US20230364369A1 - Systems and methods for automatic cycling or cycling detection - Google Patents
Systems and methods for automatic cycling or cycling detection Download PDFInfo
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Definitions
- ventilator systems have long been used to provide ventilatory and supplemental oxygen support to patients. These ventilators typically comprise a source of pressurized oxygen which is fluidly connected to the patient through a conduit or tubing. As each patient may require a different ventilation strategy, modern ventilators can be customized for the particular needs of an individual patient. For example, several different ventilator modes or settings have been created to provide better ventilation for patients in various different scenarios, such as mandatory ventilation modes and assist control ventilation modes.
- aspects of the disclosure relate to providing novel systems and methods for cycling or ending exhalation during mechanical ventilation of a patient. More specifically, this disclosure describes systems and methods for cycling ventilation based on estimated muscle pressure.
- a ventilator system includes at least one sensor, a gas-delivery system configured to deliver ventilation gases to a patient, at least one processor, and at least one memory comprising computer-executable instructions that when executed by the at least one processor cause the ventilator system to perform various operations.
- the operations include receiving one or more sensor measurements from the at least one sensor during inhalation of the patient and, based on the one or more sensor measurements, estimating a muscle pressure (P MUS ) of the patient during the inhalation of the patient. Based on the estimate of P MUS , the operations further include determining a P MUS -based metric and, in response to determining that the P MUS -based metric meets a cycling threshold, determining a patient intention to cycle. Additionally, the operations include evaluating one or more characteristics of the patient intention to cycle and, when the one or more characteristics of the patient intention to cycle are abnormal, determining a missed cycling effort. In response to the missed cycling effort, the operations include performing an action.
- a method of determining a patient intention to cycle includes delivering spontaneous ventilation to a patient and, based on a target setting for the spontaneous ventilation, determining a percent support setting.
- the method further includes temporarily switching to a proportional assist (PA) breath type and delivering at least one PA breath based on the determined percent support setting.
- PA proportional assist
- the method includes receiving one or more sensor measurements from the at least one sensor and, based on the one or more sensor measurements, estimating a muscle pressure (P MUS ) of the patient.
- P MUS muscle pressure
- a method for detecting a patient intention to cycle during spontaneous ventilation of the patient on a ventilator includes monitoring at least one parameter of the patient receiving spontaneous ventilation based on one or more received non-invasive sensor measurements during inhalation and, based on the one or more received non-invasive sensor measurements, estimating a muscle pressure (P MUS ) of the patient during the inhalation.
- the method further includes comparing a P MUS -based metric to a cycling threshold and determining that the P MUS -based metric meets the cycling threshold to identify a patient intention to cycle.
- the method includes evaluating one or more characteristics of the patient intention to cycle and, when the one or more characteristics of the patient intention to cycle are abnormal, determining a missed cycling effort. Additionally, the method includes performing an action in response to the missed cycling effort.
- FIG. 1 is a schematic diagram illustrating a ventilator capable of detecting patient exhalation or cycling efforts based on estimated muscle pressure, in accordance with aspects of the disclosure.
- FIG. 2 is a flow diagram illustrating a method for cycling detection based on estimated muscle pressure in a spontaneous breath type during ventilation of a patient with a ventilator, in accordance with aspects of the disclosure.
- FIG. 3 is a flow diagram illustrating a method for performing process operation 204 of FIG. 2 when the spontaneous breath type is TC, PS or VS and the processed parameter is estimated muscle pressure during ventilation of a patient with a ventilator, in accordance with aspects of the disclosure.
- FIG. 4 is a graph illustrating a muscle pressure curve of a volunteer in synchrony with the ventilator and actively exhaling in response to externally imposed breathing resistance.
- FIG. 5 is a graph illustrating a missed cycle based on estimated muscle pressure monitoring during a high-percentage support using a proportional assist (PA) breath type of a volunteer, in accordance with aspects of the disclosure.
- PA proportional assist
- FIG. 6 illustrates the tidal volume and flow curves for ventilation of the volunteer in FIG. 5 .
- FIG. 7 is a graph illustrating P MUS of an intubated volunteer as measured by an esophageal catheter during a proportional assist (PA) breath type.
- PA proportional assist
- FIG. 8 is a graph illustrating P MUS of an intubated volunteer as measured by a catheter during a high-percentage support, proportional assist (PA) breath type.
- ventilators are used to provide a breathing gas to a patient who may otherwise be unable to breathe sufficiently.
- pressurized air and oxygen sources are often available from wall outlets.
- ventilators may provide pressure regulating valves (or regulators) connected to centralized sources of pressurized air and pressurized oxygen.
- the regulating valves function to regulate flow so that respiratory gas having a desired concentration of oxygen is supplied to the patient at desired pressures and flow rates.
- Ventilators capable of operating independently of external sources of pressurized air are also available.
- ventilators can be customized for the particular needs of an individual patient. For example, several different ventilator modes, breath types, and/or settings have been created to provide better ventilation for patients in various different scenarios, such as mandatory ventilation modes and assist control ventilation modes.
- mandatory ventilation modes provide ventilator-initiated triggering and cycling
- assist control modes allow a spontaneously breathing patient to trigger inspiration during ventilation.
- the ventilator triggers inspiration upon the detection of patient demand or patient effort to inhale and cycles or initiates expiration when a predetermined threshold is met or when a patient demand or effort for exhalation is detected.
- the response performance of a medical ventilator to a patient cycle from inhalation into exhalation represents an important characteristic of a medical ventilator.
- a ventilator's exhalation trigger or cycle response impacts the patient's work of breathing and the overall patient-ventilator synchrony.
- the exhalation cycle response performance of a ventilator is a function of a patient's expiratory behavior (breathing effort magnitude and timing characteristics) as well as the ventilator's gas delivery dynamics and flow control parameters (actuator response, dead bands, etc.).
- Triggering delay time, cycling delay time, and asynchrony index are among key parameters that are used to measure the patient-ventilator synchrony.
- the asynchrony index is the ratio between the number of asynchronous events and the total respiratory rate. Miss-cycling is also considered as one of the factors that increases the patient-ventilator asynchrony index. Several different factors cause asynchrony events, such as variation in patient's breathing pattern, muscle strength, respiratory mechanics, ventilator performance, and ventilator characteristics.
- E SENS threshold which may be a set percentage (normally 25%) of the peak inspiratory flow or a set flow value on many intensive care ventilators.
- This adjustable value is often not optimal, resulting in patient-ventilator expiratory asynchrony.
- Expiratory asynchrony has been shown to be a clinical issue in the patients with partial ventilatory support. Under the expiratory asynchrony situation, the termination of the ventilator flow occurs either before or after patients stop their inspiratory efforts. When the termination of the ventilator flow falls behind the end of the patient inspiratory effort (i.e. delayed cycling), the patient recruits his or her expiratory muscles to “fight” against the ventilator flow, which increases expiratory workload, resulting in intrinsic PEEP.
- the percent support setting may be increased or the E SENS setting may be decreased (less sensitive).
- the percent support setting may be decreased or the E SENS setting may be increased (more sensitive).
- PS and VS there is an FAP setting or “rise time %” setting indicating how aggressively the pressure rises. If this setting is too low, then pressure rises sluggishly, which can affect patient support and cycling. This might result in early cycling with the patient continuing to inhale because the pressure rise was not fast enough. In this case, an adjustment could be to increase the “rise time %” setting.
- a high lung volume caused by the previous breath with delayed cycling may result in a missed trigger of the subsequent inspiratory effort in patients with Chronic Obstructive Pulmonary Disease (COPD) or with high breathing rates.
- COPD Chronic Obstructive Pulmonary Disease
- PS pressure support
- the exhalation sensitivity (E SENS ) setting is frequently left at the default value (25%), which can cause asynchrony in some types of patients. For example, with COPD patients, this value can lead to the patient fighting the ventilator trying to exhale.
- the exhalation sensitivity (E SENS ) setting is also frequently left at a default value (such as 3.0 Lpm), which can cause asynchrony in some types of patients.
- a default value such as 3.0 Lpm
- proportional assist (PA) ventilation if the percent support setting is set too high, the patient can be over-supported leading to the patient forcing the exhalation mid-way through inspiration. Having the ventilator identify this over-support condition could give the ventilator the ability to detect the patient fighting the ventilator to exhale, not just in PA, but in PS, VS or TC as well. The exhalation issues contribute to poor synchrony.
- the systems and methods described herein provide improved exhalation cycling systems and methods.
