the functional residual capacity (and therefore the diaphragm resting length) has not changed between breaths.
- One of the means to perform this validation is to analyze the trend data of the end-expiratory volume, before stimulating the diaphragm.
- FIG. 30 illustrates one example of a routine 500 executed by the system 20 to carry out one or more functions, including the Pacer-Initiated Ventilation Mode.
- many mechanical ventilators have an assist/support mode, whereby ventilation is provided when the patient attempts to breathe on their own.
- the system 20 can be programmed to trigger the ventilator 32 working in assistive modes by using stimulation shown by “D” in FIG. 31 (and resultant response from the diaphragm) to mimic spontaneous effort by the patient, as shown in FIG. 31 .
- the ventilator 32 responds to this trigger signal/event and delivers a breath to the patient (based on parameters set by the clinician) shown by “B” in FIG. 31 .
- the system 20 drives breath delivery from the ventilator 32 (which is opposite from the Ventilator-Initiated Pacing Mode described above) shown by “C” in FIG. 31 .
- the system 20 does not perform breath detection, and thus, the breath sensor 50 can be omitted.
- the breath sensor 50 may be used to carry out various assessment routines and feedback schemes.
- the system 20 can control the rate of pacing via the programmable parameters such as breath rate (in Breaths per minute), skipped breaths and sigh breaths.
- the Pacer-Initiated Ventilation Mode can also include one or more of the adaptive functionality, closed loop control, diaphragm assessment, successive approximation features described above with reference to Ventilator-Initiated Pacing Mode are also applicable to this mode.
- the system 20 can use feedback to ensure proper diaphragm contribution.
- Some ventilator modes suitable for this embodiment are Pressure Support Ventilation (PSV), Pressure Regulated Volume Control (PRVC), Proportional Assist Ventilation (PAV) and Adaptive Support Ventilation (ASV).
- PSV Pressure Support Ventilation
- PRVC Pressure Regulated Volume Control
- PAV Proportional Assist Ventilation
- ASV Adaptive Support Ventilation
- Embodiments of the system 20 can also be operated in Autonomous Mode, or A-Mode.
- A-Mode is a life-sustaining mode that can operate independently of the ventilator 32 .
- FIG. 32 illustrates one example of a routine 600 executed by the system 20 for carrying out one or more functions, including the Autonomous Mode.
- the A-Mode operates in closed-loop control fashion using feedback from various sensors, such as one or more of the sensors 48 , 50 . These sensors can be used to monitor physiological variables that can include, but are not limited to: central venous pressure, mixed venous oxygen saturation, heart rate and movement activity levels.
- A-Mode provides adjustable diaphragmatic pacing to a patient retaining none, some or all of his/her spontaneous breathing and requiring assisted breathing and can automatically adjust to the patient's physiological needs and changed activity levels, as needed.
- A-mode can be a life-sustaining mode, it may or may not be used in this capacity (i.e. could be interfaced with a backup ventilator).
- A-Mode may be applicable to patients who are permanently dependent on mechanical ventilators or otherwise in need of continuous pacing from the system 20 .
- embodiments of the system 20 carrying out the A-Mode can be totally implanted under the skin of the patient in the upper chest area.
- the system 20 is powered by a power storage source, such as either primary or rechargeable implantable batteries, and may be integrated with other implantable devices that support heart or other functions to a patient.
- the system 20 operating in A-Mode involves a closed-loop operation to autonomously pace the diaphragm.
- This mode may make use of any patient response signal (feedback) that will help indicate that pacing is required; these signals include, but are not limited to: oxygen saturation, end-tidal CO2 (EtCO2), airflow, heart rate, movement-detecting accelerometer signals, etc.
- Pacing is administered continuously in A-mode, and an algorithm is used to detect and/or modify physiological response signals to determine whether a change in stimulation pattern, frequency, breath rate, intensity, type, and/or shape profile is required to elicit the expected response.
Landscapes
- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Engineering & Computer Science (AREA)
- Veterinary Medicine (AREA)
- Biomedical Technology (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Heart & Thoracic Surgery (AREA)
- Pulmonology (AREA)
- Radiology & Medical Imaging (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Neurosurgery (AREA)
- Neurology (AREA)
- Physiology (AREA)
- Signal Processing (AREA)
- Hematology (AREA)
- Anesthesiology (AREA)
- Emergency Medicine (AREA)
- Biophysics (AREA)
- Cardiology (AREA)
- Computer Networks & Wireless Communication (AREA)
- Orthopedic Medicine & Surgery (AREA)
- Vascular Medicine (AREA)
- Physics & Mathematics (AREA)
- Surgery (AREA)
- Molecular Biology (AREA)
- Medical Informatics (AREA)
- Pathology (AREA)
- Theoretical Computer Science (AREA)
- Electrotherapy Devices (AREA)
- Synchronisation In Digital Transmission Systems (AREA)
Priority Applications (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US14/410,022 US20150265833A1 (en) | 2013-06-21 | 2013-06-21 | Transvascular diaphragm pacing systems and methods of use |
US16/114,064 US10561844B2 (en) | 2013-06-21 | 2018-08-27 | Diaphragm pacing systems and methods of use |
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
PCT/CA2013/000594 WO2013188965A1 (fr) | 2012-06-21 | 2013-06-21 | Systèmes de stimulation de diaphragme transvasculaire et procédés d'utilisation |
US14/410,022 US20150265833A1 (en) | 2013-06-21 | 2013-06-21 | Transvascular diaphragm pacing systems and methods of use |
US201261662579P | 2021-07-27 | 2021-07-27 |
Related Parent Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/CA2013/000594 A-371-Of-International WO2013188965A1 (fr) | 2012-06-21 | 2013-06-21 | Systèmes de stimulation de diaphragme transvasculaire et procédés d'utilisation |
Related Child Applications (3)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US14/839,432 Continuation US9776005B2 (en) | 2013-06-21 | 2015-08-28 | Transvascular diaphragm pacing systems and methods of use |
US16/111,644 Continuation US10406367B2 (en) | 2013-06-21 | 2018-08-24 | Transvascular diaphragm pacing system and methods of use |
US16/114,064 Continuation US10561844B2 (en) | 2013-06-21 | 2018-08-27 | Diaphragm pacing systems and methods of use |
Publications (1)
Publication Number | Publication Date |
---|---|
US20150265833A1 true US20150265833A1 (en) | 2015-09-24 |
Family
ID=49767975
Family Applications (7)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US14/410,022 Abandoned US20150265833A1 (en) | 2013-06-21 | 2013-06-21 | Transvascular diaphragm pacing systems and methods of use |
US14/839,432 Active US9776005B2 (en) | 2013-06-21 | 2015-08-28 | Transvascular diaphragm pacing systems and methods of use |
US16/111,644 Active US10406367B2 (en) | 2013-06-21 | 2018-08-24 | Transvascular diaphragm pacing system and methods of use |
US16/114,064 Active US10561844B2 (en) | 2013-06-21 | 2018-08-27 | Diaphragm pacing systems and methods of use |
US16/460,728 Active US10589097B2 (en) | 2013-06-21 | 2019-07-02 | Transvascular diaphragm pacing systems and methods of use |
US16/778,952 Active 2034-02-16 US11357985B2 (en) | 2013-06-21 | 2020-01-31 | Transvascular diaphragm pacing systems and methods of use |
US17/498,870 Pending US20220023625A1 (en) | 2013-06-21 | 2021-10-12 | Transvascular diaphragm pacing systems and methods of use |
Family Applications After (6)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US14/839,432 Active US9776005B2 (en) | 2013-06-21 | 2015-08-28 | Transvascular diaphragm pacing systems and methods of use |
US16/111,644 Active US10406367B2 (en) | 2013-06-21 | 2018-08-24 | Transvascular diaphragm pacing system and methods of use |
US16/114,064 Active US10561844B2 (en) | 2013-06-21 | 2018-08-27 | Diaphragm pacing systems and methods of use |
US16/460,728 Active US10589097B2 (en) | 2013-06-21 | 2019-07-02 | Transvascular diaphragm pacing systems and methods of use |
US16/778,952 Active 2034-02-16 US11357985B2 (en) | 2013-06-21 | 2020-01-31 | Transvascular diaphragm pacing systems and methods of use |
US17/498,870 Pending US20220023625A1 (en) | 2013-06-21 | 2021-10-12 | Transvascular diaphragm pacing systems and methods of use |
Country Status (8)
Country | Link |
---|---|
US (7) | US20150265833A1 (fr) |
EP (2) | EP4233953A3 (fr) |
JP (5) | JP6359528B2 (fr) |
CN (1) | CN104684614B (fr) |
AU (1) | AU2013280184B2 (fr) |
BR (1) | BR112014032002A2 (fr) |
CA (2) | CA2877049C (fr) |
WO (1) | WO2013188965A1 (fr) |
Cited By (18)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20170128684A1 (en) * | 2015-09-10 | 2017-05-11 | St. Michael's Hospital | Method and system for adjusting a level of ventilatory assist to a patient |
US9682235B1 (en) | 2015-12-14 | 2017-06-20 | Stimdia Medical, Inc. | Electrical stimulation for preservation and restoration of diaphragm function |
US9931504B2 (en) | 2013-11-22 | 2018-04-03 | Lungpacer Medical, Inc. | Apparatus and methods for assisted breathing by transvascular nerve stimulation |
US10039920B1 (en) | 2017-08-02 | 2018-08-07 | Lungpacer Medical, Inc. | Systems and methods for intravascular catheter positioning and/or nerve stimulation |
US10293164B2 (en) | 2017-05-26 | 2019-05-21 | Lungpacer Medical Inc. | Apparatus and methods for assisted breathing by transvascular nerve stimulation |
US10391314B2 (en) | 2014-01-21 | 2019-08-27 | Lungpacer Medical Inc. | Systems and related methods for optimization of multi-electrode nerve pacing |
US10406367B2 (en) | 2013-06-21 | 2019-09-10 | Lungpacer Medical Inc. | Transvascular diaphragm pacing system and methods of use |
US10512772B2 (en) | 2012-03-05 | 2019-12-24 | Lungpacer Medical Inc. | Transvascular nerve stimulation apparatus and methods |
US10561843B2 (en) | 2007-01-29 | 2020-02-18 | Lungpacer Medical, Inc. | Transvascular nerve stimulation apparatus and methods |
US10940308B2 (en) | 2017-08-04 | 2021-03-09 | Lungpacer Medical Inc. | Systems and methods for trans-esophageal sympathetic ganglion recruitment |
US10987511B2 (en) | 2018-11-08 | 2021-04-27 | Lungpacer Medical Inc. | Stimulation systems and related user interfaces |
US11207517B2 (en) | 2017-07-06 | 2021-12-28 | Stimdia Medical, Inc. | Percutaneous electrical phrenic nerve stimulation system |
US11357979B2 (en) | 2019-05-16 | 2022-06-14 | Lungpacer Medical Inc. | Systems and methods for sensing and stimulation |
US11553963B2 (en) | 2021-03-09 | 2023-01-17 | Circle Safe | Phrenic nerve stimulation |
US11771900B2 (en) | 2019-06-12 | 2023-10-03 | Lungpacer Medical Inc. | Circuitry for medical stimulation systems |
US11883658B2 (en) | 2017-06-30 | 2024-01-30 | Lungpacer Medical Inc. | Devices and methods for prevention, moderation, and/or treatment of cognitive injury |
US12029903B2 (en) | 2017-12-11 | 2024-07-09 | Lungpacer Medical Inc. | Systems and methods for strengthening a respiratory muscle |