- the improved exhalation cycling systems and methods monitor a P MUS -based metric to detect patient cycling efforts and/or to determine if the set cycling threshold is appropriate for the patient. Based on this monitoring, the ventilator performs one or more actions. The action may include triggering exhalation, adjusting an exhalation threshold setting, adjusting another ventilator setting, providing a notification, and/or providing a recommendation.
- the P MUS -based metric monitoring can be utilized to adjust E SENS for PS, PA, TC, and VS breath types to improve ventilator cycling or the percent support setting for PA breath type to improve ventilator-patient synchrony.
- the improved exhalation cycling systems and methods are referred to herein as “cycling systems and methods” or “cycling settings.”
- the cycling setting reduces the occurrence of cycling asynchrony and requires less operator training or knowledge for effective use. While the cycling setting is referred to herein as a cycling setting, it may also be referred to as a cycling mode, supplemental cycling mode, or supplemental mode because the cycling setting is utilized in conjunction with or in addition to any spontaneous mode of ventilation running any suitable breath type (PS, VS, TC, or PA) for a spontaneous mode of ventilation.
- PS spontaneous mode of ventilation running any suitable breath type (PS, VS, TC, or PA) for a spontaneous mode of ventilation.
- the cycling setting improves ventilator synchrony by changing the cycling threshold or recommending a change in cycling threshold based on the monitoring of estimated patient muscle pressure (P MUS ) or a P MUS -based metric.
- the P MUS -based metric may be P MUS , may be a processed signal of P MUS , or may represent a shape of the P MUS waveform.
- the cycling setting improves ventilator synchrony by cycling exhalation based on the monitoring of the P MUS -based metric.
- estimated patient muscle pressure is a strong indicator of a patient's effort to exhale
- a patient P MUS -based metric can be utilized to detect cycling or intended cycling and/or to determine if the cycling threshold or pattern is appropriate.
- a “breath” refers to a single cycle of inspiration and exhalation delivered with the assistance of a ventilator.
- breath type refers to some specific definition or set of rules dictating how the pressure and flow of respiratory gas is controlled by the ventilator during a breath.
- a simple mandatory mode of ventilation is to deliver one breath of a specified mandatory breath type at a clinician-selected respiratory rate (e.g., one breath every 6 seconds). Until the mode is changed, ventilators will continue to provide breaths of the specified breath type as dictated by the rules defining the mode.
- breath types may be mandatory mode breath types (that is, the initiation and termination of the breath is made by the ventilator) or spontaneous mode breath types (which refers to breath types in which the breath is initiated and/or terminated by the patient).
- breath types utilized in the spontaneous mode of ventilation include proportional assist (PA) breath type (including different versions of PA, such as plus and optimized), tube compensated (TC) breath type, volume support (VS) breath type, pressure support (PS) breath type, and etc.
- PA proportional assist
- TC tube compensated
- VS volume support
- PS pressure support
- mandatory breath types include a volume control breath type, a pressure control breath type, and etc.
- FIG. 1 illustrates a schematic diagram of an aspect of an exemplary ventilator 100 .
- the exemplary ventilator 100 illustrated in FIG. 1 is connected to a human patient 150 .
- Ventilator 100 includes a pneumatic system 102 (also referred to as a pressure generating system 102 ) for circulating breathing gases to and from patient 150 via the ventilation tubing system 130 , which couples the patient 150 to the pneumatic system 102 via an invasive (e.g., endotracheal tube, as shown) or a non-invasive (e.g., nasal mask) patient interface 180 .
- invasive e.g., endotracheal tube, as shown
- non-invasive e.g., nasal mask
- Ventilation tubing system 130 may be a two-limb (shown) or a one-limb circuit for carrying gases to and from the patient 150 .
- a fitting typically referred to as a “wye-fitting” 170 , may be provided to couple the patient interface 180 (shown as an endotracheal tube in FIG. 1 ) to an inspiratory limb 132 and an expiratory limb 134 of the ventilation tubing system 130 .
- pneumatic system 102 may be configured in a variety of ways.
- pneumatic system 102 includes an expiratory module 108 coupled with the expiratory limb 134 and an inspiratory module 104 coupled with the inspiratory limb 132 .
- Compressor 106 , accumulator and/or other source(s) of pressurized gases e.g., air, oxygen, and/or helium
- inspiratory module 104 is coupled with inspiratory module 104 and the expiratory module 108 to provide a gas source for ventilatory support via inspiratory limb 132 .
- the inspiratory module 104 is configured to deliver gases to the patient 150 and/or through the inspiratory limb 132 according to prescribed ventilatory settings.
- the inspiratory module 104 is associated with and/or controls an inspiratory valve for controlling gas delivery to the patient 150 and/or gas delivery through the inspiratory limb 132 .
- inspiratory module 104 is configured to provide ventilation according to various ventilator modes, such as mandatory, spontaneous, and/or assist modes.
- the expiratory module 108 is configured to release gases from the patient's lungs according to prescribed ventilatory settings.
- the expiratory module 108 is associated with and/or controls an expiratory valve for releasing gases from the patient 150 .
- expiratory module 108 is configured to release gas according to various ventilator modes, such as mandatory, spontaneous, and/or assist modes.
- the ventilator 100 may also include one or more sensors 107 communicatively coupled to ventilator 100 .
- the sensors 107 may be located in the pneumatic system 102 , ventilation tubing system 130 , and/or on the patient 150 .
- FIG. 1 illustrates a sensor 107 (e.g., flow sensor, pressure sensor, etc.) in pneumatic system 102 .
- the ventilator 100 may also include one or more non-invasive sensors 107 communicatively coupled to ventilator 100 .
- Sensors are referred to herein as non-invasive when the sensors are located externally to patient.
- sensors located in the patient wye 170 , in the expiratory module 108 , in the inspiratory module 104 , or on the patient's finger are all external to the patient and are non-invasive.
- Sensors are referred to herein as invasive when the sensors are located within the patient or placed inside the patient's body, such as sensors located in an endotracheal tube, near a patient diaphragm, or on an esophageal balloon. While invasive sensors can provide great patient data or measurements, these sensors can often be hard to maintain or keep properly positioned.
- FIG. 1 illustrates a sensor 107 in pneumatic system 102 .
- Sensors 107 may communicate with various components of ventilator 100 , e.g., pneumatic system 102 , other sensors 107 , expiratory module 108 , inspiratory module 104 , processor 116 , controller 110 , cycling module 118 , and any other suitable components and/or modules.
- a module as used herein refers to memory, one or more processors, storage, and/or other components of the type commonly found in command and control computing devices.
- sensors 107 generate output, such as measurements, and send this output to pneumatic system 102 , other sensors 107 , expiratory module 108 , inspiratory module 104 , processor 116 , controller 110 , cycling module 118 , and any other suitable components and/or modules.
- Sensors 107 may employ any suitable sensory or derivative technique for monitoring one or more patient parameters or ventilator parameters associated with the ventilation of a patient 150 .
- Sensors 107 may detect changes in patient parameters indicative of patient inspiratory or expiratory triggering, for example.
- Sensors 107 may be placed in any suitable location, e.g., within the ventilatory circuitry or other devices communicatively coupled to the ventilator 100 .
- one or more sensors 107 may be located in an accumulator.
- sensors 107 may be placed in any suitable internal location, such as, within the ventilatory circuitry or within components or modules of ventilator 100 .
- sensors 107 may be coupled to the inspiratory module 104 and/or expiratory module 108 for detecting changes in, for example, circuit pressure and/or flow.
- sensors 107 may be affixed to the ventilatory tubing or may be embedded in the tubing itself.
- sensors 107 may be provided at or near the lungs (or diaphragm) for detecting a pressure in the lungs.
- sensors 107 may be affixed or embedded in or near wye-fitting 170 and/or patient interface 180 . Any sensory device useful for monitoring changes in measurable parameters during ventilatory treatment may be employed in accordance with aspects described herein.
- the one or more sensors 107 of the ventilator 100 include an inspiratory flow sensor and an expiratory flow sensor.
- ventilatory parameters are highly interrelated and, according to aspects, may be either directly or indirectly monitored. That is, parameters may be directly monitored by one or more sensors 107 , as described above, or may be indirectly monitored or estimated by derivation according to the Equation of Motion or other known relationships from the monitored parameters.
- the cycling module 118 monitors a physiological parameter of the patient for each sample period from sensor output from one or more sensors.
- the sample period as used herein refers to a discrete period of time required to monitor a physiological parameter.
- the sample period is a computation cycle for the ventilator 100 .
- the sample period is every 5 milliseconds (ms), 10 ms, 15 ms, 20 ms, 25 ms, or 30 ms. This list is exemplary only and is not meant to be limiting. Any suitable sample period for monitoring a physiological parameter of the patient may be utilized by the ventilator 100 as would be understood by a person of skill in the art.