US12070601B2 (en) * | 2014-03-28 | 2024-08-27 | Pinnacle Bionics. Inc. | Stimulation system for exercising diaphragm and method of operation thereof |
Families Citing this family (31)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
WO2012094346A2 (fr) | 2011-01-03 | 2012-07-12 | The Regents Of The University Of California | Stimulation épidurale à haute densité pour faciliter la locomotion, la posture, le mouvement volontaire et le rétablissement de la fonction d'autonomie, sexuelle, vasomotrice et cognitive après lésion neurologique |
KR20140098780A (ko) | 2011-11-11 | 2014-08-08 | 뉴로이네이블링 테크놀로지스, 인크. | 운동, 감각, 자율적, 성적, 혈관운동 및 인식 기능의 복원을 가능하게 하기 위한 비침습성 신경조절 디바이스 |
AU2014228794B2 (en) | 2013-03-15 | 2019-04-18 | The Regents Of The University Of California | Multi-site transcutaneous electrical stimulation of the spinal cord for facilitation of locomotion |
WO2015048563A2 (fr) | 2013-09-27 | 2015-04-02 | The Regents Of The University Of California | Implication des circuits de la moelle épinière cervicale pour recréer un contrôle volitif de la fonction manuelle chez des sujets tétraplégiques |
CN103933648B (zh) * | 2014-03-26 | 2016-09-07 | 北京雅果科技有限公司 | 一种膈肌刺激吸排气系统 |
CN104353167B (zh) * | 2014-11-28 | 2017-03-29 | 山东大学齐鲁医院 | 一种具有体外膈肌起搏功能的呼气正压通气面罩 |
WO2017011410A1 (fr) * | 2015-07-13 | 2017-01-19 | The Regents Of The University Of California | Accès à un réseau vertébral pour permettre la fonction respiratoire |
WO2017035512A1 (fr) | 2015-08-26 | 2017-03-02 | The Regents Of The University Of California | Utilisation concertée d'un dispositif de neuromodulation non invasif avec un exosquelette pour permettre un mouvement volontaire et une activation musculaire supérieure lors de la marche chez un sujet souffrant de paralysie chronique |
US11097122B2 (en) | 2015-11-04 | 2021-08-24 | The Regents Of The University Of California | Magnetic stimulation of the spinal cord to restore control of bladder and/or bowel |
RU2737295C2 (ru) * | 2016-02-18 | 2020-11-26 | Конинклейке Филипс Н.В. | Аппарат для механической искусственной вентиляции легких и мониторинга дыхания |
CN106215319B (zh) * | 2016-08-12 | 2019-04-16 | 北京雅果科技有限公司 | 一种电刺激辅助呼吸的装置 |
US11173301B2 (en) | 2016-08-12 | 2021-11-16 | Yaguo Inc. | Method and device for assisting respiration by electrical stimulation |
CN106422060A (zh) * | 2016-10-21 | 2017-02-22 | 上海海神医疗电子仪器有限公司 | 一种双模双控膈肌刺激机械通气辅助装置 |
EP3974021B1 (fr) | 2017-06-30 | 2023-06-14 | ONWARD Medical N.V. | Système de neuromodulation |
WO2019075072A1 (fr) * | 2017-10-10 | 2019-04-18 | Northwestern University | Système stimulateur du nerf phrénique à réglage numérique |
US11992684B2 (en) | 2017-12-05 | 2024-05-28 | Ecole Polytechnique Federale De Lausanne (Epfl) | System for planning and/or providing neuromodulation |
US20210361964A1 (en) * | 2018-02-06 | 2021-11-25 | Stimit Ag | Ventilation machine and method of ventilating a patient |
EP3653256B1 (fr) | 2018-11-13 | 2022-03-30 | ONWARD Medical N.V. | Système de commande pour la reconstruction et/ou la restauration des mouvements d'un patient |
EP3695878B1 (fr) | 2019-02-12 | 2023-04-19 | ONWARD Medical N.V. | Système de neuromodulation |
CN109998518B (zh) * | 2019-03-05 | 2020-08-07 | 深圳先进技术研究院 | 一种膈运动辅助装置及膈运动辅助系统 |
DE102019001926A1 (de) * | 2019-03-20 | 2020-09-24 | Drägerwerk AG & Co. KGaA | Vorrichutung, Verfahren und Computerprogramm zur Atmungsbeeinflussung einer Person |
US11324954B2 (en) * | 2019-06-28 | 2022-05-10 | Covidien Lp | Achieving smooth breathing by modified bilateral phrenic nerve pacing |
CN111150933B (zh) * | 2019-09-02 | 2022-08-09 | 杭州神络医疗科技有限公司 | 导管电极和体内植入神经刺激装置 |
DE19211698T1 (de) | 2019-11-27 | 2021-09-02 | Onward Medical B.V. | Neuromodulation system |
US20230173290A1 (en) * | 2020-04-09 | 2023-06-08 | Stimit Ag | Stimulation arrangement and method of activating a patient |
RU2750236C1 (ru) * | 2020-06-25 | 2021-06-24 | Евгений Александрович Горемыкин | Система для поддержания дыхательной функции посредством нейростимуляции пациентов, подключенных к аппаратам искусственной вентиляции легких |
US11763947B2 (en) | 2020-10-14 | 2023-09-19 | Etiometry Inc. | System and method for providing clinical decision support |
CN116963847B (zh) | 2021-12-30 | 2024-08-02 | 米凯·亚历山大维奇·米山尼诺夫 | 废物处理装置的反应器 |
DE102022100939A1 (de) * | 2022-01-17 | 2023-07-20 | Drägerwerk AG & Co. KGaA | System, Vorrichtung zur Stimulation und Verfahren zur Durchführung einer Stimulation |
IL313816A (en) | 2022-02-17 | 2024-08-01 | Dmitrii Yanovich Agasarov | Electrostatic friction pulse generator |
US11890398B2 (en) | 2022-02-17 | 2024-02-06 | Mikhail Aleksandrovich Meshchaninov | Air cleaning device |
Citations (8)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US3983881A (en) * | 1975-05-21 | 1976-10-05 | Telectronics Pty. Limited | Muscle stimulator |
US4827935A (en) * | 1986-04-24 | 1989-05-09 | Purdue Research Foundation | Demand electroventilator |
US5549655A (en) * | 1994-09-21 | 1996-08-27 | Medtronic, Inc. | Method and apparatus for synchronized treatment of obstructive sleep apnea |
US20050165457A1 (en) * | 2004-01-26 | 2005-07-28 | Michael Benser | Tiered therapy for respiratory oscillations characteristic of Cheyne-Stokes respiration |
US20100036451A1 (en) * | 2007-01-29 | 2010-02-11 | Simon Fraser University | Transvascular nerve stimulation apparatus and methods |
US7962215B2 (en) * | 2004-07-23 | 2011-06-14 | Synapse Biomedical, Inc. | Ventilatory assist system and methods to improve respiratory function |
US20120158091A1 (en) * | 2003-10-15 | 2012-06-21 | Rmx, Llc | Therapeutic diaphragm stimulation device and method |
US8504158B2 (en) * | 2011-05-09 | 2013-08-06 | Medtronic, Inc. | Phrenic nerve stimulation during cardiac refractory period |
Family Cites Families (481)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US1693734A (en) | 1923-06-29 | 1928-12-04 | Mcintosh Electrical Corp | Switching means for effecting electrotherapeutic treatment |
US2532788A (en) | 1948-01-03 | 1950-12-05 | Stanley J Sarnoff | Artificial respiration by electronic stimulation |
US2664880A (en) | 1951-11-23 | 1954-01-05 | Jr Nathaniel B Wales | Electric stimulator for artificial respiration |
US3348548A (en) | 1965-04-26 | 1967-10-24 | William M Chardack | Implantable electrode with stiffening stylet |
US3470876A (en) | 1966-09-28 | 1969-10-07 | John Barchilon | Dirigible catheter |
US3835864A (en) | 1970-09-21 | 1974-09-17 | Rasor Ass Inc | Intra-cardiac stimulator |
US3769984A (en) | 1971-03-11 | 1973-11-06 | Sherwood Medical Ind Inc | Pacing catheter with frictional fit lead attachment |
US3817241A (en) | 1972-02-16 | 1974-06-18 | Henry And Carol Grausz | Disposable central venous catheter and method of use |
US3938502A (en) | 1972-02-22 | 1976-02-17 | Nicolaas Bom | Apparatus with a catheter for examining hollow organs or bodies with the ultrasonic waves |
US3804098A (en) | 1972-04-17 | 1974-04-16 | Medronic Inc | Body implantable lead |
US3896373A (en) | 1972-11-30 | 1975-07-22 | Stein Paul D | Method and apparatus for determining cross-sectional area of a blood conduit and volumetric flow therethrough |
US3847157A (en) | 1973-06-18 | 1974-11-12 | J Caillouette | Medico-surgical tube |
US3851641A (en) | 1973-11-29 | 1974-12-03 | J Toole | Method and apparatus for determining internal impedance of animal body part |
US4054881A (en) | 1976-04-26 | 1977-10-18 | The Austin Company | Remote object position locater |
US4114601A (en) | 1976-08-09 | 1978-09-19 | Micro Tec Instrumentation, Inc. | Medical and surgical implement detection system |
USRE31873F1 (en) | 1976-09-08 | 1988-11-15 | Venous catheter device | |
US4072146A (en) | 1976-09-08 | 1978-02-07 | Howes Randolph M | Venous catheter device |
US4143872A (en) | 1977-04-07 | 1979-03-13 | Hudson Oxygen Therapy Sales Company | Lung volume exerciser |
US4173228A (en) | 1977-05-16 | 1979-11-06 | Applied Medical Devices | Catheter locating device |
US4249539A (en) | 1979-02-09 | 1981-02-10 | Technicare Corporation | Ultrasound needle tip localization system |
US4317078A (en) | 1979-10-15 | 1982-02-23 | Ohio State University Research Foundation | Remote position and orientation detection employing magnetic flux linkage |
US4380237A (en) | 1979-12-03 | 1983-04-19 | Massachusetts General Hospital | Apparatus for making cardiac output conductivity measurements |
US4643201A (en) | 1981-02-02 | 1987-02-17 | Medtronic, Inc. | Single-pass A-V lead |
US4416289A (en) | 1981-05-07 | 1983-11-22 | Mccormick Laboratories, Inc. | Circuits for determining very accurately the position of a device inside biological tissue |
US4445501A (en) | 1981-05-07 | 1984-05-01 | Mccormick Laboratories, Inc. | Circuits for determining very accurately the position of a device inside biological tissue |
US4431005A (en) | 1981-05-07 | 1984-02-14 | Mccormick Laboratories, Inc. | Method of and apparatus for determining very accurately the position of a device inside biological tissue |
US4407294A (en) | 1982-01-07 | 1983-10-04 | Technicare Corporation | Ultrasound tissue probe localization system |
US4431006A (en) | 1982-01-07 | 1984-02-14 | Technicare Corporation | Passive ultrasound needle probe locator |
US4681117A (en) | 1983-02-15 | 1987-07-21 | Brodman Richard F | Intracardiac catheter and a method for detecting myocardial ischemia |
FR2566276B1 (fr) * | 1984-06-21 | 1988-07-08 | Medtronic Bv | Procede et appareil de stimulation diaphragmatique |
US4586923A (en) | 1984-06-25 | 1986-05-06 | Cordis Corporation | Curving tip catheter |
US4573481A (en) | 1984-06-25 | 1986-03-04 | Huntington Institute Of Applied Research | Implantable electrode array |
US4587975A (en) | 1984-07-02 | 1986-05-13 | Cardiac Pacemakers, Inc. | Dimension sensitive angioplasty catheter |
US4697595A (en) | 1984-07-24 | 1987-10-06 | Telectronics N.V. | Ultrasonically marked cardiac catheters |
YU132884A (en) | 1984-07-26 | 1987-12-31 | Branko Breyer | Electrode cateter with ultrasonic marking |
US4674518A (en) | 1985-09-06 | 1987-06-23 | Cardiac Pacemakers, Inc. | Method and apparatus for measuring ventricular volume |
US4683890A (en) | 1985-12-23 | 1987-08-04 | Brunswick Manufacturing Co., Inc. | Method and apparatus for controlled breathing employing internal and external electrodes |
US4771788A (en) | 1986-07-18 | 1988-09-20 | Pfizer Hospital Products Group, Inc. | Doppler tip wire guide |
US4852580A (en) | 1986-09-17 | 1989-08-01 | Axiom Medical, Inc. | Catheter for measuring bioimpedance |
US4830008A (en) | 1987-04-24 | 1989-05-16 | Meer Jeffrey A | Method and system for treatment of sleep apnea |
US4819662A (en) | 1987-10-26 | 1989-04-11 | Cardiac Pacemakers, Inc. | Cardiac electrode with drug delivery capabilities |
US4860769A (en) | 1987-11-12 | 1989-08-29 | Thomas J. Fogarty | Implantable defibrillation electrode |
CA1330285C (fr) | 1987-12-22 | 1994-06-21 | Geoffrey S. Martin | Catheter a triple voie |
US4840182A (en) | 1988-04-04 | 1989-06-20 | Rhode Island Hospital | Conductance catheter |
US4944088A (en) | 1988-05-25 | 1990-07-31 | Medtronic, Inc. | Ring electrode for multiconductor pacing leads |
US4951682A (en) | 1988-06-22 | 1990-08-28 | The Cleveland Clinic Foundation | Continuous cardiac output by impedance measurements in the heart |
US4905698A (en) | 1988-09-13 | 1990-03-06 | Pharmacia Deltec Inc. | Method and apparatus for catheter location determination |
US4911174A (en) | 1989-02-13 | 1990-03-27 | Cardiac Pacemakers, Inc. | Method for matching the sense length of an impedance measuring catheter to a ventricular chamber |
US4957110A (en) | 1989-03-17 | 1990-09-18 | C. R. Bard, Inc. | Steerable guidewire having electrodes for measuring vessel cross-section and blood flow |
US4934049A (en) | 1989-07-07 | 1990-06-19 | Medtronic, Inc. | Method for fabrication of a medical electrode |
US4989617A (en) | 1989-07-14 | 1991-02-05 | Case Western Reserve University | Intramuscular electrode for neuromuscular stimulation system |
US5036848A (en) | 1989-10-16 | 1991-08-06 | Brunswick Biomedical Technologies, Inc. | Method and apparatus for controlling breathing employing internal and external electrodes |
US5005587A (en) | 1989-11-13 | 1991-04-09 | Pacing Systems, Inc. | Braid Electrode leads and catheters and methods for using the same |
US5254088A (en) | 1990-02-02 | 1993-10-19 | Ep Technologies, Inc. | Catheter steering mechanism |
US5115818A (en) | 1990-02-14 | 1992-05-26 | Medtronic, Inc. | Implantable electrode |
US5042143A (en) | 1990-02-14 | 1991-08-27 | Medtronic, Inc. | Method for fabrication of implantable electrode |
CH681351A5 (fr) | 1990-04-12 | 1993-03-15 | Hans Baer Dr | |
US5056519A (en) | 1990-05-14 | 1991-10-15 | Vince Dennis J | Unilateral diaphragmatic pacer |
US5265604A (en) | 1990-05-14 | 1993-11-30 | Vince Dennis J | Demand - diaphragmatic pacing (skeletal muscle pressure modified) |
US5383923A (en) | 1990-10-20 | 1995-01-24 | Webster Laboratories, Inc. | Steerable catheter having puller wire with shape memory |
DE9015857U1 (de) | 1990-11-21 | 1991-02-07 | B. Braun Melsungen Ag, 3508 Melsungen | Führungssonde |
US5224491A (en) | 1991-01-07 | 1993-07-06 | Medtronic, Inc. | Implantable electrode for location within a blood vessel |
US5170802A (en) | 1991-01-07 | 1992-12-15 | Medtronic, Inc. | Implantable electrode for location within a blood vessel |
US5465717A (en) | 1991-02-15 | 1995-11-14 | Cardiac Pathways Corporation | Apparatus and Method for ventricular mapping and ablation |
US5345936A (en) | 1991-02-15 | 1994-09-13 | Cardiac Pathways Corporation | Apparatus with basket assembly for endocardial mapping |
US5456254A (en) | 1991-02-15 | 1995-10-10 | Cardiac Pathways Corp | Flexible strip assembly having insulating layer with conductive pads exposed through insulating layer and device utilizing the same |
US5146918A (en) | 1991-03-19 | 1992-09-15 | Medtronic, Inc. | Demand apnea control of central and obstructive sleep apnea |
US5184621A (en) | 1991-05-29 | 1993-02-09 | C. R. Bard, Inc. | Steerable guidewire having electrodes for measuring vessel cross-section and blood flow |
JP2582010B2 (ja) | 1991-07-05 | 1997-02-19 | 芳嗣 山田 | 呼吸筋活動のモニタ装置 |
US5241957A (en) | 1991-11-18 | 1993-09-07 | Medtronic, Inc. | Bipolar temporary pacing lead and connector and permanent bipolar nerve wire |
US5324322A (en) | 1992-04-20 | 1994-06-28 | Case Western Reserve University | Thin film implantable electrode and method of manufacture |
US5843028A (en) | 1992-05-11 | 1998-12-01 | Medical Innovations Corporation | Multi-lumen endoscopic catheter |
US5411025A (en) | 1992-06-30 | 1995-05-02 | Cordis Webster, Inc. | Cardiovascular catheter with laterally stable basket-shaped electrode array |
WO1994007564A2 (fr) | 1992-10-01 | 1994-04-14 | Cardiac Pacemakers, Inc. | Structure d'electrodes de defibrillation de type extenseur |
CA2110668A1 (fr) | 1992-12-04 | 1994-06-05 | Debbie Stevens-Wright | Actionneur a utiliser avec un catheter guidable |
US5368564A (en) | 1992-12-23 | 1994-11-29 | Angeion Corporation | Steerable catheter |
US5330522A (en) | 1992-12-29 | 1994-07-19 | Siemens Pacesetter, Inc. | Ring electrode for a multilumen lead and method of constructing a multilumen lead |
US5706809A (en) | 1993-01-29 | 1998-01-13 | Cardima, Inc. | Method and system for using multiple intravascular sensing devices to detect electrical activity |
US5813399A (en) | 1993-03-16 | 1998-09-29 | Puritan Bennett Corporation | System and method for closed loop airway pressure control during the inspiratory cycle of a breath in a patient ventilator using the exhalation valve as a microcomputer-controlled relief valve |
JPH08511005A (ja) | 1993-06-01 | 1996-11-19 | コーテックス ファーマシューティカルズ インコーポレイテッド | 神経疾患の治療におけるアルカリ性または酸性ホスファターゼインヒビター |
US5348536A (en) | 1993-08-02 | 1994-09-20 | Quinton Instrument Company | Coextruded catheter and method of forming |
US5607462A (en) | 1993-09-24 | 1997-03-04 | Cardiac Pathways Corporation | Catheter assembly, catheter and multi-catheter introducer for use therewith |
US5486159A (en) | 1993-10-01 | 1996-01-23 | Mahurkar; Sakharam D. | Multiple-lumen catheter |
US5417208A (en) | 1993-10-12 | 1995-05-23 | Arrow International Investment Corp. | Electrode-carrying catheter and method of making same |
US5555618A (en) | 1993-10-12 | 1996-09-17 | Arrow International Investment Corp. | Method of making electrode-carrying catheter |
US5524632A (en) | 1994-01-07 | 1996-06-11 | Medtronic, Inc. | Method for implanting electromyographic sensing electrodes |
US5527358A (en) | 1994-01-21 | 1996-06-18 | Medtronic, Inc. | Temporary medical electrical lead |
JP3269125B2 (ja) | 1994-01-28 | 2002-03-25 | 東レ株式会社 | アトピー性皮膚炎治療薬 |
US5476498A (en) | 1994-08-15 | 1995-12-19 | Incontrol, Inc. | Coronary sinus channel lead and method |
US5604231A (en) | 1995-01-06 | 1997-02-18 | Smith; Carr J. | Pharmaceutical compositions for prevention and treatment of ulcerative colitis |
US5678535A (en) | 1995-04-21 | 1997-10-21 | Dimarco; Anthony Fortunato | Method and apparatus for electrical stimulation of the respiratory muscles to achieve artificial ventilation in a patient |
US5584873A (en) | 1995-05-08 | 1996-12-17 | Medtronic, Inc. | Medical lead with compression lumens |
WO1997014473A1 (fr) | 1995-10-18 | 1997-04-24 | Novartis Ag | Dispositif d'apport transdermique de medicament, commande par une thermopile |
US6198970B1 (en) | 1995-10-27 | 2001-03-06 | Esd Limited Liability Company | Method and apparatus for treating oropharyngeal respiratory and oral motor neuromuscular disorders with electrical stimulation |
AU722212B2 (en) | 1995-11-17 | 2000-07-27 | New York University | Apparatus and method for monitoring and analysing breathing |
US5697377A (en) | 1995-11-22 | 1997-12-16 | Medtronic, Inc. | Catheter mapping system and method |
US5716392A (en) | 1996-01-05 | 1998-02-10 | Medtronic, Inc. | Minimally invasive medical electrical lead |
US5772693A (en) | 1996-02-09 | 1998-06-30 | Cardiac Control Systems, Inc. | Single preformed catheter configuration for a dual-chamber pacemaker system |
US6096728A (en) | 1996-02-09 | 2000-08-01 | Amgen Inc. | Composition and method for treating inflammatory diseases |
US5665103A (en) | 1996-03-07 | 1997-09-09 | Scimed Life Systems, Inc. | Stent locating device |
US6166048A (en) | 1999-04-20 | 2000-12-26 | Targacept, Inc. | Pharmaceutical compositions for inhibition of cytokine production and secretion |
US20070208388A1 (en) | 1996-04-30 | 2007-09-06 | Jahns Scott E | Method and system for nerve stimulation and cardiac sensing prior to and during a medical procedure |
US6006134A (en) * | 1998-04-30 | 1999-12-21 | Medtronic, Inc. | Method and device for electronically controlling the beating of a heart using venous electrical stimulation of nerve fibers |
US7225019B2 (en) | 1996-04-30 | 2007-05-29 | Medtronic, Inc. | Method and system for nerve stimulation and cardiac sensing prior to and during a medical procedure |
USRE38705E1 (en) | 1996-04-30 | 2005-02-22 | Medtronic, Inc. | Method and device for electronically controlling the beating of a heart using venous electrical stimulation of nerve fibers |
US6449507B1 (en) | 1996-04-30 | 2002-09-10 | Medtronic, Inc. | Method and system for nerve stimulation prior to and during a medical procedure |
US5913848A (en) | 1996-06-06 | 1999-06-22 | Luther Medical Products, Inc. | Hard tip over-the-needle catheter and method of manufacturing the same |
US5827192A (en) | 1996-08-21 | 1998-10-27 | Cleveland Clinic Foundation | Method of determining the conductivity of blood |
US5971933A (en) | 1996-09-17 | 1999-10-26 | Cleveland Clinic Foundation | Method and apparatus to correct for electric field non-uniformity in conductance catheter volumetry |
SE9603841D0 (sv) | 1996-10-18 | 1996-10-18 | Pacesetter Ab | A tissue stimulating apparatus |
US5776111A (en) | 1996-11-07 | 1998-07-07 | Medical Components, Inc. | Multiple catheter assembly |
US5785706A (en) | 1996-11-18 | 1998-07-28 | Daig Corporation | Nonsurgical mapping and treatment of cardiac arrhythmia using a catheter contained within a guiding introducer containing openings |
US5782828A (en) | 1996-12-11 | 1998-07-21 | Irvine Biomedical, Inc. | Ablation catheter with multiple flexible curves |
US5755765A (en) | 1997-01-24 | 1998-05-26 | Cardiac Pacemakers, Inc. | Pacing lead having detachable positioning member |
US5916163A (en) | 1997-03-07 | 1999-06-29 | Ep Technologies, Inc. | Graphical user interface for use with multiple electrode catheters |
US5954761A (en) | 1997-03-25 | 1999-09-21 | Intermedics Inc. | Implantable endocardial lead assembly having a stent |
US5779732A (en) | 1997-03-31 | 1998-07-14 | Medtronic, Inc. | Method and apparatus for implanting a film with an exandable stent |
US5944022A (en) | 1997-04-28 | 1999-08-31 | American Cardiac Ablation Co. Inc. | Catheter positioning system |
US6869431B2 (en) | 1997-07-08 | 2005-03-22 | Atrionix, Inc. | Medical device with sensor cooperating with expandable member |
US5824027A (en) | 1997-08-14 | 1998-10-20 | Simon Fraser University | Nerve cuff having one or more isolated chambers |
US6479523B1 (en) | 1997-08-26 | 2002-11-12 | Emory University | Pharmacologic drug combination in vagal-induced asystole |
US6249708B1 (en) | 1997-08-26 | 2001-06-19 | Angeion Corporation | Fluted channel construction for a multi-conductor catheter lead |
US5922014A (en) | 1997-09-02 | 1999-07-13 | Medtronic, Inc. | Single pass lead and method of use |
US6024702A (en) | 1997-09-03 | 2000-02-15 | Pmt Corporation | Implantable electrode manufactured with flexible printed circuit |
US6123699A (en) | 1997-09-05 | 2000-09-26 | Cordis Webster, Inc. | Omni-directional steerable catheter |
US6179832B1 (en) | 1997-09-11 | 2001-01-30 | Vnus Medical Technologies, Inc. | Expandable catheter having two sets of electrodes |
US6120476A (en) | 1997-12-01 | 2000-09-19 | Cordis Webster, Inc. | Irrigated tip catheter |
US6171277B1 (en) | 1997-12-01 | 2001-01-09 | Cordis Webster, Inc. | Bi-directional control handle for steerable catheter |
US6183463B1 (en) | 1997-12-01 | 2001-02-06 | Cordis Webster, Inc. | Bidirectional steerable cathether with bidirectional control handle |
US6415187B1 (en) | 1998-02-10 | 2002-07-02 | Advanced Bionics Corporation | Implantable, expandable, multicontact electrodes and insertion needle for use therewith |
US6269269B1 (en) | 1998-04-23 | 2001-07-31 | Medtronic Inc. | Method and apparatus for synchronized treatment of obstructive sleep apnea |
US6251126B1 (en) | 1998-04-23 | 2001-06-26 | Medtronic Inc | Method and apparatus for synchronized treatment of obstructive sleep apnea |
US6161047A (en) | 1998-04-30 | 2000-12-12 | Medtronic Inc. | Apparatus and method for expanding a stimulation lead body in situ |
US6240320B1 (en) | 1998-06-05 | 2001-05-29 | Intermedics Inc. | Cardiac lead with zone insulated electrodes |