- the cycling module 118 estimates and/or calculates the physiological parameter for monitoring based on the sensor output from one or more sensors. In other aspects, cycling module 118 determines the physiological parameter for monitoring directly from the sensor output received from the one or more sensors.
- the physiological parameter may be any suitable physiological parameter for determining a patient initiated cycle as would be known by a person of skill in the art.
- the physiological parameter is flow rate, net flow, pressure, estimated pressure, estimated flow, other derived signals, and/or etc. This list is exemplary only and is not meant to be limiting.
- the cycling module 118 may send the physiological parameter to any suitable component and/or module of the ventilator 100 , such as the pneumatic system 102 , expiratory module 108 , inspiratory module 104 , processor 116 , controller 110 , and/or etc.
- the cycling module 118 receives the physiological parameter measurements from other components of the ventilator, such as a sensor 107 , controller 110 , and/or processor 116 .
- the cycling module 118 processes the physiological parameter to detect patient cycling efforts. In some aspects, the cycling module 118 processes the physiological parameter to determine a P MUS to detect patient cycling efforts. In further aspects, the cycling module 118 processes the physiological parameter to determine a P MUS -based metric to detect patient cycling efforts.
- the cycling module 118 calculates the P MUS based on measured flow and/or pressure and based on calculated resistance and/or compliance.
- the ventilator is configured to calculate resistance, compliance, and a P MUS utilizing non-invasive sensor measurements.
- the PA breath type can calculate compliance and resistance. Knowing compliance and resistance, an estimate of the diaphragmatic muscle pressure can be computed non-invasively.
- an invasive sensor located in an esophageal balloon is needed to measure the diaphragmatic pressure.
- an esophageal balloon can easily become dislodged if the patient moves affecting sensor accuracy, is highly invasive to implant, and/or is uncomfortable for a spontaneously breathing patient.
- the ventilator is not configured to calculate resistance, compliance, and/or P MUS utilizing non-invasive sensor measurements. Accordingly, the cycling module 118 during a spontaneous breath type that is not a PA breath type will temporarily switch from the current breath type into the PA breath type for a predetermined number of breaths, time or measurements in order to calculate resistance and/or compliance and then estimate P MUS based on one or more non-invasive sensor measurements.
- a PA breath type refers to a type of ventilation in which the ventilator acts as an inspiratory amplifier that provides pressure support based on the patient's effort.
- the degree of amplification (the “percent support setting”) during a PA breath type is set by an operator or clinician, for example as a percentage based on the patient's effort.
- the cycling module 118 determines the percent support setting provided during the temporary PA breath type.
- the PA breath type is capable of determining a patient respiratory system compliance and/or resistance in an end inspiratory hold of 300 ms or 0.3 seconds, which will usually go unnoticed by a spontaneously breathing patient.
- this 300 ms end inspiratory hold is provided intermittently at random.
- the 300 ms end inspiratory hold may be provided in the first, second, third, and/or fourth breath of the temporary PA breath type. Any additional 300 ms holds are provided after a predetermined number of breaths or after a set time period during the temporary PA breath type.
- the temporary PA breath type does not provide the 300 ms end inspiratory hold at random but instead at predetermined intervals.
- the cycling module 118 is able to calculate patient respiratory compliance and patient respiratory system resistance.
- the cycling module 118 utilizes the following equation to determine patient respiratory system compliance:
- the cycling module 118 utilizes the following equation to determine patient respiratory system resistance:
- R RAW R RAW+ET ⁇ R ET ,
- the cycling module 118 calculates patient respiratory resistance and/or compliance based on non-invasive sensor output.
- the cycling module 118 provides the temporary PA breath type for at least one breath.
- the cycling module 118 provides the temporary PA breath type for at least three breaths.
- the cycling module 118 provides the temporary PA breath type until a predetermined number of patient respiratory compliance and/or resistance measurements or calculations have been made by the ventilator 100 .
- the cycling module 118 provides the temporary PA breath type until at least two or three patient respiratory compliance and/or resistance measurements have been made by the ventilator 100 .
- the cycling module 118 provides the temporary PA breath type until at least one, two, three, four, or five patient respiratory compliance and/or resistance measurements have been made by the ventilator 100 .
- the predetermined number of patient respiratory compliance and/or resistance measurements can be completed in 1 breath, 2 breaths, 3 breaths, 5 breaths, 7 breaths, 8 breaths, 10 breaths, 12 breaths, 15 breaths, 20 breaths, 25 breaths or 30 breaths.
- a predetermined number of patient respiratory compliance and/or resistance measurements can be completed by the cycling module 118 in 4 to 12 breaths.
- the cycling module 118 switches the ventilation of the patient back to the previously utilized spontaneous breath type (TC, PS or VS).
- the cycling module 118 monitors respiratory data of the patient, such as the non-invasive sensor output. In some aspects, the cycling module 118 calculates a P MUS of the patient during the spontaneous breath type utilizing the respiratory system compliance and/or the respiratory system resistance calculated during the temporary PA breath type, and the current respiratory data measured after the return to TC, VS or PS breath type.
- the cycling module 118 measures the P MUS repeatedly throughout a breath. In some aspects, the cycling module 118 measures P MUS every servo cycle, such as every 2 milliseconds, 5 millisecond, or 10 milliseconds.
- the servo cycle is a fixed, periodic amount of time during which sensor data from sensors 107 are sampled, control calculations are made by the processor 116 or controller 110 of the ventilator 100 , and new valve or actuator commands are issued. In some aspects, the sensors 107 send output or measurements every servo cycle.
- the cycling module 118 communicates the P MUS to other modules, such as the controller 110 , the pneumatic system 102 , and/or the display 122 .
- the cycling module 118 determines when to perform the temporary switch into the PA breath type by monitoring input to determine the occurrence of one or more conditions. In some aspects, the cycling module 118 monitors the measurements from the non-invasive sensors. In other aspects, the cycling module 118 monitors other received ventilator data or calculations to determine the occurrence of the condition.
- the condition may be any event that is indicative of a change in patient respiratory system compliance and/or patient respiratory system resistance, such as a predetermined pressure differential, volume differential, a tidal volume differential, a specific flow waveform shape, a specific volume waveform shape, a specific pressure waveform shape, a predetermined change in pressure, a predetermined change in flow, a predetermined change in tidal volume and/or etc.
- the condition may be a change in non-invasively monitored flow, pressure, and/or of volume of at least 25%.
- the condition is an expiration of a set period or predetermined number of breaths, since the last temporary PA breath type switch or since the start of the last temporary PA breath type.
- the condition may be the expiration of 30, 60, 90, or 120 minutes or the occurrence of 400, 300, or 200 breaths since the last temporary switch into the PA breath type or the start of the last temporary PA breath type.
- the cycling module 118 monitors for the following condition to occur: 1) expiration of 1 hour since the last temporary PA breath type; or 2) a 25% change in one of non-invasively measured pressure, flow, or tidal volume during the spontaneous breath type that is not a PA breath type. If the breath type was just initialized, the conditions discussed above may be monitored from the start of ventilation or the start of the breath type instead of since the last temporary switch into the PA breath type or the start of the last temporary PA breath type. If the cycling module 118 detects a condition, the cycling module 118 of the controller 110 determines a percent support setting and sends instructions to the pressure generating system 102 to provide a short temporary switch into a PA breath type utilizing the determined percent support setting.
- the cycling module 118 determines a percent support setting for the temporary PA breath by utilizing a predetermined or preset percent support setting. In other aspects, the cycling module 118 determines a percent support setting based on a target setting for the spontaneous breath type that is not the PA breath type. For example, if the target pressure for the PS breath type is 10 cm H 2 O, then the cycling module 118 will determine a percent supporting setting for the temporary PA breath to achieve approximately the same pressure level. In another example, if the target volume for a VS breath type is 400 ml, then the cycling module 118 will determine a percent support setting for the temporary PA breath to achieve approximately the same volume level. In other aspects, the percent setting is determined by the cycling module 118 based on outputs from the non-invasive sensor.
- the cycling module 118 will determine a percent support setting for the temporary PA breath to achieve approximately the same pressure level.
- the cycling module 118 may utilize additional ventilator parameters or inputs to the target setting and/or the outputs from the non-invasive sensor to determine a percent support setting for the temporary PA breath, such as mask type, patient circuit diameter, and etc.
- the cycling module 118 may compare the P MUS -based metric to a cycling threshold to form a comparison. If the P MUS -based metric meets the cycling threshold based on the comparison, the cycling module 118 determines that the patient is making an effort to end inhalation and start exhalation. If the P MUS -based metric does not meet the cycling threshold based on the comparison, the cycling module 118 determines that the patient is not making an effort to end inhalation and start exhalation. In response to determining that the patient is not making an effort to end inhalation and start exhalation, the cycling module 118 continues to the monitor the P MUS -based metric and compare it to the cycling threshold.
- the cycling threshold may be dynamic and/or dependent on the magnitude of P MUS -based metric.
- the cycling module 118 In response to determining that the patient is making an effort to end inhalation and start exhalation, the cycling module 118 performs one or more actions.
- the one or more actions may include cycling, providing a notification, providing a recommendation, determining cycling synchrony, displaying a detected cycling effort, recommending a parameter change, and/or automatically changing a parameter.
- the one or more actions may include sending a command to end inspiration and begin exhalation.
- the spontaneous breath types may be adjusted to cycle in response meeting a P MUS -based metric threshold instead of based on E SENS (such as a percent of peak flow or a set flow value in Lpm) in PS, VS, TC or PA.
- E SENS such as a percent of peak flow or a set flow value in Lpm
- the ventilator effectively identifies the end of patient inspiratory effort and determines the optimal time to trigger the expiratory phase. Based on this approach, cycling to the expiratory phase will be variable based on patient effort and will not be purely dependent upon exhaled flow.
- the cycling module 118 minimizes the patient-to-ventilator asynchrony and provides a feature that is easy to use by the clinician since the clinician does not have to set an E SENS as a primary cycling mechanism.
- the one or more actions may include determining if exhalation was provided by the breath type within an interval of time of the detected cycling effort.
- cycling is still controlled by E SENS in PS, VS, TC and PA and can be influenced by the percent support setting in PA and the rise-time setting in PS or VS.
- the cycling module 118 determines if the detected cycling effort occurred within a predetermined amount of time of the cycling effort delivered by the spontaneous breath type. In some aspects, the interval of time may be about 300 ms. If the detected effort is not within the interval of time from the delivered exhalation, the cycling module 118 determines asynchronous cycling.
- the cycling module 118 may provide a notification (such as a notification of an asynchronous cycling), provide a recommendation (such as a recommendation to adjust E SENS for a VS, PS, TC or PA breath type or percent support setting for PA breath type), automatically adjust a ventilator setting (such as automatically adjust E SENS for a VS, PS, TC or PA breath type or percent support setting for PA breath type).
- a notification such as a notification of an asynchronous cycling
- a recommendation such as a recommendation to adjust E SENS for a VS, PS, TC or PA breath type or percent support setting for PA breath type
- a ventilator setting such as automatically adjust E SENS for a VS, PS, TC or PA breath type or percent support setting for PA breath type.
- the one or more actions may include displaying the detected cycling effort.
- the detected cycling effort may be displayed on a waveform.
- a prompt may indicate that a cycling effort was detected and/or missed.
- the one or more actions may include providing, such as displaying, a recommendation to change a percent support setting in PA, an E SENS setting in PS, VS, TC or PA, or a rise-time setting in PS or VS, as discussed above. For example, if the detected cycling effort happened before exhalation was delivered, the cycling module 118 may recommend increasing the E SENS setting or decreasing the percent support setting. If the detected cycling effort happened after exhalation was delivered, the cycling module 118 may recommend decreasing the E SENS setting or increasing the percent support setting.
- the one or more actions may include automatically changing a percent support setting in PA, an E SENS setting in PS, VS, TC or PA, or a rise-time setting in PS or VS. For example, if the detected cycling effort happened before exhalation was delivered, the cycling module 118 may automatically increase the E SENS setting or decrease the percent support setting. For example, if the detected cycling effort happened after exhalation was delivered, the cycling module 118 may automatically decrease the E SENS setting or increase the percent support setting.
- the cycling module 118 ends inspiration by sending instructions and/or a command to a pneumatic system 102 , an expiratory module 108 , an inspiratory module 104 , a processor 116 , and/or a controller 110 .
- the instructions and/or commands cause the one or more ventilator components and/or modules to change the delivered flow and/or pressure and to adjust the valves as needed to end inspiration and start exhalation.
- the pneumatic system 102 may include a variety of other components, including mixing modules, valves, tubing, accumulators, filters, etc.
- Controller 110 is operatively coupled with pneumatic system 102 , signal measurement and acquisition systems (e.g., sensor(s) 107 ), and an operator interface 120 that may enable an operator to interact with the ventilator 100 (e.g., change ventilator settings, select operational modes, view monitored parameters, etc.).
- the operator interface 120 of the ventilator 100 includes a display 122 communicatively coupled to ventilator 100 .
- Display 122 may provide various input screens, for receiving clinician input, and various display screens, for presenting useful information to the clinician.
- the display 122 is configured to include a graphical user interface (GUI).
- GUI graphical user interface
- the GUI may be an interactive display, e.g., a touch-sensitive screen or otherwise, and may provide various windows and elements for receiving input and interface command operations.
- other suitable means of communication with the ventilator 100 may be provided, for instance by a wheel, keyboard, mouse, or other suitable interactive device.
- operator interface 120 may accept commands and input through display 122 .
- Display 122 may also provide useful information in the form of various ventilatory data regarding the physical condition of a patient 150 .
- the useful information may be derived by the ventilator 100 , based on data collected by a processor 116 , and the useful information may be displayed to the clinician in the form of graphs, wave representations, pie graphs, text, or other suitable forms of graphic display.
- patient data may be displayed on the GUI and/or display 122 .
- patient data may be communicated to a remote monitoring system coupled via any suitable means to the ventilator 100 .
- the display 122 illustrates a physiological parameter, a graph or waveform of the physiological parameter, a graph or waveform of P MUS , a detected patient cycle effort, an exhalation sensitivity, a cycle type, a recommendation, a notification, and/or any other information known, received, or stored by the ventilator 100 .
- controller 110 includes memory 112 , one or more processors 116 , storage 114 , and/or other components of the type commonly found in command and control computing devices. Controller 110 may further include the cycling module 118 as illustrated in FIG. 1 . In alternative aspects, the cycling module 118 is located in other components of the ventilator 100 , such as in the pressure generating system 102 (also known as the pneumatic system 102 ) or inspiratory module 104 .
- the memory 112 includes non-transitory, computer-readable storage media that stores and/or encodes software (or computer readable instructions) that is executed by the processor 116 and which controls the operation of the ventilator 100 .
- the memory 112 includes one or more solid-state storage devices such as flash memory chips.
- the memory 112 may be mass storage connected to the processor 116 through a mass storage controller (not shown) and a communications bus (not shown).
- computer-readable storage media includes non-transitory, volatile and non-volatile, removable and non-removable media implemented in any method or technology for storage of information such as computer-readable instructions, data structures, program modules or other data.
- computer-readable storage media includes RAM, ROM, EPROM, EEPROM, flash memory or other solid state memory technology, CD-ROM, DVD, or other optical storage, magnetic cassettes, magnetic tape, magnetic disk storage or other magnetic storage devices, or any other medium which can be used to store the desired information and which can be accessed by the computer.
- FIG. 2 illustrates an example of a method 200 for cycling from inspiration to exhalation during ventilation of a patient on a ventilator.
- method 200 cycles to exhalation based on the monitoring of a P MUS -based metric.
- method 200 provides spontaneous ventilation utilizing a cycling setting.
- Method 200 begins at the start of spontaneous ventilation utilizing a cycling setting.
- method 200 can detect a patient's attempt to exhale.
- method 200 improves ventilator synchrony by detecting patient efforts to exhale and/or by changing or recommending setting changes to improve cycling.
- method 200 includes a monitor operation 202 , a process operation 204 , a compare operation 206 , a threshold decision operation 208 , and an action operation 214 .
- method 200 also includes an optional timing operation 210 and/or an optional missed cycling determination operation 212 .
- the ventilator monitors a physiological parameter based on one or more sensor measurements for each sample period in a first set of sample periods during inspiration.
- the ventilator during the monitor operation 202 monitors flow, pressure, and/or other derived signals, such as a P MUS -based metric. Sensors suitable for this detection may include any suitable sensing device as known by a person of skill in the art for a ventilator, such as an inspiratory flow sensor, inspiratory pressure sensor, an exhalation flow sensor, an exhalation pressure sensor, and/or exhalation auxiliary pressure sensor.
- the one or more sensor measurements are from one or more non-invasive sensors.
- the ventilator during the monitor operation 202 is delivering inhalation.
- the ventilator processes the one or more received sensor measurements of the physiological patient parameter.