US6134478A (en) | 1998-06-05 | 2000-10-17 | Intermedics Inc. | Method for making cardiac leads with zone insulated electrodes |
US6002965A (en) | 1998-06-10 | 1999-12-14 | Katz; Amiram | Self applied device and method for prevention of deep vein thrombosis |
US6463327B1 (en) | 1998-06-11 | 2002-10-08 | Cprx Llc | Stimulatory device and methods to electrically stimulate the phrenic nerve |
US6213960B1 (en) | 1998-06-19 | 2001-04-10 | Revivant Corporation | Chest compression device with electro-stimulation |
US6292695B1 (en) | 1998-06-19 | 2001-09-18 | Wilton W. Webster, Jr. | Method and apparatus for transvascular treatment of tachycardia and fibrillation |
SE9802335D0 (sv) | 1998-06-30 | 1998-06-30 | Siemens Elema Ab | Andningshjälpsystem |
US6198974B1 (en) | 1998-08-14 | 2001-03-06 | Cordis Webster, Inc. | Bi-directional steerable catheter |
US7972323B1 (en) | 1998-10-02 | 2011-07-05 | Boston Scientific Scimed, Inc. | Steerable device for introducing diagnostic and therapeutic apparatus into the body |
FR2784300B1 (fr) | 1998-10-13 | 2000-12-08 | Ela Medical Sa | Sonde de stimulation du ventricule gauche implantable dans le reseau veineux coronarien pour dispositif medical implantable actif, notamment stimulateur de type "multisite" |
SE9803508D0 (sv) | 1998-10-14 | 1998-10-14 | Siemens Elema Ab | System for assisted breathing |
US6208881B1 (en) | 1998-10-20 | 2001-03-27 | Micropure Medical, Inc. | Catheter with thin film electrodes and method for making same |
US7076307B2 (en) | 2002-05-09 | 2006-07-11 | Boveja Birinder R | Method and system for modulating the vagus nerve (10th cranial nerve) with electrical pulses using implanted and external components, to provide therapy neurological and neuropsychiatric disorders |
US6212435B1 (en) | 1998-11-13 | 2001-04-03 | Respironics, Inc. | Intraoral electromuscular stimulation device and method |
EP1025822A1 (fr) | 1999-02-08 | 2000-08-09 | Paul Hartmann Aktiengesellschaft | Corps absorbant pour article hygiénique |
US6210339B1 (en) | 1999-03-03 | 2001-04-03 | Endosonics Corporation | Flexible elongate member having one or more electrical contacts |
US6161029A (en) | 1999-03-08 | 2000-12-12 | Medtronic, Inc. | Apparatus and method for fixing electrodes in a blood vessel |
DE19912635A1 (de) | 1999-03-20 | 2000-09-21 | Biotronik Mess & Therapieg | Dilatierbare Herzelektrodenanordnung zur Implantation insbesondere im Koronarsinus des Herzens |
US6136021A (en) | 1999-03-23 | 2000-10-24 | Cardiac Pacemakers, Inc. | Expandable electrode for coronary venous leads |
US6593754B1 (en) | 1999-04-01 | 2003-07-15 | Actuant Corporation | Compact subsurface object locator |
US6216045B1 (en) | 1999-04-26 | 2001-04-10 | Advanced Neuromodulation Systems, Inc. | Implantable lead and method of manufacture |
US6126649A (en) | 1999-06-10 | 2000-10-03 | Transvascular, Inc. | Steerable catheter with external guidewire as catheter tip deflector |
AU779255B2 (en) | 1999-06-25 | 2005-01-13 | Emory University | Devices and methods for vagus nerve stimulation |
WO2001000264A1 (fr) | 1999-06-30 | 2001-01-04 | University Of Florida Research Foundation, Inc. | Systeme de commande de ventilateur et procede permettant de l'utiliser |
US6702780B1 (en) | 1999-09-08 | 2004-03-09 | Super Dimension Ltd. | Steering configuration for catheter with rigid distal device |
US6236892B1 (en) | 1999-10-07 | 2001-05-22 | Claudio A. Feler | Spinal cord stimulation lead |
US6295475B1 (en) | 1999-10-27 | 2001-09-25 | Pacesetter, Inc. | Single-pass atrial ventricular lead with multiple atrial ring electrodes and a selective atrial electrode adaptor for the coronary sinus region |
US7206636B1 (en) | 1999-11-10 | 2007-04-17 | Pacesetter, Inc. | Pacing optimization based on changes in pulse amplitude and pulse amplitude variability |
US6556873B1 (en) | 1999-11-29 | 2003-04-29 | Medtronic, Inc. | Medical electrical lead having variable bending stiffness |
US20020026228A1 (en) | 1999-11-30 | 2002-02-28 | Patrick Schauerte | Electrode for intravascular stimulation, cardioversion and/or defibrillation |
US6415183B1 (en) | 1999-12-09 | 2002-07-02 | Cardiac Pacemakers, Inc. | Method and apparatus for diaphragmatic pacing |
US6885888B2 (en) | 2000-01-20 | 2005-04-26 | The Cleveland Clinic Foundation | Electrical stimulation of the sympathetic nerve chain |
US6493590B1 (en) | 2000-02-09 | 2002-12-10 | Micronet Medical, Inc. | Flexible band electrodes for medical leads |
AU2001257582A1 (en) | 2000-03-14 | 2001-09-24 | Children's Medical Center Corporation, The | Method for improving respiratory function and inhibiting muscular degeneration |
US6397108B1 (en) | 2000-04-03 | 2002-05-28 | Medtronic Inc. | Safety adaptor for temporary medical leads |
US6638268B2 (en) | 2000-04-07 | 2003-10-28 | Imran K. Niazi | Catheter to cannulate the coronary sinus |
US6442413B1 (en) | 2000-05-15 | 2002-08-27 | James H. Silver | Implantable sensor |
US6610713B2 (en) | 2000-05-23 | 2003-08-26 | North Shore - Long Island Jewish Research Institute | Inhibition of inflammatory cytokine production by cholinergic agonists and vagus nerve stimulation |
US6508802B1 (en) | 2000-05-23 | 2003-01-21 | Cornell Research Foundation, Inc. | Remote sensing gene therapy delivery device and method of administering a therapeutic solution to a heart |
US6719749B1 (en) | 2000-06-01 | 2004-04-13 | Medical Components, Inc. | Multilumen catheter assembly and methods for making and inserting the same |
US6695832B2 (en) | 2000-06-01 | 2004-02-24 | Twincath, Llc | Multilumen catheter and methods for making the catheter |
US6584362B1 (en) | 2000-08-30 | 2003-06-24 | Cardiac Pacemakers, Inc. | Leads for pacing and/or sensing the heart from within the coronary veins |
US7555349B2 (en) | 2000-09-26 | 2009-06-30 | Advanced Neuromodulation Systems, Inc. | Lead body and method of lead body construction |
US7149585B2 (en) | 2001-03-30 | 2006-12-12 | Micronet Medical, Inc. | Lead body and method of lead body construction |
US7499742B2 (en) | 2001-09-26 | 2009-03-03 | Cvrx, Inc. | Electrode structures and methods for their use in cardiovascular reflex control |
US6757970B1 (en) | 2000-11-07 | 2004-07-06 | Advanced Bionics Corporation | Method of making multi-contact electrode array |
SE0004141D0 (sv) | 2000-11-13 | 2000-11-13 | Siemens Elema Ab | Method for adaptive triggering of breathing devices and a breathing device |
EP1341579B1 (fr) | 2000-12-07 | 2006-11-29 | Medtronic, Inc. | Stimulation directionnelle du cerveau et broches de raccordement |
US6445953B1 (en) | 2001-01-16 | 2002-09-03 | Kenergy, Inc. | Wireless cardiac pacing system with vascular electrode-stents |
US7519421B2 (en) | 2001-01-16 | 2009-04-14 | Kenergy, Inc. | Vagal nerve stimulation using vascular implanted devices for treatment of atrial fibrillation |
DE10103288A1 (de) | 2001-01-25 | 2002-08-01 | Patrick Schauerte | Gefäßschleuse zur intravaskulären Nervenstimulation und Flüssigkeitsinfusion |
DE10105383C2 (de) | 2001-02-06 | 2003-06-05 | Heptec Gmbh | Antischnarchgerät |
ZA200306564B (en) | 2001-02-26 | 2004-10-15 | Optinose As | Nasal devices. |
US7167751B1 (en) | 2001-03-01 | 2007-01-23 | Advanced Bionics Corporation | Method of using a fully implantable miniature neurostimulator for vagus nerve stimulation |
US6585718B2 (en) | 2001-05-02 | 2003-07-01 | Cardiac Pacemakers, Inc. | Steerable catheter with shaft support system for resisting axial compressive loads |
WO2002096482A2 (fr) | 2001-05-30 | 2002-12-05 | Innersea Technology | Appareils implantables dotes d'un substrat en polymere cristaux liquides |
WO2003005887A2 (fr) | 2001-07-11 | 2003-01-23 | Nuvasive, Inc. | Systeme et methodes permettant de determiner la proximite d'un nerf et sa position par rapport a un instrument chirurgical, ainsi que son etat, lors d'une operation chirurgicale |
US6569114B2 (en) | 2001-08-31 | 2003-05-27 | Biosense Webster, Inc. | Steerable catheter with struts |
US7974693B2 (en) | 2001-08-31 | 2011-07-05 | Bio Control Medical (B.C.M.) Ltd. | Techniques for applying, configuring, and coordinating nerve fiber stimulation |
EP1435828A4 (fr) | 2001-09-25 | 2009-11-11 | Nuvasive Inc | Systeme et procedes pour evaluations et actes chirurgicaux |
US7168429B2 (en) | 2001-10-12 | 2007-01-30 | Ric Investments, Llc | Auto-titration pressure support system and method of using same |
US6934583B2 (en) | 2001-10-22 | 2005-08-23 | Pacesetter, Inc. | Implantable lead and method for stimulating the vagus nerve |
US6721603B2 (en) | 2002-01-25 | 2004-04-13 | Cyberonics, Inc. | Nerve stimulation as a treatment for pain |
US20060035849A1 (en) | 2002-02-13 | 2006-02-16 | Danafarber Cancer Institute, Inc | Methods and composition for modulating type I muscle formation using pgc-1 alpha |
US7653438B2 (en) | 2002-04-08 | 2010-01-26 | Ardian, Inc. | Methods and apparatus for renal neuromodulation |
US7620451B2 (en) | 2005-12-29 | 2009-11-17 | Ardian, Inc. | Methods and apparatus for pulsed electric field neuromodulation via an intra-to-extravascular approach |
US20030195571A1 (en) | 2002-04-12 | 2003-10-16 | Burnes John E. | Method and apparatus for the treatment of central sleep apnea using biventricular pacing |
BR0311849A (pt) | 2002-05-08 | 2005-04-05 | Univ California | Sistema para formar um bloqueio de condução em uma estrutura de tecido cardìaco para tratar uma arritmia cardìaca em um coração de um paciente, métodos para tratar uma arritmia cardìaca em um coração de um paciente e para montar um sistema de tratamento de arritmia cardìaca a partir de uma pluralidade de sistemas de distribuição cardìacos, e, sistema para tratar uma arritmia cardìaca em um coração de um paciente |
US7292890B2 (en) | 2002-06-20 | 2007-11-06 | Advanced Bionics Corporation | Vagus nerve stimulation via unidirectional propagation of action potentials |
SE0202537D0 (sv) | 2002-08-28 | 2002-08-28 | Siemens Elema Ab | Nervstimuleringsapparat |
US20040064069A1 (en) | 2002-09-30 | 2004-04-01 | Reynolds Brian R. | Medical device with support member |
SE0203108D0 (en) | 2002-10-22 | 2002-10-22 | Siemens Elema Ab | Multi-Electrode Catheter |
US20050033137A1 (en) | 2002-10-25 | 2005-02-10 | The Regents Of The University Of Michigan | Ablation catheters and methods for their use |
US7277757B2 (en) | 2002-10-31 | 2007-10-02 | Medtronic, Inc. | Respiratory nerve stimulation |
US7130700B2 (en) | 2002-11-19 | 2006-10-31 | Medtronic, Inc. | Multilumen body for an implantable medical device |
US20040111139A1 (en) | 2002-12-10 | 2004-06-10 | Mccreery Douglas B. | Apparatus and methods for differential stimulation of nerve fibers |
US7613515B2 (en) | 2003-02-03 | 2009-11-03 | Enteromedics Inc. | High frequency vagal blockage therapy |
WO2004075928A2 (fr) | 2003-02-21 | 2004-09-10 | Electro-Cat, Llc | Systeme et procede pour mesurer des parties transversales et des gradients de pression dans des organes intracavitaires |
US7142903B2 (en) | 2003-03-12 | 2006-11-28 | Biosense Webster, Inc. | Catheter with contractable mapping assembly |
US7155278B2 (en) | 2003-04-21 | 2006-12-26 | Medtronic, Inc. | Neurostimulation to treat effects of sleep apnea |
EP3064242A1 (fr) | 2003-04-28 | 2016-09-07 | Advanced Circulatory Systems Inc. | Ventilateur et procédés de traitement de traumatisme crânien et d'hypotension |
US7836881B2 (en) * | 2003-04-28 | 2010-11-23 | Advanced Circulatory Systems, Inc. | Ventilator and methods for treating head trauma and low blood circulation |