- the ventilator processes the received sensor measurements of the physiological parameter by calculating a P MUS or a P MUS -based metric based on the received sensor measurements.
- the one or more processed parameters include P MUS or a P MUS -based metric.
- the ventilator compares the one or more processed parameters to a cycling threshold.
- a cycling threshold For example, the P MUS -based metric is compared to a cycling threshold.
- the cycling threshold for the P MUS -based metric may be a dynamic function of its magnitude.
- the ventilator determines if the one or more processed parameters meet a cycling threshold based on the comparison of the one or more processed parameters to the cycling threshold performed during operation 206 .
- the ventilator during threshold decision operation 208 determines a patient intention to cycle based on the comparison of a P MUS -based metric to a cycling threshold.
- the ventilator may determine based on a shape of the P MUS curve a patient intention to cycle.
- the ventilator may compare one or more measured parameters to an E SENS setting to determine a patient intention to cycle.
- the ventilator during threshold decision operation 208 determines if a patient intends to cycle based on the comparison of a P MUS -based metric to a cycling threshold and scores or grades the asynchrony based on the comparison.
- An example of a score or grade of asynchrony includes an asynchrony index.
- the method progresses to cycling operation 216 . Additionally, if a patient intention to cycle is detected, an optional evaluation of cycling characteristics may be performed at evaluation operation 210 . Alternatively, if a patient intention to cycle is not detected, the method may return to monitor operation 202 .
- the ventilator may evaluate one or more cycling conditions associated with the patient intention to cycle. For instance, the ventilator may evaluate the shape of the P MUS curve. Additionally or alternatively, the ventilator may evaluate a timing of the ventilator cycling versus a timing of the patient intention to cycle. For instance, at evaluation operation 210 , the ventilator may evaluate the shape of the P MUS curve to determine whether the curve is normal or abnormal. In other aspects, at evaluation operation 210 , the ventilator may evaluate a timing of the detected patient intention to cycle to a timing of the cycling delivered by the ventilator.
- the ventilator may determine whether characteristics of the patient intention to cycle are normal or abnormal. In aspects, when the P MUS curve is abnormal or the timing of the patient intention to cycle is abnormal, a percent support setting, a rise-time setting, or an E SENS setting may be inappropriate.
- the ventilator determines or detects if characteristics of the detected patient intention to cycle are normal or abnormal. For instance, if the shape of the P MUS curve is indicative of the patient actively exhaling (see e.g., FIG. 5 ), the P MUS curve may be identified as “abnormal.” Additionally or alternatively, if the timing of the patient intention to cycle falls outside of a timing threshold, the timing may be identified as “abnormal.” In aspects, timing of ventilator cycling may be abnormal when the timing of ventilator cycling is too early (before the patient intention to cycle) or too late (after the patient intention to cycle).
- the timing of the ventilator cycling may be compared to a patient neural inspiratory time (e.g., a P MUS -based characteristic) to determine whether characteristics of the patient intention to cycle are abnormal. If the ventilator determines or detects during decision operation 212 that the characteristics of the patient intention to cycle (e.g., the P MUS curve, the timing, or the like) are not abnormal, the ventilator may return to monitor operation 202 . If the ventilator determines or detects during decision operation 212 that the characteristics of the patient intention to cycle (e.g., the P MUS curve, the timing, or the like) are not abnormal, the ventilator is in synchrony with the patient exhalation demand.
- a patient neural inspiratory time e.g., a P MUS -based characteristic
- the ventilator may progress to optional action operation 214 . If the ventilator determines or detects during decision operation 212 that the characteristics of the patient intention to cycle (e.g., the P MUS curve, the timing, or the like) are abnormal, the ventilator is not in synchrony with the patient exhalation demand.
- the characteristics of the patient intention to cycle e.g., the P MUS curve, the timing, or the like
- the ventilator is not in synchrony with the patient exhalation demand.
- the ventilator may performs an action.
- the action is performed in response to detection that characteristics of a patient intention to cycle are abnormal at decision operation 208 .
- the action may be one or more of: a notification of a missed cycling effort, display of a missed cycling effort, a recommendation to change a ventilator setting (e.g., a percent support setting or an E SENS setting), an automatic change of a ventilator setting, and/or notification of an automatic change of ventilator setting.
- the ventilator may recommend or automatically change percent support setting or an E SENS setting during a PA, TC, VS or PS breath type.
- the ventilator may additionally or alternatively recommend or automatically change a rise-time setting during a VS or PS breath type.
- the process operation 204 includes several additional steps to determine the P MUS -based metric as illustrated in FIG. 3 .
- the process operation 204 may include a determination operation 302 , a support setting operation 304 , a switch operation 306 , an analyze operation 308 , a respiratory mechanics estimation operation 310 , and a return operation 312 .
- FIG. 3 is a flow diagram illustrating a method for performing process operation 204 of FIG. 2 when the spontaneous breath type is TC, PS or VS and the processed parameter is a P MUS -based metric during ventilation of a patient with a ventilator, in accordance with aspects of the disclosure.
- the ventilator determines if a condition occurred. In some aspects, the ventilator during determination operation 302 monitors non-invasive sensor output to determine if the condition has occurred. In other aspects, the ventilator during determination operation 302 monitors the number of delivered breaths or the passage of time to determine if a condition has occurred. If the ventilator determines that the condition occurred at determination operation 302 , the ventilator selects to perform support setting operation 304 . If the ventilator determines that the condition did not occur during determination operation 302 , the ventilator selects to continue to monitor the non-invasive sensor output during determination operation 302 .
- the condition may be the expiration of a predetermined amount of time, the delivery of a predetermined number of breaths, and/or a change in one or more monitored parameters that indicates that a change in patient respiratory system compliance and/or resistance has occurred.
- the condition is a change in monitored pressure, monitored tidal volume, or monitored flow of at least 25%.
- the condition is expiration of 1 hour from the last use of a temporary PA breath type without a change in monitored pressure, monitored tidal volume, monitored flow by a specific value (such as 3 Lpm), or monitored flow of at least 25% since the last temporary PA breath type.
- condition is the delivery of 200 breaths from the last use of the temporary PA breath type without a change in monitored pressure, monitored tidal volume, monitored flow by a specific value (such as 3 Lpm), or monitored flow of at least 25% since the last temporary PA breath type.
- the ventilator determines a percent support setting for a temporary PA breath type.
- the ventilator utilizes a predetermined support setting.
- the ventilator selects a support setting based on at least one of a target setting from the spontaneous TC, PS or VS breath type or the non-invasively measured respiratory data collected during the TC, PS or VS spontaneous breath type.
- the ventilator during support setting operation 304 determines other settings for the temporary PA breath type. For example, a PEEP level for the temporary PA breath type may be set based on a PEEP level utilized in the spontaneous TC, PS or VS breath type.
- switch operation 306 is performed by the ventilator.
- the ventilator automatically and temporarily switches from the TC, PS or VS spontaneous breath type into a temporary PA breath type for at least one breath utilizing the determined or calculated percent support setting.
- the ventilator automatically and temporarily switches from the spontaneous TC, PS or VS breath type into the temporary PA breath type for at least three breaths utilizing the determined or calculated percent support setting.
- the temporary PA breath type is performed for at least one breath, at least two breaths, or at least three breaths.
- the temporary PA breath type is delivered by the ventilator during switch operation 306 until at least one patient respiratory system compliance and/or resistance measurement has been obtained.
- the temporary PA breath type is delivered by the ventilator during switch operation 306 until at least two different patient respiratory system compliance and/or resistance measurements have been obtained. In some aspects, the temporary PA breath type is delivered by the ventilator during the switch operation 306 until 5, 4, 3, or 2 patient respiratory system compliance and/or resistance measurements have been obtained. As such, the ventilator may deliver ventilation utilizing the temporary PA breath type for at most 4 breaths, 8 breaths, 10 breaths, 12 breaths, 15 breaths, 20 breaths, 30 breaths, 40 breaths, or 50 breaths.
- the ventilator during the PA collect and analyze operation 308 collects and analyzes the non-invasively measured respiratory data during the temporary PA breath type.
- a respiratory mechanics estimation operation 310 is performed by the ventilator.
- the ventilator calculates or estimates the patient respiratory system compliance and/or resistance based on the non-invasively measured respiratory data taken during the temporary PA breath type during the PA collect and analyze operation 308 . If multiple patient respiratory system compliance and/or resistance measurements are taken by the ventilator during respiratory mechanics estimation operation 310 , the ventilator determines a compliance measurement and/or a resistance measurement based on these multiple measurements. For example, if multiple patient respiratory system compliance measurements are taken, the ventilator may average the measurements or select the middle or last obtained measurement to be utilized as the temporary PA breath type calculated compliance measurement for use during process operation 204 .