US20060111755A1 (en) | 2003-05-16 | 2006-05-25 | Stone Robert T | Method and system to control respiration by means of neuro-electrical coded signals |
US20060287679A1 (en) | 2003-05-16 | 2006-12-21 | Stone Robert T | Method and system to control respiration by means of confounding neuro-electrical signals |
US6999820B2 (en) | 2003-05-29 | 2006-02-14 | Advanced Neuromodulation Systems, Inc. | Winged electrode body for spinal cord stimulation |
EP1633434B1 (fr) | 2003-06-04 | 2014-11-19 | Synecor | Systeme electrophysiologiques intravasculaires |
US7235070B2 (en) | 2003-07-02 | 2007-06-26 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Ablation fluid manifold for ablation catheter |
TW200503738A (en) | 2003-07-16 | 2005-02-01 | Tzu Chi Buddhist General Hospital | Method for extracting antineoplastic components from bupleurum scorzonerifolium |
US7840270B2 (en) * | 2003-07-23 | 2010-11-23 | Synapse Biomedical, Inc. | System and method for conditioning a diaphragm of a patient |
US20050027338A1 (en) | 2003-07-29 | 2005-02-03 | Advanced Neuromodulation Systems, Inc. | Stretchable lead body, method of manufacture, and system |
US20050033136A1 (en) | 2003-08-01 | 2005-02-10 | Assaf Govari | Catheter with electrode strip |
US7662101B2 (en) * | 2003-09-18 | 2010-02-16 | Cardiac Pacemakers, Inc. | Therapy control based on cardiopulmonary status |
EP1670547B1 (fr) | 2003-08-18 | 2008-11-12 | Cardiac Pacemakers, Inc. | Systeme de surveillance de patient |
US7591265B2 (en) | 2003-09-18 | 2009-09-22 | Cardiac Pacemakers, Inc. | Coordinated use of respiratory and cardiac therapies for sleep disordered breathing |
WO2005018524A2 (fr) | 2003-08-18 | 2005-03-03 | Wondka Anthony D | Procede et dispositif pour ventilation non invasive avec interface nasale |
US7887493B2 (en) | 2003-09-18 | 2011-02-15 | Cardiac Pacemakers, Inc. | Implantable device employing movement sensing for detecting sleep-related disorders |
US8147486B2 (en) | 2003-09-22 | 2012-04-03 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Medical device with flexible printed circuit |
US7502650B2 (en) | 2003-09-22 | 2009-03-10 | Cvrx, Inc. | Baroreceptor activation for epilepsy control |
US20050070981A1 (en) | 2003-09-29 | 2005-03-31 | Sumit Verma | Active fixation coronary sinus lead apparatus |
NO319063B1 (no) | 2003-10-06 | 2005-06-13 | Laerdal Medical As | Medisinsk pasientsimulator |
US7970475B2 (en) | 2003-10-15 | 2011-06-28 | Rmx, Llc | Device and method for biasing lung volume |
US8265759B2 (en) | 2003-10-15 | 2012-09-11 | Rmx, Llc | Device and method for treating disorders of the cardiovascular system or heart |
US20080215106A1 (en) | 2003-10-15 | 2008-09-04 | Chang Lee | Thoracoscopically implantable diaphragm stimulator |
US20110288609A1 (en) * | 2003-10-15 | 2011-11-24 | Rmx, Llc | Therapeutic diaphragm stimulation device and method |
US20080161878A1 (en) | 2003-10-15 | 2008-07-03 | Tehrani Amir J | Device and method to for independently stimulating hemidiaphragms |
US20060167523A1 (en) | 2003-10-15 | 2006-07-27 | Tehrani Amir J | Device and method for improving upper airway functionality |
US20080288010A1 (en) | 2003-10-15 | 2008-11-20 | Rmx, Llc | Subcutaneous diaphragm stimulation device and method for use |
US20080288015A1 (en) | 2003-10-15 | 2008-11-20 | Rmx, Llc | Diaphragm stimulation device and method for use with cardiovascular or heart patients |
US7979128B2 (en) | 2003-10-15 | 2011-07-12 | Rmx, Llc | Device and method for gradually controlling breathing |
US8467876B2 (en) | 2003-10-15 | 2013-06-18 | Rmx, Llc | Breathing disorder detection and therapy delivery device and method |
US9259573B2 (en) | 2003-10-15 | 2016-02-16 | Rmx, Llc | Device and method for manipulating exhalation |
US8140164B2 (en) | 2003-10-15 | 2012-03-20 | Rmx, Llc | Therapeutic diaphragm stimulation device and method |
US8244358B2 (en) | 2003-10-15 | 2012-08-14 | Rmx, Llc | Device and method for treating obstructive sleep apnea |
US8160711B2 (en) | 2003-10-15 | 2012-04-17 | Rmx, Llc | Multimode device and method for controlling breathing |
US20060074449A1 (en) | 2003-11-03 | 2006-04-06 | Stephen Denker | Intravascular stimulation system with wireless power supply |
US7077823B2 (en) | 2003-11-19 | 2006-07-18 | Biosense Webster, Inc. | Bidirectional steerable catheter with slidable mated puller wires |
US7802571B2 (en) | 2003-11-21 | 2010-09-28 | Tehrani Fleur T | Method and apparatus for controlling a ventilator |
WO2005053789A2 (fr) | 2003-11-25 | 2005-06-16 | Advanced Neuromodulation Systems, Inc. | Fil de stimulation directionnelle et systeme d'orientation, aiguille amelioree d'insertion percutanee et procede d'implantation du fil electrique |
US7363085B1 (en) | 2004-01-26 | 2008-04-22 | Pacesetters, Inc. | Augmenting hypoventilation |
US7421296B1 (en) | 2004-01-26 | 2008-09-02 | Pacesetter, Inc. | Termination of respiratory oscillations characteristic of Cheyne-Stokes respiration |
EP1715787A4 (fr) | 2004-02-18 | 2009-04-08 | Maquet Critical Care Ab | Procede et dispositif destines a utiliser l'activite myoelectrique pour optimiser une assistance ventilatoire a un patient |
US7569029B2 (en) | 2004-04-12 | 2009-08-04 | Clark Timothy W I | Multi-lumen catheter |
US7082331B1 (en) | 2004-04-21 | 2006-07-25 | Pacesetter, Inc. | System and method for applying therapy during hyperpnea phase of periodic breathing using an implantable medical device |
US8412348B2 (en) | 2004-05-06 | 2013-04-02 | Boston Scientific Neuromodulation Corporation | Intravascular self-anchoring integrated tubular electrode body |
US20070106357A1 (en) | 2005-11-04 | 2007-05-10 | Stephen Denker | Intravascular Electronics Carrier Electrode for a Transvascular Tissue Stimulation System |
US7747323B2 (en) * | 2004-06-08 | 2010-06-29 | Cardiac Pacemakers, Inc. | Adaptive baroreflex stimulation therapy for disordered breathing |
US7591799B2 (en) | 2004-06-14 | 2009-09-22 | Biosense Webster, Inc. | Steering mechanism for bi-directional catheter |
US7225016B1 (en) | 2004-06-16 | 2007-05-29 | Pacesetter, Inc. | Implantable medical device with nerve signal sensing |
US7371220B1 (en) | 2004-06-30 | 2008-05-13 | Pacesetter, Inc. | System and method for real-time apnea/hypopnea detection using an implantable medical system |
EP1621247A1 (fr) | 2004-07-30 | 2006-02-01 | MAN DWE GmbH | Exécutions de réactions exothermiques en phase gazeuse |
US20060058852A1 (en) | 2004-09-10 | 2006-03-16 | Steve Koh | Multi-variable feedback control of stimulation for inspiratory facilitation |
US7340302B1 (en) | 2004-09-27 | 2008-03-04 | Pacesetter, Inc. | Treating sleep apnea in patients using phrenic nerve stimulation |
US9026228B2 (en) | 2004-10-21 | 2015-05-05 | Medtronic, Inc. | Transverse tripole neurostimulation lead, system and method |
US10537741B2 (en) | 2004-12-03 | 2020-01-21 | Boston Scientific Neuromodulation Corporation | System and method for choosing electrodes in an implanted stimulator device |
US20060122661A1 (en) | 2004-12-03 | 2006-06-08 | Mandell Lee J | Diaphragmatic pacing with activity monitor adjustment |
US7798148B2 (en) | 2004-12-08 | 2010-09-21 | Ventus Medical, Inc. | Respiratory devices |
US20060130833A1 (en) | 2004-12-16 | 2006-06-22 | Magdy Younes | Treatment of obstructive sleep apnea |
US7869865B2 (en) | 2005-01-07 | 2011-01-11 | Biosense Webster, Inc. | Current-based position sensing |
US8019439B2 (en) | 2005-01-11 | 2011-09-13 | Boston Scientific Neuromodulation Corporation | Lead assembly and method of making same |
US7891085B1 (en) | 2005-01-11 | 2011-02-22 | Boston Scientific Neuromodulation Corporation | Electrode array assembly and method of making same |
US7269459B1 (en) | 2005-02-08 | 2007-09-11 | Pacesetter, Inc. | Implantable cardiac device with selectable tiered sleep apnea therapies and method |
US7255511B2 (en) | 2005-02-22 | 2007-08-14 | Dolan Kevin P | Releasable dovetail corner joint |
US7920915B2 (en) | 2005-11-16 | 2011-04-05 | Boston Scientific Neuromodulation Corporation | Implantable stimulator |
US7363086B1 (en) | 2005-03-21 | 2008-04-22 | Pacesetter, Inc. | Capture verification in respiratory diaphragm stimulation |
US20060217791A1 (en) | 2005-03-23 | 2006-09-28 | Arrow International, Inc. | Multi-lumen catheter having external electrical leads |
US8401665B2 (en) | 2005-04-01 | 2013-03-19 | Boston Scientific Neuromodulation Corporation | Apparatus and methods for detecting position and migration of neurostimulation leads |
US7499748B2 (en) | 2005-04-11 | 2009-03-03 | Cardiac Pacemakers, Inc. | Transvascular neural stimulation device |
US20060229687A1 (en) * | 2005-04-11 | 2006-10-12 | Medtronic, Inc. | Shifting between electrode combinations in electrical stimulation device |
US7676275B1 (en) | 2005-05-02 | 2010-03-09 | Pacesetter, Inc. | Endovascular lead for chronic nerve stimulation |
US7561923B2 (en) | 2005-05-09 | 2009-07-14 | Cardiac Pacemakers, Inc. | Method and apparatus for controlling autonomic balance using neural stimulation |
US7617003B2 (en) | 2005-05-16 | 2009-11-10 | Cardiac Pacemakers, Inc. | System for selective activation of a nerve trunk using a transvascular reshaping lead |
US7949412B1 (en) | 2005-06-02 | 2011-05-24 | Advanced Bionics, Llc | Coated electrode array having uncoated electrode contacts |
US7553305B2 (en) | 2005-06-09 | 2009-06-30 | Enpath Medical, Inc. | Push-pull wire anchor |
US8036750B2 (en) | 2005-06-13 | 2011-10-11 | Cardiac Pacemakers, Inc. | System for neural control of respiration |
US20070005053A1 (en) | 2005-06-30 | 2007-01-04 | Dando Jeremy D | Ablation catheter with contoured openings in insulated electrodes |
US7879030B2 (en) | 2005-07-27 | 2011-02-01 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Multipolar, virtual-electrode catheter with at least one surface electrode and method for ablation |
US7416552B2 (en) | 2005-08-22 | 2008-08-26 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Multipolar, multi-lumen, virtual-electrode catheter with at least one surface electrode and method for ablation |
US7519426B1 (en) | 2005-10-07 | 2009-04-14 | Pacesetter, Inc. | Techniques for reducing orthostatic hypotension |
US7771388B2 (en) | 2005-10-12 | 2010-08-10 | Daniel Olsen | Steerable catheter system |
US20070112402A1 (en) | 2005-10-19 | 2007-05-17 | Duke University | Electrode systems and related methods for providing therapeutic differential tissue stimulation |
US7636600B1 (en) | 2005-10-21 | 2009-12-22 | Pacesetter, Inc. | Pressure monitoring for apnea prevention and/or therapy |
US7616990B2 (en) | 2005-10-24 | 2009-11-10 | Cardiac Pacemakers, Inc. | Implantable and rechargeable neural stimulator |
AU2006311701B2 (en) | 2005-11-08 | 2012-08-30 | Custom Medical Applications, Inc. | Reinforced catheter with articulated distal tip |
US10406366B2 (en) | 2006-11-17 | 2019-09-10 | Respicardia, Inc. | Transvenous phrenic nerve stimulation system |
US8696656B2 (en) | 2005-11-18 | 2014-04-15 | Medtronic Cryocath Lp | System and method for monitoring bioimpedance and respiration |
CA2865410C (fr) | 2005-11-18 | 2022-04-26 | Mark Gelfand | Systeme et procede pour moduler le nerf phrenique et prevenir l'apnee du sommeil |
US20220212005A9 (en) | 2005-11-18 | 2022-07-07 | Zoll Respicardia, Inc. | Transvenous Phrenic Nerve Stimulation System |
WO2007075974A2 (fr) | 2005-12-22 | 2007-07-05 | Proteus Biomedical, Inc. | Circuit intégré implantable |
US7672728B2 (en) | 2005-12-28 | 2010-03-02 | Cardiac Pacemakers, Inc. | Neural stimulator to treat sleep disordered breathing |
US8281792B2 (en) | 2005-12-31 | 2012-10-09 | John W Royalty | Electromagnetic diaphragm assist device and method for assisting a diaphragm function |
US7813805B1 (en) | 2006-01-11 | 2010-10-12 | Pacesetter, Inc. | Subcardiac threshold vagal nerve stimulation |
US7763034B2 (en) | 2006-01-24 | 2010-07-27 | Medtronic, Inc. | Transobturator lead implantation for pelvic floor stimulation |
CA2637787A1 (fr) | 2006-02-03 | 2007-08-16 | Synecor, Llc | Dispositif intravasculaire pour neuromodulation |
US7347695B2 (en) | 2006-02-03 | 2008-03-25 | Ware Linda M | Chronic obstructive pulmonary disease simulator |
WO2007098367A2 (fr) | 2006-02-16 | 2007-08-30 | University Of Pittsburgh - Of The Commonwealth System Of Higher Education | Methode et appareil pour stimuler un muscle denerve |
US7810497B2 (en) | 2006-03-20 | 2010-10-12 | Ric Investments, Llc | Ventilatory control system |
US7900626B2 (en) | 2006-04-17 | 2011-03-08 | Daly Robert W | Method and system for controlling breathing |
WO2007146076A2 (fr) | 2006-06-07 | 2007-12-21 | Cherik Bulkes | stimulateur de tissu biologique avec porte-électrode flexible |
JP4731606B2 (ja) | 2006-06-08 | 2011-07-27 | サージカル・ソルーシヨンズ・エルエルシー | 関節連結シャフトを有する医療デバイス |
US20080039916A1 (en) | 2006-08-08 | 2008-02-14 | Olivier Colliou | Distally distributed multi-electrode lead |
US8121692B2 (en) | 2006-08-30 | 2012-02-21 | Cardiac Pacemakers, Inc. | Method and apparatus for neural stimulation with respiratory feedback |
US8050765B2 (en) | 2006-08-30 | 2011-11-01 | Cardiac Pacemakers, Inc. | Method and apparatus for controlling neural stimulation during disordered breathing |
US20080065002A1 (en) | 2006-09-07 | 2008-03-13 | Neurosystec Corporation | Catheter for Localized Drug Delivery and/or Electrical Stimulation |
WO2008045877A2 (fr) | 2006-10-10 | 2008-04-17 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Pointe d'électrode et système d'ablation |
EP3527255B1 (fr) * | 2006-10-13 | 2020-08-05 | Cyberonics, Inc. | Dispositifs et systèmes pour le traitement du syndrome d'apnée obstructive du sommeil |
US7794407B2 (en) | 2006-10-23 | 2010-09-14 | Bard Access Systems, Inc. | Method of locating the tip of a central venous catheter |
US8388546B2 (en) | 2006-10-23 | 2013-03-05 | Bard Access Systems, Inc. | Method of locating the tip of a central venous catheter |
US9314618B2 (en) | 2006-12-06 | 2016-04-19 | Spinal Modulation, Inc. | Implantable flexible circuit leads and methods of use |
US8798759B2 (en) | 2006-12-06 | 2014-08-05 | Medtronic, Inc. | User interface with toolbar for programming electrical stimulation therapy |
US8280513B2 (en) | 2006-12-22 | 2012-10-02 | Rmx, Llc | Device and method to treat flow limitations |
US8909341B2 (en) | 2007-01-22 | 2014-12-09 | Respicardia, Inc. | Device and method for the treatment of breathing disorders and cardiac disorders |
US20080183265A1 (en) | 2007-01-30 | 2008-07-31 | Cardiac Pacemakers, Inc. | Transvascular lead with proximal force relief |
US8244378B2 (en) | 2007-01-30 | 2012-08-14 | Cardiac Pacemakers, Inc. | Spiral configurations for intravascular lead stability |
US7949409B2 (en) | 2007-01-30 | 2011-05-24 | Cardiac Pacemakers, Inc. | Dual spiral lead configurations |
US20080183186A1 (en) | 2007-01-30 | 2008-07-31 | Cardiac Pacemakers, Inc. | Method and apparatus for delivering a transvascular lead |
US20080183187A1 (en) | 2007-01-30 | 2008-07-31 | Cardiac Pacemakers, Inc. | Direct delivery system for transvascular lead |
US7917230B2 (en) | 2007-01-30 | 2011-03-29 | Cardiac Pacemakers, Inc. | Neurostimulating lead having a stent-like anchor |
US20080183264A1 (en) | 2007-01-30 | 2008-07-31 | Cardiac Pacemakers, Inc. | Electrode configurations for transvascular nerve stimulation |
US20080183255A1 (en) | 2007-01-30 | 2008-07-31 | Cardiac Pacemakers, Inc. | Side port lead delivery system |
US7819883B2 (en) | 2007-03-13 | 2010-10-26 | Cardiac Pacemakers, Inc. | Method and apparatus for endoscopic access to the vagus nerve |
GB0707906D0 (en) | 2007-04-24 | 2007-05-30 | Apparatus for detecting the position of a catheter | |
EP2148712B1 (fr) | 2007-04-27 | 2018-10-31 | Maquet Critical Care AB | Unité de commande et unité d'affichage pour ventilateur commandé par emg |
US10492729B2 (en) | 2007-05-23 | 2019-12-03 | St. Jude Medical, Cardiology Division, Inc. | Flexible high-density mapping catheter tips and flexible ablation catheter tips with onboard high-density mapping electrodes |
EP2170458A1 (fr) | 2007-06-13 | 2010-04-07 | E- Pacing, Inc. | Dispositifs implantables et procédés destinés à stimuler des tissus cardiaques ou d'autres tissus |
US20080312712A1 (en) | 2007-06-13 | 2008-12-18 | E-Pacing, Inc. | Implantable Devices and Methods for Stimulation of Cardiac or Other Tissues |
US9987488B1 (en) | 2007-06-27 | 2018-06-05 | Respicardia, Inc. | Detecting and treating disordered breathing |
EP2164560B8 (fr) | 2007-06-29 | 2016-10-12 | NewStim, Inc. | Systèmes pour la gestion du rythme cardiaque au moyen d'un ensemble électrode |
US20090024047A1 (en) | 2007-07-20 | 2009-01-22 | Cardiac Pacemakers, Inc. | Devices and methods for respiration therapy |
US8265736B2 (en) | 2007-08-07 | 2012-09-11 | Cardiac Pacemakers, Inc. | Method and apparatus to perform electrode combination selection |
US9037239B2 (en) | 2007-08-07 | 2015-05-19 | Cardiac Pacemakers, Inc. | Method and apparatus to perform electrode combination selection |
US7994655B2 (en) | 2007-08-17 | 2011-08-09 | Inovise Medical, Inc. | Mechanical, anatomical heart-pumping assist |
US8135471B2 (en) | 2007-08-28 | 2012-03-13 | Cardiac Pacemakers, Inc. | Method and apparatus for inspiratory muscle stimulation using implantable device |
US8527036B2 (en) | 2007-09-28 | 2013-09-03 | Maquet Critical Care Ab | Catheter positioning method and computerized control unit for implementing the method |
US8428711B2 (en) | 2007-10-10 | 2013-04-23 | Cardiac Pacemakers, Inc. | Respiratory stimulation for treating periodic breathing |
US8428726B2 (en) | 2007-10-30 | 2013-04-23 | Synapse Biomedical, Inc. | Device and method of neuromodulation to effect a functionally restorative adaption of the neuromuscular system |
US8478412B2 (en) | 2007-10-30 | 2013-07-02 | Synapse Biomedical, Inc. | Method of improving sleep disordered breathing |
AU2008329807B2 (en) | 2007-11-26 | 2014-02-27 | C. R. Bard, Inc. | Integrated system for intravascular placement of a catheter |
US8406883B1 (en) | 2007-12-27 | 2013-03-26 | Boston Scientific Neuromodulation Corporation | Lead assembly for electrical stimulation systems and methods of making and using |
US9060771B2 (en) * | 2008-01-29 | 2015-06-23 | Peter Forsell | Method and instrument for treating obesity |
US20130123891A1 (en) | 2008-02-01 | 2013-05-16 | John Swanson | High density terminal contacts for stimulation lead and stimulation system employing the same, and method of stimulation lead fabrication |
US9199075B1 (en) | 2008-02-07 | 2015-12-01 | Respicardia, Inc. | Transvascular medical lead |
US7925352B2 (en) | 2008-03-27 | 2011-04-12 | Synecor Llc | System and method for transvascularly stimulating contents of the carotid sheath |
US8052607B2 (en) | 2008-04-22 | 2011-11-08 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Ultrasound imaging catheter with pivoting head |
US8315713B2 (en) | 2008-04-30 | 2012-11-20 | Medtronic, Inc. | Techniques for placing medical leads for electrical stimulation of nerve tissue |
WO2009134459A2 (fr) | 2008-05-02 | 2009-11-05 | The Johns Hopkins University | Dispositif portable de ventilation à pression négative et ses procédés et son logiciel |
US9409012B2 (en) | 2008-06-19 | 2016-08-09 | Cardiac Pacemakers, Inc. | Pacemaker integrated with vascular intervention catheter |
US8239037B2 (en) | 2008-07-06 | 2012-08-07 | Synecor Llc | Intravascular implant anchors having remote communication and/or battery recharging capabilities |
AU2009269901B2 (en) | 2008-07-08 | 2012-09-06 | Cardiac Pacemakers, Inc. | Systems for delivering vagal nerve stimulation |
US8734437B2 (en) | 2008-07-23 | 2014-05-27 | Boston Scientific Scimed, Inc. | Catheter having electrically conductive pathways |
JP4545210B2 (ja) | 2008-09-11 | 2010-09-15 | 日本ライフライン株式会社 | 除細動カテーテル |
US8195297B2 (en) | 2008-10-13 | 2012-06-05 | E-Pacing, Inc. | Devices and methods for electrical stimulation of the diaphragm and nerves |
US20100114227A1 (en) | 2008-10-30 | 2010-05-06 | Pacesetter, Inc. | Systems and Methds for Use by an Implantable Medical Device for Controlling Vagus Nerve Stimulation Based on Heart Rate Reduction Curves and Thresholds to Mitigate Heart Failure |
US8386053B2 (en) | 2008-10-31 | 2013-02-26 | Medtronic, Inc. | Subclavian ansae stimulation |
EP2352551A4 (fr) | 2008-11-13 | 2012-04-25 | Proteus Biomedical Inc | Dispositif rechargeable de stimulation, système et procédé associés |
JP2012508624A (ja) | 2008-11-13 | 2012-04-12 | プロテウス バイオメディカル インコーポレイテッド | 多重化複数電極神経刺激装置 |
US8781578B2 (en) | 2008-11-14 | 2014-07-15 | Cardiac Pacemakers, Inc. | Mass attribute detection through phrenic stimulation |
US8644939B2 (en) | 2008-11-18 | 2014-02-04 | Neurostream Technologies General Partnership | Method and device for the detection, identification and treatment of sleep apnea/hypopnea |
KR101088806B1 (ko) | 2009-01-07 | 2011-12-01 | 주식회사 뉴로바이오시스 | 액정 폴리머를 이용한 미세 전극 어레이 패키지 및 그의 제조 방법 |
WO2010091435A2 (fr) | 2009-02-09 | 2010-08-12 | Proteus Biomedical, Inc. | Dispositifs de neurostimulation à électrodes multiples multiplexées avec circuit intégré contenant des électrodes |
US9226688B2 (en) | 2009-03-10 | 2016-01-05 | Medtronic Xomed, Inc. | Flexible circuit assemblies |
US9226689B2 (en) | 2009-03-10 | 2016-01-05 | Medtronic Xomed, Inc. | Flexible circuit sheet |
US20100268311A1 (en) | 2009-04-17 | 2010-10-21 | Ralph Cardinal | Method for Implanting Electrode on Nerve |
US8626292B2 (en) | 2009-05-27 | 2014-01-07 | Cardiac Pacemakers, Inc. | Respiration sensor processing for phrenic nerve activation detection |
US9149642B2 (en) | 2009-05-27 | 2015-10-06 | Cardiac Pacemakers, Inc. | Method and apparatus for phrenic nerve activation detection with respiration cross-checking |
US9532724B2 (en) | 2009-06-12 | 2017-01-03 | Bard Access Systems, Inc. | Apparatus and method for catheter navigation using endovascular energy mapping |
US8694123B2 (en) | 2009-06-19 | 2014-04-08 | Medtronic, Inc. | Helical electrode arrangements for medical leads |
US8340783B2 (en) | 2009-06-30 | 2012-12-25 | Medtronic, Inc. | Implantable medical device lead with selectively exposed electrodes and reinforcement member |
AU2010281644A1 (en) | 2009-08-05 | 2012-02-23 | Ndi Medical, Llc | Systems and methods for maintaining airway patency |
US8374704B2 (en) | 2009-09-02 | 2013-02-12 | Cardiac Pacemakers, Inc. | Polyisobutylene urethane, urea and urethane/urea copolymers and medical leads containing the same |
US8644952B2 (en) | 2009-09-02 | 2014-02-04 | Cardiac Pacemakers, Inc. | Medical devices including polyisobutylene based polymers and derivatives thereof |
US9072899B1 (en) | 2009-09-04 | 2015-07-07 | Todd Nickloes | Diaphragm pacemaker |
US8233987B2 (en) | 2009-09-10 | 2012-07-31 | Respicardia, Inc. | Respiratory rectification |
US9468755B2 (en) | 2009-09-30 | 2016-10-18 | Respicardia, Inc. | Medical lead with preformed bias |