- the ventilator switches from the temporary PA breath type back to the previously utilized spontaneous TC, PS or VS breath type.
- the ventilator returns to the spontaneous TC, VS or PS breath type after a predetermined number of patient respiratory system compliance or resistance measurements have been obtained during the temporary PA breath type, after a predetermined number of breaths, or after a predetermined amount of time.
- FIG. 4 is a graph illustrating a P MUS curve of a volunteer in response to additional externally applied resistance.
- P MUS ends coincident with cycling at 402 as indicated by the synchronicity with the ventilator phase signal.
- R external resistance
- P MUS of the volunteer is elevated during exhalation, as shown by the upward slope of the P MUS curve at 404 . In this case, active exhalation is indicated.
- FIG. 5 is a graph illustrating a missed cycle during ventilation of a volunteer in the laboratory with a ventilator based on P MUS monitoring, in accordance with aspects of the disclosure.
- the volunteer is being ventilated in a PA breath type with a plateau breath.
- the PA support setting was set to 95% to force the over-support condition and the volunteer was ventilated.
- the volunteer was intentionally over-supported.
- the P MUS shape pushed to positive pressure (as shown by reference circle 502 ), which indicates that the patient was actively exhaling in response to the over-support.
- the ventilator did not deliver exhalation until about a 1.5 seconds later, which is outside of a time interval of 300 ms.
- the ventilator detects a missed exhalation attempt. Accordingly, the ventilator may perform an action in response to this determination, such as display a missed cycle, indicate that the percent support setting is set too high, recommend lowering the percent support setting, and/or automatically lower the percent support setting to eliminate over-support. Additionally or alternatively, the ventilator indicate that the E SENS setting is too low, may recommend increasing the E SENS setting, or may automatically increase the E SENS setting to improve cycling synchrony.
- FIG. 6 illustrates the tidal volume and flow curves for ventilation of the volunteer in FIG. 5 .
- the flow waveform peaks in response to the volunteer pushing back against the ventilator's over-support, that is, actively exhaling to avoid over-delivery. This peak is in synchrony with the pressure waveform peak of FIG. 5 .
- the volume waveform shows the high inspired volume (nearly 1800 mL) in response to this self-truncated breath.
- FIG. 7 is a graph illustrating P MUS of an intubated volunteer as measured by an esophageal catheter during a PA breath type.
- the inverted P MUS shape 702 is due to the sign of the catheter pressures.
- This waveform shows the relationship between the ventilator pressure at the patient connection port or “wye” and the measured P MUS curve or the difference between the gastric and esophageal pressures that cross the diaphragm muscle (lower large dashed line).
- there is late ventilator triggering that might have been created by a trigger sensitivity that was too high.
- the cycling was reasonably synchronous with the end of the P MUS effort. This demonstrates good cycling synchrony.
- FIG. 8 is a graph illustrating P MUS of an intubated volunteer as measured by an esophageal catheter during high-percentage support.
- percent support is set to 80% and the patient appears to be pushing against the ventilator due to the rise in gastric pressure at 802 .
- the flat gastric curve at 704 in FIG. 7 For comparison, see the flat gastric curve at 704 in FIG. 7 .
- the P MUS curve also shows a flat push 808 at the end of inhalation to a lower pressure than at the start of the inhalation. Based on the indications associated with over-support illustrated by FIG.
- the ventilator may indicate that the percent support setting is set too high, may recommend lowering the percent support setting, and/or may automatically lower the percent support setting to eliminate over-support. Additionally or alternatively, the ventilator indicate that the E SENS setting is too low, may recommend increasing the E SENS setting, or may automatically increase the E SENS setting to improve cycling synchrony.
Abstract
Systems and methods for novel ventilation that allows the ventilator to detect a patient intention to cycle exhalation are provided. Further, systems and methods for cycling exhalation based on a muscle pressure are provided.
Description
- This application is a continuation of U.S. patent application Ser. No. 16/590,530 filed Oct. 2, 2019, which claims the benefit of U.S. Provisional Application Ser. No. 62/740,740, filed Oct. 3, 2018, the complete disclosures of which are hereby incorporated by reference in their entireties. To the extent appropriate a claim of priority is made to each of the above disclosed applications.
- Medical ventilator systems have long been used to provide ventilatory and supplemental oxygen support to patients. These ventilators typically comprise a source of pressurized oxygen which is fluidly connected to the patient through a conduit or tubing. As each patient may require a different ventilation strategy, modern ventilators can be customized for the particular needs of an individual patient. For example, several different ventilator modes or settings have been created to provide better ventilation for patients in various different scenarios, such as mandatory ventilation modes and assist control ventilation modes.
- It is with respect to this general technical environment that aspects of the present technology disclosed herein have been contemplated. Furthermore, although a general environment has been discussed, it should be understood that the examples described herein should not be limited to the general environment identified herein.
- This summary is provided to introduce a selection of concepts in a simplified form that are further described below in the Detailed Description section. This summary is not intended to identify key features or essential features of the claimed subject matter, nor is it intended to be used as an aid in determining the scope of the claimed subject matter.
- Aspects of the disclosure relate to providing novel systems and methods for cycling or ending exhalation during mechanical ventilation of a patient. More specifically, this disclosure describes systems and methods for cycling ventilation based on estimated muscle pressure.
- In an aspect, a ventilator system is provided. The ventilator system includes at least one sensor, a gas-delivery system configured to deliver ventilation gases to a patient, at least one processor, and at least one memory comprising computer-executable instructions that when executed by the at least one processor cause the ventilator system to perform various operations. The operations include receiving one or more sensor measurements from the at least one sensor during inhalation of the patient and, based on the one or more sensor measurements, estimating a muscle pressure (PMUS) of the patient during the inhalation of the patient. Based on the estimate of PMUS, the operations further include determining a PMUS-based metric and, in response to determining that the PMUS-based metric meets a cycling threshold, determining a patient intention to cycle. Additionally, the operations include evaluating one or more characteristics of the patient intention to cycle and, when the one or more characteristics of the patient intention to cycle are abnormal, determining a missed cycling effort. In response to the missed cycling effort, the operations include performing an action.
- In another aspect, a method of determining a patient intention to cycle is provided. The method includes delivering spontaneous ventilation to a patient and, based on a target setting for the spontaneous ventilation, determining a percent support setting. The method further includes temporarily switching to a proportional assist (PA) breath type and delivering at least one PA breath based on the determined percent support setting. During the at least one PA breath, the method includes receiving one or more sensor measurements from the at least one sensor and, based on the one or more sensor measurements, estimating a muscle pressure (PMUS) of the patient. In response to determining that the PMUS meets a cycling threshold, the method includes determining a patient intention to cycle.
- In yet another aspect, a method for detecting a patient intention to cycle during spontaneous ventilation of the patient on a ventilator is provided. The method includes monitoring at least one parameter of the patient receiving spontaneous ventilation based on one or more received non-invasive sensor measurements during inhalation and, based on the one or more received non-invasive sensor measurements, estimating a muscle pressure (PMUS) of the patient during the inhalation. The method further includes comparing a PMUS-based metric to a cycling threshold and determining that the PMUS-based metric meets the cycling threshold to identify a patient intention to cycle. In response to identifying the patient intention to cycle, the method includes evaluating one or more characteristics of the patient intention to cycle and, when the one or more characteristics of the patient intention to cycle are abnormal, determining a missed cycling effort. Additionally, the method includes performing an action in response to the missed cycling effort.
- It is to be understood that both the foregoing general description and the following detailed description are exemplary and explanatory and are intended to provide further explanation of the disclosure as claimed.
- This summary is provided to introduce a selection of concepts in a simplified form that are further described below in the Detailed Description. This summary is not intended to identify key features or essential features of the claimed subject matter, nor is it intended to be used to limit the scope of the claimed subject matter.
- The following drawing figures, which form a part of this application, are illustrative of aspects of systems and methods described below and are not meant to limit the scope of the disclosure in any manner, which scope shall be based on the claims.