US8617228B2 (en) | 2009-10-23 | 2013-12-31 | Medtronic Cryocath Lp | Method and system for preventing nerve injury during a medical procedure |
CN102821676B (zh) | 2010-01-29 | 2016-09-07 | C·R·巴德股份有限公司 | 牺牲导管 |
ES2811107T3 (es) | 2010-02-02 | 2021-03-10 | Bard Inc C R | Aparato y método para conducción de catéter y localización de punta |
JP5537213B2 (ja) | 2010-03-26 | 2014-07-02 | オリンパス株式会社 | 電気刺激電極組立体 |
US20110230945A1 (en) | 2010-03-19 | 2011-09-22 | Olympus Corporation | Electrostimulation system, and electrostimulation electrode assembly and biological implantable electrode therefor |
US20110270358A1 (en) | 2010-04-30 | 2011-11-03 | Medtronic, Inc. | Implantable medical device programming using gesture-based control |
US10631912B2 (en) | 2010-04-30 | 2020-04-28 | Medtronic Xomed, Inc. | Interface module for use with nerve monitoring and electrosurgery |
US8755889B2 (en) | 2010-04-30 | 2014-06-17 | Medtronic, Inc. | Method and apparatus to enhance therapy during stimulation of vagus nerve |
WO2011153027A1 (fr) | 2010-06-03 | 2011-12-08 | Cardiac Pacemakers, Inc. | Système de contrôle de cible de neurostimulation utilisant des paramètres temporaux |
JP5769036B2 (ja) | 2010-06-03 | 2015-08-26 | カーディアック ペースメイカーズ, インコーポレイテッド | 空間選択的迷走神経刺激のためのシステム |
JP4940332B2 (ja) | 2010-06-15 | 2012-05-30 | 日本ライフライン株式会社 | カテーテル |
US20120130217A1 (en) | 2010-11-23 | 2012-05-24 | Kauphusman James V | Medical devices having electrodes mounted thereon and methods of manufacturing therefor |
WO2012003295A1 (fr) | 2010-06-30 | 2012-01-05 | Med-El Elektromedizinische Geraete Gmbh | Electrode d'implant auditif et procédé de fabrication |
WO2012012432A1 (fr) | 2010-07-19 | 2012-01-26 | Cardiac Pacemakers, Inc. | Système minimalement invasif de conducteurs pour stimulation du nerf vague |
US8478426B2 (en) | 2010-07-29 | 2013-07-02 | Boston Scientific Neuromodulation Corporation | Systems and methods for making and using electrical stimulation systems having multi-lead-element lead bodies |
US9138585B2 (en) | 2010-08-06 | 2015-09-22 | Cardiac Pacemakers, Inc. | User interface system for use with multipolar pacing leads |
US8934956B2 (en) | 2010-08-31 | 2015-01-13 | Interventional Autonomics Corporation | Intravascular electrodes and anchoring devices for transvascular stimulation |
US20120078320A1 (en) | 2010-09-29 | 2012-03-29 | Medtronic, Inc. | Prioritized programming of multi-electrode pacing leads |
KR101304338B1 (ko) | 2010-10-21 | 2013-09-11 | 주식회사 엠아이텍 | 액정폴리머 기반의 전광극 신경 인터페이스 및 그 제조 방법 |
CN103189009B (zh) | 2010-10-29 | 2016-09-07 | C·R·巴德股份有限公司 | 医疗设备的生物阻抗辅助放置 |
US8391956B2 (en) | 2010-11-18 | 2013-03-05 | Robert D. Zellers | Medical device location systems, devices and methods |
US8560086B2 (en) | 2010-12-02 | 2013-10-15 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Catheter electrode assemblies and methods of construction therefor |
US8725259B2 (en) | 2011-01-19 | 2014-05-13 | Medtronic, Inc. | Vagal stimulation |
US8781582B2 (en) | 2011-01-19 | 2014-07-15 | Medtronic, Inc. | Vagal stimulation |
US8718763B2 (en) | 2011-01-19 | 2014-05-06 | Medtronic, Inc. | Vagal stimulation |
US8706223B2 (en) | 2011-01-19 | 2014-04-22 | Medtronic, Inc. | Preventative vagal stimulation |
US8781583B2 (en) | 2011-01-19 | 2014-07-15 | Medtronic, Inc. | Vagal stimulation |
JP6441572B2 (ja) | 2011-01-25 | 2018-12-19 | アペリス・ホールディングス,エルエルシー | 呼吸を支援するための装置および方法 |
US9550041B2 (en) | 2011-02-04 | 2017-01-24 | Advanced Pain Center, Llc. | Continuous single wire steerable catheter |
US9744349B2 (en) | 2011-02-10 | 2017-08-29 | Respicardia, Inc. | Medical lead and implantation |
US8430864B2 (en) | 2011-02-16 | 2013-04-30 | Biosense Webster, Inc. | Catheter with multiple deflections |
US9615759B2 (en) | 2011-07-12 | 2017-04-11 | Bard Access Systems, Inc. | Devices and methods for ECG guided vascular access |
US20130018427A1 (en) | 2011-07-15 | 2013-01-17 | Khiem Pham | Screw Implants For Bone Fusion |
US8805511B2 (en) | 2011-07-27 | 2014-08-12 | Medtronic, Inc. | Method and apparatus to detect subcerebral ischemia |
US20130030497A1 (en) | 2011-07-27 | 2013-01-31 | Medtronic, Inc. | Nerve stimulator for reduced muscle fatigue |
US8706235B2 (en) | 2011-07-27 | 2014-04-22 | Medtronic, Inc. | Transvenous method to induce respiration |
US8478413B2 (en) | 2011-07-27 | 2013-07-02 | Medtronic, Inc. | Bilateral phrenic nerve stimulation with reduced dyssynchrony |
US9861817B2 (en) | 2011-07-28 | 2018-01-09 | Medtronic, Inc. | Medical device to provide breathing therapy |
US8509902B2 (en) | 2011-07-28 | 2013-08-13 | Medtronic, Inc. | Medical device to provide breathing therapy |
US10201385B2 (en) | 2011-09-01 | 2019-02-12 | Biosense Webster (Israel) Ltd. | Catheter adapted for direct tissue contact |
US9724018B2 (en) | 2011-10-27 | 2017-08-08 | Medtronic Cryocath Lp | Method for monitoring phrenic nerve function |
US8897879B2 (en) | 2011-11-04 | 2014-11-25 | Medtronic, Inc. | Method and apparatus for therapies of the cardiovascular and cardiorenal system |
EP3287067B1 (fr) | 2011-11-07 | 2019-10-30 | Medtronic Ardian Luxembourg S.à.r.l. | Dispositifs endovasculaires de surveillance de nerfs et systèmes |
US9956396B2 (en) | 2012-02-08 | 2018-05-01 | Medtronic Bakken Research Center B.V. | Thin film for a lead for brain applications |
CN107126622A (zh) | 2012-03-05 | 2017-09-05 | 西蒙·弗雷瑟大学 | 神经刺激系统 |
JP6026567B2 (ja) | 2012-03-21 | 2016-11-16 | カーディアック ペースメイカーズ, インコーポレイテッド | 迷走神経を刺激するためのシステムおよび方法 |
US10413203B2 (en) | 2012-03-27 | 2019-09-17 | Cardiac Pacemakers, Inc. | Baseline determination for phrenic nerve stimulation detection |
WO2013165920A1 (fr) | 2012-04-29 | 2013-11-07 | Synecor Llc | Réseaux d'électrodes intravasculaires pour une neuromodulation |
US9179972B2 (en) | 2012-05-04 | 2015-11-10 | St. Jude Medical, Atrial Fibrillation Division, Inc. | System and method for controlling delivery of ablation energy to tissue |
US20130317587A1 (en) | 2012-05-25 | 2013-11-28 | Boston Scientific Neuromodulation Corporation | Methods for stimulating the dorsal root ganglion with a lead having segmented electrodes |
CA2877049C (fr) | 2012-06-21 | 2022-08-16 | Simon Fraser University | Systemes de stimulation de diaphragme transvasculaire et procedes d'utilisation |
US20150165207A1 (en) | 2012-07-02 | 2015-06-18 | Medisci L.L.C. | Method and device for respiratory and cardiorespiratory support |
US8504161B1 (en) | 2012-08-07 | 2013-08-06 | Medtronic, Inc. | Modulate vagal signals to reduce inflammation |
WO2014030099A1 (fr) | 2012-08-20 | 2014-02-27 | Koninklijke Philips N.V. | Synchronisation de l'insufflation/exsufflation mécanique et de la stimulation du diaphragme |
EP2722071A1 (fr) | 2012-10-16 | 2014-04-23 | Sapiens Steering Brain Stimulation B.V. | Sonde et en particulier une sonde pour applications neuronales |
US20140121716A1 (en) | 2012-10-31 | 2014-05-01 | Medtronic, Inc. | High voltage therapy diversion algorithms |
WO2014071386A1 (fr) | 2012-11-05 | 2014-05-08 | Regents Of The University Of Minnesota | Stimulation pulmonaire non invasive |
CN102949770B (zh) | 2012-11-09 | 2015-04-22 | 张红璇 | 一种体外膈肌起搏与呼吸机协同送气的方法及其装置 |
US9072864B2 (en) | 2012-11-28 | 2015-07-07 | Ad-Tech Medical Instrument Corporation | Catheter with depth electrode for dual-purpose use |
US9884179B2 (en) | 2012-12-05 | 2018-02-06 | Bbattelle Memorial Institute | Neural sleeve for neuromuscular stimulation, sensing and recording |
EP2928545B1 (fr) | 2012-12-05 | 2023-04-05 | Battelle Memorial Institute | Manchon de stimulation neuromusculaire |
US10335592B2 (en) | 2012-12-19 | 2019-07-02 | Viscardia, Inc. | Systems, devices, and methods for improving hemodynamic performance through asymptomatic diaphragm stimulation |
JP6285956B2 (ja) | 2012-12-19 | 2018-02-28 | ヴィスカルディア インコーポレイテッド | 無症候性横隔膜刺激を介する血行動態性能の向上 |
US9485873B2 (en) | 2013-03-15 | 2016-11-01 | Lawrence Livermore National Security, Llc | Depositing bulk or micro-scale electrodes |
EP2818104B1 (fr) | 2013-06-25 | 2016-01-06 | VascoMed GmbH | Cathéter et méthode de sa fabrication |
US9427566B2 (en) | 2013-08-14 | 2016-08-30 | Syntilla Medical LLC | Implantable neurostimulation lead for head pain |
EP3038702B1 (fr) | 2013-08-27 | 2019-02-27 | Advanced Bionics AG | Réseaux d'électrodes thermoformés |
US9504837B2 (en) | 2013-10-25 | 2016-11-29 | Medtronic, Inc. | Automated phrenic nerve stimulation and pacing capture threshold test |
US9205258B2 (en) | 2013-11-04 | 2015-12-08 | ElectroCore, LLC | Nerve stimulator system |
WO2015075548A1 (fr) | 2013-11-22 | 2015-05-28 | Simon Fraser University | Appareil et procédés d'assistance respiratoire par stimulation nerveuse transvasculaire |
AU2015204617B2 (en) | 2014-01-10 | 2017-06-29 | Boston Scientific Scimed, Inc. | Medical devices with flexible circuit assemblies |
AU2015208640B2 (en) | 2014-01-21 | 2020-02-20 | Lungpacer Medical Inc. | Systems and related methods for optimization of multi-electrode nerve pacing |
US9498631B2 (en) | 2014-02-20 | 2016-11-22 | Medtronic, Inc. | Automated phrenic nerve stimulation and pacing capture threshold test |
US9844644B2 (en) | 2014-03-05 | 2017-12-19 | Oscor Inc. | Intravascular sheath with mapping capabilities to deliver therapeutic devices to a targeted location within a blood vessel |
US12070601B2 (en) | 2014-03-28 | 2024-08-27 | Pinnacle Bionics. Inc. | Stimulation system for exercising diaphragm and method of operation thereof |
US10194978B2 (en) | 2014-06-13 | 2019-02-05 | Medtronic Cryocath Lp | Supporting catheter for use for phrenic nerve pacing |
KR101654801B1 (ko) | 2014-08-08 | 2016-09-07 | 서울대학교산학협력단 | 액정 폴리머 기반의 신경 임플란트용 전극 어레이와 패키지 및 그 제조 방법 |
WO2016033245A1 (fr) | 2014-08-26 | 2016-03-03 | Rmx, Llc | Dispositifs et procédés de réduction de la pression intrathoracique |
US9474894B2 (en) | 2014-08-27 | 2016-10-25 | Aleva Neurotherapeutics | Deep brain stimulation lead |
CN107205641A (zh) | 2014-08-29 | 2017-09-26 | 因赛飞公司 | 用于增强神经功能的方法和装置 |
US10507321B2 (en) | 2014-11-25 | 2019-12-17 | Medtronic Bakken Research Center B.V. | Multilayer structure and method of manufacturing a multilayer structure |
US20160331326A1 (en) | 2015-02-13 | 2016-11-17 | National University Of Singapore | Flexible neural strip electrodes, flexible neural ribbon electrodes and compartment based embedded nerve tissue electrode interfaces for peripheral nerves |
US10622107B2 (en) | 2015-02-13 | 2020-04-14 | Medtronic, Inc. | Tools for medical device configuration |
EP3064131A1 (fr) | 2015-03-03 | 2016-09-07 | BIOTRONIK SE & Co. KG | Appareil de stimulation du nerf vague-phrénique combiné |
US9872989B2 (en) | 2015-04-02 | 2018-01-23 | The Florida International University Board Of Trustees | System and method for neuromorphic controlled adaptive pacing of respiratory muscles and nerves |
EP3328481B1 (fr) | 2015-07-30 | 2019-05-15 | Boston Scientific Neuromodulation Corporation | Interface utilisateur de stimulation électrique à motifs personnalisés |
CA3008265A1 (fr) | 2015-12-14 | 2017-06-22 | Stimdia Medical, Inc. | Stimulation electrique pour conservation et retablissement de fonction de diaphragme |
US10369361B2 (en) | 2016-04-29 | 2019-08-06 | Viscardia, Inc. | Leads for implantable medical device that affects pressures within the intrathoracic cavity through diaphragmatic stimulation |
US10695564B2 (en) | 2016-06-02 | 2020-06-30 | Battelle Memorial Institute | Flexible sheet for neuromuscular stimulation |