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FIG. 1 is a schematic diagram illustrating a ventilator capable of detecting patient exhalation or cycling efforts based on estimated muscle pressure, in accordance with aspects of the disclosure. -
FIG. 2 is a flow diagram illustrating a method for cycling detection based on estimated muscle pressure in a spontaneous breath type during ventilation of a patient with a ventilator, in accordance with aspects of the disclosure. -
FIG. 3 is a flow diagram illustrating a method for performingprocess operation 204 ofFIG. 2 when the spontaneous breath type is TC, PS or VS and the processed parameter is estimated muscle pressure during ventilation of a patient with a ventilator, in accordance with aspects of the disclosure. -
FIG. 4 is a graph illustrating a muscle pressure curve of a volunteer in synchrony with the ventilator and actively exhaling in response to externally imposed breathing resistance. -
FIG. 5 is a graph illustrating a missed cycle based on estimated muscle pressure monitoring during a high-percentage support using a proportional assist (PA) breath type of a volunteer, in accordance with aspects of the disclosure. -
FIG. 6 illustrates the tidal volume and flow curves for ventilation of the volunteer inFIG. 5 . -
FIG. 7 is a graph illustrating PMUS of an intubated volunteer as measured by an esophageal catheter during a proportional assist (PA) breath type. -
FIG. 8 is a graph illustrating PMUS of an intubated volunteer as measured by a catheter during a high-percentage support, proportional assist (PA) breath type. - Although the techniques introduced above and discussed in detail below may be implemented for a variety of medical devices, the present disclosure will discuss the implementation of these techniques in the context of a medical ventilator for use in providing ventilation support to a human patient. A person of skill in the art will understand that the technology described in the context of a medical ventilator for human patients could be adapted for use with other systems such as ventilators for non-human patients and general gas transport systems.
- Medical ventilators are used to provide a breathing gas to a patient who may otherwise be unable to breathe sufficiently. In modern medical facilities, pressurized air and oxygen sources are often available from wall outlets. Accordingly, ventilators may provide pressure regulating valves (or regulators) connected to centralized sources of pressurized air and pressurized oxygen. The regulating valves function to regulate flow so that respiratory gas having a desired concentration of oxygen is supplied to the patient at desired pressures and flow rates. Ventilators capable of operating independently of external sources of pressurized air are also available.
- As each patient may require a different ventilation strategy, modern ventilators can be customized for the particular needs of an individual patient. For example, several different ventilator modes, breath types, and/or settings have been created to provide better ventilation for patients in various different scenarios, such as mandatory ventilation modes and assist control ventilation modes. Mandatory ventilation modes provide ventilator-initiated triggering and cycling, whereas assist control modes allow a spontaneously breathing patient to trigger inspiration during ventilation. In a spontaneous mode of ventilation, the ventilator triggers inspiration upon the detection of patient demand or patient effort to inhale and cycles or initiates expiration when a predetermined threshold is met or when a patient demand or effort for exhalation is detected.
- The response performance of a medical ventilator to a patient cycle from inhalation into exhalation represents an important characteristic of a medical ventilator. A ventilator's exhalation trigger or cycle response impacts the patient's work of breathing and the overall patient-ventilator synchrony. The exhalation cycle response performance of a ventilator is a function of a patient's expiratory behavior (breathing effort magnitude and timing characteristics) as well as the ventilator's gas delivery dynamics and flow control parameters (actuator response, dead bands, etc.).
- Triggering delay time, cycling delay time, and asynchrony index are among key parameters that are used to measure the patient-ventilator synchrony. The asynchrony index is the ratio between the number of asynchronous events and the total respiratory rate. Miss-cycling is also considered as one of the factors that increases the patient-ventilator asynchrony index. Several different factors cause asynchrony events, such as variation in patient's breathing pattern, muscle strength, respiratory mechanics, ventilator performance, and ventilator characteristics.
- Traditionally the inspiration is cycled off based on an ESENS threshold, which may be a set percentage (normally 25%) of the peak inspiratory flow or a set flow value on many intensive care ventilators. This adjustable value, however, is often not optimal, resulting in patient-ventilator expiratory asynchrony. Expiratory asynchrony has been shown to be a clinical issue in the patients with partial ventilatory support. Under the expiratory asynchrony situation, the termination of the ventilator flow occurs either before or after patients stop their inspiratory efforts. When the termination of the ventilator flow falls behind the end of the patient inspiratory effort (i.e. delayed cycling), the patient recruits his or her expiratory muscles to “fight” against the ventilator flow, which increases expiratory workload, resulting in intrinsic PEEP. When the termination of the ventilator flow occurs before the end of patient inspiratory effort (i.e. premature cycling), the patient inspiratory muscle work continues into or even throughout the ventilator's expiratory phase, thus resulting in inefficient inspiratory muscle work. For PA, TC, PS or VS, to address premature cycling, the percent support setting may be increased or the ESENS setting may be decreased (less sensitive). Alternatively, for PA, TC, PS or VS, to address delayed cycling, the percent support setting may be decreased or the ESENS setting may be increased (more sensitive). For PS and VS, there is an FAP setting or “rise time %” setting indicating how aggressively the pressure rises. If this setting is too low, then pressure rises sluggishly, which can affect patient support and cycling. This might result in early cycling with the patient continuing to inhale because the pressure rise was not fast enough. In this case, an adjustment could be to increase the “rise time %” setting.
- Furthermore, a high lung volume caused by the previous breath with delayed cycling may result in a missed trigger of the subsequent inspiratory effort in patients with Chronic Obstructive Pulmonary Disease (COPD) or with high breathing rates. For patients ventilated with pressure support (PS) ventilation, premature cycling may result in double-triggering or auto-triggering.
- Most ventilators in the current market allow the user to select an expiratory cycling setting from a specific range provided by the ventilator. Unlike universal settings such as respiratory rate, PEEP, tidal volume, and pressure support, the expiratory cycling settings are unique to each ventilator. Users who are unfamiliar with a specific ventilator outside their daily use may struggle to properly set the expiratory cycling settings. Moreover, patients need different adjustments when their recovery conditions have changed, or their sedation and pain medications are adjusted. But many clinicians do not adjust the settings optimally to support patient effort.
- For example, for triggering the start of exhalation in tube compensated (TC), pressure support (PS) or volume support (VS) ventilation (cycling), the exhalation sensitivity (ESENS) setting is frequently left at the default value (25%), which can cause asynchrony in some types of patients. For example, with COPD patients, this value can lead to the patient fighting the ventilator trying to exhale. In proportional assist (PA) ventilation, the exhalation sensitivity (ESENS) setting is also frequently left at a default value (such as 3.0 Lpm), which can cause asynchrony in some types of patients. Further, in proportional assist (PA) ventilation, if the percent support setting is set too high, the patient can be over-supported leading to the patient forcing the exhalation mid-way through inspiration. Having the ventilator identify this over-support condition could give the ventilator the ability to detect the patient fighting the ventilator to exhale, not just in PA, but in PS, VS or TC as well. The exhalation issues contribute to poor synchrony.
- Therefore, there is a need to have a smarter, or more intuitive, expiratory cycling method to reduce expiratory asynchrony and optimize the patient-to-ventilator interactions.
- Accordingly, the systems and methods described herein provide improved exhalation cycling systems and methods. For example, the improved exhalation cycling systems and methods monitor a PMUS-based metric to detect patient cycling efforts and/or to determine if the set cycling threshold is appropriate for the patient. Based on this monitoring, the ventilator performs one or more actions. The action may include triggering exhalation, adjusting an exhalation threshold setting, adjusting another ventilator setting, providing a notification, and/or providing a recommendation. For example, the PMUS-based metric monitoring can be utilized to adjust ESENS for PS, PA, TC, and VS breath types to improve ventilator cycling or the percent support setting for PA breath type to improve ventilator-patient synchrony. The improved exhalation cycling systems and methods, in these aspects, are referred to herein as “cycling systems and methods” or “cycling settings.” The cycling setting reduces the occurrence of cycling asynchrony and requires less operator training or knowledge for effective use. While the cycling setting is referred to herein as a cycling setting, it may also be referred to as a cycling mode, supplemental cycling mode, or supplemental mode because the cycling setting is utilized in conjunction with or in addition to any spontaneous mode of ventilation running any suitable breath type (PS, VS, TC, or PA) for a spontaneous mode of ventilation.
- In some aspects, the cycling setting improves ventilator synchrony by changing the cycling threshold or recommending a change in cycling threshold based on the monitoring of estimated patient muscle pressure (PMUS) or a PMUS-based metric. The PMUS-based metric may be PMUS, may be a processed signal of PMUS, or may represent a shape of the PMUS waveform. In other aspects, the cycling setting improves ventilator synchrony by cycling exhalation based on the monitoring of the PMUS-based metric. As estimated patient muscle pressure is a strong indicator of a patient's effort to exhale, a patient PMUS-based metric can be utilized to detect cycling or intended cycling and/or to determine if the cycling threshold or pattern is appropriate.
- For the purposes of this disclosure, a “breath” refers to a single cycle of inspiration and exhalation delivered with the assistance of a ventilator. The term “breath type” refers to some specific definition or set of rules dictating how the pressure and flow of respiratory gas is controlled by the ventilator during a breath.