WO2017210672A1 (fr) | 2016-06-03 | 2017-12-07 | The Cleveland Clinic Foundation | Systèmes et procédés pour surveiller une profondeur de blocage neuromusculaire |
US10207103B2 (en) | 2016-07-05 | 2019-02-19 | Pacesetter, Inc. | Implantable thin film devices |
US10898262B2 (en) | 2016-10-25 | 2021-01-26 | Biosense Webster (Israel) Ltd. | Catheter distal end made of plastic tube and flexible printed circuit boards |
US10293164B2 (en) | 2017-05-26 | 2019-05-21 | Lungpacer Medical Inc. | Apparatus and methods for assisted breathing by transvascular nerve stimulation |
US10195429B1 (en) | 2017-08-02 | 2019-02-05 | Lungpacer Medical Inc. | Systems and methods for intravascular catheter positioning and/or nerve stimulation |
US20210361964A1 (en) | 2018-02-06 | 2021-11-25 | Stimit Ag | Ventilation machine and method of ventilating a patient |
-
2013
- 2013-06-21 CA CA2877049A patent/CA2877049C/fr active Active
- 2013-06-21 US US14/410,022 patent/US20150265833A1/en not_active Abandoned
- 2013-06-21 AU AU2013280184A patent/AU2013280184B2/en active Active
- 2013-06-21 WO PCT/CA2013/000594 patent/WO2013188965A1/fr active Application Filing
- 2013-06-21 CA CA3161433A patent/CA3161433A1/fr active Pending
- 2013-06-21 JP JP2015517565A patent/JP6359528B2/ja active Active
- 2013-06-21 BR BR112014032002A patent/BR112014032002A2/pt not_active Application Discontinuation
- 2013-06-21 CN CN201380039158.3A patent/CN104684614B/zh active Active
- 2013-06-21 EP EP23180190.3A patent/EP4233953A3/fr active Pending
- 2013-06-21 EP EP13807238.4A patent/EP2863987B1/fr active Active
-
2015
- 2015-08-28 US US14/839,432 patent/US9776005B2/en active Active
-
2018
- 2018-06-20 JP JP2018116590A patent/JP6677764B2/ja active Active
- 2018-08-24 US US16/111,644 patent/US10406367B2/en active Active
- 2018-08-27 US US16/114,064 patent/US10561844B2/en active Active
-
2019
- 2019-07-02 US US16/460,728 patent/US10589097B2/en active Active
-
2020
- 2020-01-31 US US16/778,952 patent/US11357985B2/en active Active
- 2020-03-13 JP JP2020043613A patent/JP7176773B2/ja active Active
-
2021
- 2021-10-12 US US17/498,870 patent/US20220023625A1/en active Pending
- 2021-12-01 JP JP2021195133A patent/JP7313723B2/ja active Active
-
2023
- 2023-07-05 JP JP2023110484A patent/JP2023118874A/ja active Pending
Patent Citations (9)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US3983881A (en) * | 1975-05-21 | 1976-10-05 | Telectronics Pty. Limited | Muscle stimulator |
US4827935A (en) * | 1986-04-24 | 1989-05-09 | Purdue Research Foundation | Demand electroventilator |
US5549655A (en) * | 1994-09-21 | 1996-08-27 | Medtronic, Inc. | Method and apparatus for synchronized treatment of obstructive sleep apnea |
US20120158091A1 (en) * | 2003-10-15 | 2012-06-21 | Rmx, Llc | Therapeutic diaphragm stimulation device and method |
US20050165457A1 (en) * | 2004-01-26 | 2005-07-28 | Michael Benser | Tiered therapy for respiratory oscillations characteristic of Cheyne-Stokes respiration |
US7962215B2 (en) * | 2004-07-23 | 2011-06-14 | Synapse Biomedical, Inc. | Ventilatory assist system and methods to improve respiratory function |
US20100036451A1 (en) * | 2007-01-29 | 2010-02-11 | Simon Fraser University | Transvascular nerve stimulation apparatus and methods |
US8571662B2 (en) * | 2007-01-29 | 2013-10-29 | Simon Fraser University | Transvascular nerve stimulation apparatus and methods |
US8504158B2 (en) * | 2011-05-09 | 2013-08-06 | Medtronic, Inc. | Phrenic nerve stimulation during cardiac refractory period |
Non-Patent Citations (1)
Title |
---|
Lungpacer: Therapy, News. <http://lungpacer.com>. Accessed 12/27/16. * |
Cited By (40)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US10561843B2 (en) | 2007-01-29 | 2020-02-18 | Lungpacer Medical, Inc. | Transvascular nerve stimulation apparatus and methods |
US11027130B2 (en) | 2007-01-29 | 2021-06-08 | Lungpacer Medical Inc. | Transvascular nerve stimulation apparatus and methods |
US10864374B2 (en) | 2007-01-29 | 2020-12-15 | Lungpacer Medical Inc. | Transvascular nerve stimulation apparatus and methods |
US10792499B2 (en) | 2007-01-29 | 2020-10-06 | Lungpacer Medical Inc. | Transvascular nerve stimulation apparatus and methods |
US10765867B2 (en) | 2007-01-29 | 2020-09-08 | Lungpacer Medical Inc. | Transvascular nerve stimulation apparatus and methods |
US10512772B2 (en) | 2012-03-05 | 2019-12-24 | Lungpacer Medical Inc. | Transvascular nerve stimulation apparatus and methods |
US11369787B2 (en) | 2012-03-05 | 2022-06-28 | Lungpacer Medical Inc. | Transvascular nerve stimulation apparatus and methods |
US10406367B2 (en) | 2013-06-21 | 2019-09-10 | Lungpacer Medical Inc. | Transvascular diaphragm pacing system and methods of use |
US11357985B2 (en) | 2013-06-21 | 2022-06-14 | Lungpacer Medical Inc. | Transvascular diaphragm pacing systems and methods of use |
US10589097B2 (en) | 2013-06-21 | 2020-03-17 | Lungpacer Medical Inc. | Transvascular diaphragm pacing systems and methods of use |
US10561844B2 (en) | 2013-06-21 | 2020-02-18 | Lungpacer Medical Inc. | Diaphragm pacing systems and methods of use |
US9931504B2 (en) | 2013-11-22 | 2018-04-03 | Lungpacer Medical, Inc. | Apparatus and methods for assisted breathing by transvascular nerve stimulation |
US10035017B2 (en) | 2013-11-22 | 2018-07-31 | Lungpacer Medical, Inc. | Apparatus and methods for assisted breathing by transvascular nerve stimulation |
US11707619B2 (en) | 2013-11-22 | 2023-07-25 | Lungpacer Medical Inc. | Apparatus and methods for assisted breathing by transvascular nerve stimulation |
US10391314B2 (en) | 2014-01-21 | 2019-08-27 | Lungpacer Medical Inc. | Systems and related methods for optimization of multi-electrode nerve pacing |
US11311730B2 (en) | 2014-01-21 | 2022-04-26 | Lungpacer Medical Inc. | Systems and related methods for optimization of multi-electrode nerve pacing |
US12070601B2 (en) * | 2014-03-28 | 2024-08-27 | Pinnacle Bionics. Inc. | Stimulation system for exercising diaphragm and method of operation thereof |
US10758693B2 (en) * | 2015-09-10 | 2020-09-01 | St. Michael's Hospital. | Method and system for adjusting a level of ventilatory assist to a patient |
US20170128684A1 (en) * | 2015-09-10 | 2017-05-11 | St. Michael's Hospital | Method and system for adjusting a level of ventilatory assist to a patient |
US11052250B2 (en) | 2015-12-14 | 2021-07-06 | Stimdia Medical, Inc. | Electrical stimulation for preservation and restoration of diaphragm function |
US10300272B2 (en) | 2015-12-14 | 2019-05-28 | Stimdia Medical, Inc. | Electrical stimulation for preservation and restoration of diaphragm function |
US10293157B2 (en) | 2015-12-14 | 2019-05-21 | Stimdia Medical, Inc. | Electrical stimulation for preservation and restoration of diaphragm function |
WO2017106273A1 (fr) * | 2015-12-14 | 2017-06-22 | Stimdia Medical, Inc. | Stimulation électrique pour conservation et rétablissement de fonction de diaphragme |
US9682235B1 (en) | 2015-12-14 | 2017-06-20 | Stimdia Medical, Inc. | Electrical stimulation for preservation and restoration of diaphragm function |
US10293164B2 (en) | 2017-05-26 | 2019-05-21 | Lungpacer Medical Inc. | Apparatus and methods for assisted breathing by transvascular nerve stimulation |
US11883658B2 (en) | 2017-06-30 | 2024-01-30 | Lungpacer Medical Inc. | Devices and methods for prevention, moderation, and/or treatment of cognitive injury |
US12029901B2 (en) | 2017-06-30 | 2024-07-09 | Lungpacer Medical Inc. | Devices and methods for prevention, moderation, and/or treatment of cognitive injury |
US11207517B2 (en) | 2017-07-06 | 2021-12-28 | Stimdia Medical, Inc. | Percutaneous electrical phrenic nerve stimulation system |
US10926087B2 (en) | 2017-08-02 | 2021-02-23 | Lungpacer Medical Inc. | Systems and methods for intravascular catheter positioning and/or nerve stimulation |
US10195429B1 (en) | 2017-08-02 | 2019-02-05 | Lungpacer Medical Inc. | Systems and methods for intravascular catheter positioning and/or nerve stimulation |
US10039920B1 (en) | 2017-08-02 | 2018-08-07 | Lungpacer Medical, Inc. | Systems and methods for intravascular catheter positioning and/or nerve stimulation |
US10940308B2 (en) | 2017-08-04 | 2021-03-09 | Lungpacer Medical Inc. | Systems and methods for trans-esophageal sympathetic ganglion recruitment |
US11944810B2 (en) | 2017-08-04 | 2024-04-02 | Lungpacer Medical Inc. | Systems and methods for trans-esophageal sympathetic ganglion recruitment |
US12029903B2 (en) | 2017-12-11 | 2024-07-09 | Lungpacer Medical Inc. | Systems and methods for strengthening a respiratory muscle |
US10987511B2 (en) | 2018-11-08 | 2021-04-27 | Lungpacer Medical Inc. | Stimulation systems and related user interfaces |
US11717673B2 (en) | 2018-11-08 | 2023-08-08 | Lungpacer Medical Inc. | Stimulation systems and related user interfaces |
US11890462B2 (en) | 2018-11-08 | 2024-02-06 | Lungpacer Medical Inc. | Stimulation systems and related user interfaces |
US11357979B2 (en) | 2019-05-16 | 2022-06-14 | Lungpacer Medical Inc. | Systems and methods for sensing and stimulation |
US11771900B2 (en) | 2019-06-12 | 2023-10-03 | Lungpacer Medical Inc. | Circuitry for medical stimulation systems |
US11553963B2 (en) | 2021-03-09 | 2023-01-17 | Circle Safe | Phrenic nerve stimulation |
Also Published As
Similar Documents
Publication | Publication Date | Title |
---|---|---|
US11357985B2 (en) | Transvascular diaphragm pacing systems and methods of use | |
JP6846824B2 (ja) | 横隔膜ペーシングシステム | |
JP5389650B2 (ja) | 呼吸によるフィードバックを用いた神経性刺激のためのシステム | |
US8140164B2 (en) | Therapeutic diaphragm stimulation device and method | |
US7979128B2 (en) | Device and method for gradually controlling breathing | |
US7596413B2 (en) | Coordinated therapy for disordered breathing including baroreflex modulation | |
US20150034081A1 (en) | Therapeutic diaphragm stimulation device and method | |
US20120158091A1 (en) | Therapeutic diaphragm stimulation device and method | |
JP2010502276A (ja) | 呼吸障害中の神経性刺激のためのシステム | |
US11471683B2 (en) | Systems and methods for treating sleep apnea using neuromodulation | |
US11266838B1 (en) | Airway diagnostics utilizing phrenic nerve stimulation device and method |
Legal Events
Date | Code | Title | Description |
---|---|---|---|
AS | Assignment |
Owner name: SIMON FRASER UNIVERSITY, CANADA Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:MEYYAPPAN, RAMASAMY;HOFFER, JOAQUIN ANDRES;BARU, MARCELO;AND OTHERS;SIGNING DATES FROM 20150203 TO 20150212;REEL/FRAME:035069/0253 |
|
AS | Assignment |
Owner name: SIMON FRASER UNIVERSITY, CANADA Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:MEYYAPPAN, RAMASAMY;HOFFER, JOAQUIN ANDRES;BARU, MARCELO;AND OTHERS;SIGNING DATES FROM 20130730 TO 20131107;REEL/FRAME:035366/0534 |
|
AS | Assignment |
Owner name: LUNGPACER MEDICAL, INC., CANADA Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:SIMON FRASER UNIVERSITY;REEL/FRAME:043444/0948 Effective date: 20170627 |
|
STPP | Information on status: patent application and granting procedure in general |
Free format text: RESPONSE TO NON-FINAL OFFICE ACTION ENTERED AND FORWARDED TO EXAMINER |
|
STPP | Information on status: patent application and granting procedure in general |
Free format text: NON FINAL ACTION MAILED |
|
STCB | Information on status: application discontinuation |
Free format text: ABANDONED -- FAILURE TO RESPOND TO AN OFFICE ACTION |