- A ventilation “mode”, on the other hand, is a set of rules controlling how multiple subsequent breaths should be delivered. Modes may be mandatory, that is controlled by the ventilator, or spontaneous, that is that allow a breath to be delivered or controlled upon detection of a patient's effort to inhale, exhale or both. For example, a simple mandatory mode of ventilation is to deliver one breath of a specified mandatory breath type at a clinician-selected respiratory rate (e.g., one breath every 6 seconds). Until the mode is changed, ventilators will continue to provide breaths of the specified breath type as dictated by the rules defining the mode. For example, breath types may be mandatory mode breath types (that is, the initiation and termination of the breath is made by the ventilator) or spontaneous mode breath types (which refers to breath types in which the breath is initiated and/or terminated by the patient). Examples of breath types utilized in the spontaneous mode of ventilation include proportional assist (PA) breath type (including different versions of PA, such as plus and optimized), tube compensated (TC) breath type, volume support (VS) breath type, pressure support (PS) breath type, and etc. Examples of mandatory breath types include a volume control breath type, a pressure control breath type, and etc.
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FIG. 1 illustrates a schematic diagram of an aspect of anexemplary ventilator 100. Theexemplary ventilator 100 illustrated inFIG. 1 is connected to ahuman patient 150.Ventilator 100 includes a pneumatic system 102 (also referred to as a pressure generating system 102) for circulating breathing gases to and frompatient 150 via theventilation tubing system 130, which couples thepatient 150 to thepneumatic system 102 via an invasive (e.g., endotracheal tube, as shown) or a non-invasive (e.g., nasal mask)patient interface 180. - Ventilation tubing system 130 (or patient circuit 130) may be a two-limb (shown) or a one-limb circuit for carrying gases to and from the
patient 150. In a two-limb aspect, a fitting, typically referred to as a “wye-fitting” 170, may be provided to couple the patient interface 180 (shown as an endotracheal tube inFIG. 1 ) to aninspiratory limb 132 and anexpiratory limb 134 of theventilation tubing system 130. -
Pneumatic system 102 may be configured in a variety of ways. In the present example,pneumatic system 102 includes anexpiratory module 108 coupled with theexpiratory limb 134 and aninspiratory module 104 coupled with theinspiratory limb 132.Compressor 106, accumulator and/or other source(s) of pressurized gases (e.g., air, oxygen, and/or helium) is coupled withinspiratory module 104 and theexpiratory module 108 to provide a gas source for ventilatory support viainspiratory limb 132. - The
inspiratory module 104 is configured to deliver gases to thepatient 150 and/or through theinspiratory limb 132 according to prescribed ventilatory settings. Theinspiratory module 104 is associated with and/or controls an inspiratory valve for controlling gas delivery to thepatient 150 and/or gas delivery through theinspiratory limb 132. In some aspects,inspiratory module 104 is configured to provide ventilation according to various ventilator modes, such as mandatory, spontaneous, and/or assist modes. - The
expiratory module 108 is configured to release gases from the patient's lungs according to prescribed ventilatory settings. Theexpiratory module 108 is associated with and/or controls an expiratory valve for releasing gases from thepatient 150. In some aspects,expiratory module 108 is configured to release gas according to various ventilator modes, such as mandatory, spontaneous, and/or assist modes. - The
ventilator 100 may also include one ormore sensors 107 communicatively coupled toventilator 100. Thesensors 107 may be located in thepneumatic system 102,ventilation tubing system 130, and/or on thepatient 150.FIG. 1 illustrates a sensor 107 (e.g., flow sensor, pressure sensor, etc.) inpneumatic system 102. - The
ventilator 100 may also include one or morenon-invasive sensors 107 communicatively coupled toventilator 100. Sensors are referred to herein as non-invasive when the sensors are located externally to patient. For example, sensors located in thepatient wye 170, in theexpiratory module 108, in theinspiratory module 104, or on the patient's finger are all external to the patient and are non-invasive. Sensors are referred to herein as invasive when the sensors are located within the patient or placed inside the patient's body, such as sensors located in an endotracheal tube, near a patient diaphragm, or on an esophageal balloon. While invasive sensors can provide great patient data or measurements, these sensors can often be hard to maintain or keep properly positioned. For example, an esophageal balloon can easily be knocked out of proper position in response to patient movement. Once moved, all of the data recorded from the sensors on the balloon are inaccurate. Further, if condensation or material corrupts the sensor and interferes with accurate measurements, the invasive sensor has to be removed from the body to service and/or clean it. Further, because invasive sensors are located within the patient, they usually require the patient to be sedated or undergo a surgical procedure for implantation or positioning adjustment. As such, invasive sensors are burdensome to the patient, hard to implant, hard to maintain, and hard to keep positioned when compared to non-invasive sensors. The embodiment ofFIG. 1 illustrates asensor 107 inpneumatic system 102. -
Sensors 107 may communicate with various components ofventilator 100, e.g.,pneumatic system 102,other sensors 107,expiratory module 108,inspiratory module 104,processor 116,controller 110,cycling module 118, and any other suitable components and/or modules. A module as used herein refers to memory, one or more processors, storage, and/or other components of the type commonly found in command and control computing devices. In one aspect,sensors 107 generate output, such as measurements, and send this output topneumatic system 102,other sensors 107,expiratory module 108,inspiratory module 104,processor 116,controller 110,cycling module 118, and any other suitable components and/or modules. -
Sensors 107 may employ any suitable sensory or derivative technique for monitoring one or more patient parameters or ventilator parameters associated with the ventilation of apatient 150.Sensors 107 may detect changes in patient parameters indicative of patient inspiratory or expiratory triggering, for example.Sensors 107 may be placed in any suitable location, e.g., within the ventilatory circuitry or other devices communicatively coupled to theventilator 100. For example, in some aspects, one ormore sensors 107 may be located in an accumulator. Further,sensors 107 may be placed in any suitable internal location, such as, within the ventilatory circuitry or within components or modules ofventilator 100. For example,sensors 107 may be coupled to theinspiratory module 104 and/orexpiratory module 108 for detecting changes in, for example, circuit pressure and/or flow. In other examples,sensors 107 may be affixed to the ventilatory tubing or may be embedded in the tubing itself. According to some aspects,sensors 107 may be provided at or near the lungs (or diaphragm) for detecting a pressure in the lungs. Additionally or alternatively,sensors 107 may be affixed or embedded in or near wye-fitting 170 and/orpatient interface 180. Any sensory device useful for monitoring changes in measurable parameters during ventilatory treatment may be employed in accordance with aspects described herein. For example, in some aspects, the one ormore sensors 107 of theventilator 100 include an inspiratory flow sensor and an expiratory flow sensor. - As should be appreciated, with reference to the Equation of Motion, ventilatory parameters are highly interrelated and, according to aspects, may be either directly or indirectly monitored. That is, parameters may be directly monitored by one or
more sensors 107, as described above, or may be indirectly monitored or estimated by derivation according to the Equation of Motion or other known relationships from the monitored parameters. - The
cycling module 118 monitors a physiological parameter of the patient for each sample period from sensor output from one or more sensors. In some aspects, the sample period as used herein refers to a discrete period of time required to monitor a physiological parameter. In some aspects, the sample period is a computation cycle for theventilator 100. In some aspects, the sample period is every 5 milliseconds (ms), 10 ms, 15 ms, 20 ms, 25 ms, or 30 ms. This list is exemplary only and is not meant to be limiting. Any suitable sample period for monitoring a physiological parameter of the patient may be utilized by theventilator 100 as would be understood by a person of skill in the art. In some aspects, thecycling module 118 estimates and/or calculates the physiological parameter for monitoring based on the sensor output from one or more sensors. In other aspects,cycling module 118 determines the physiological parameter for monitoring directly from the sensor output received from the one or more sensors. The physiological parameter may be any suitable physiological parameter for determining a patient initiated cycle as would be known by a person of skill in the art. In some aspects, the physiological parameter is flow rate, net flow, pressure, estimated pressure, estimated flow, other derived signals, and/or etc. This list is exemplary only and is not meant to be limiting. - After determining the physiological parameter, the
cycling module 118 may send the physiological parameter to any suitable component and/or module of theventilator 100, such as thepneumatic system 102,expiratory module 108,inspiratory module 104,processor 116,controller 110, and/or etc. In other aspects, thecycling module 118 receives the physiological parameter measurements from other components of the ventilator, such as asensor 107,controller 110, and/orprocessor 116. - The
cycling module 118 processes the physiological parameter to detect patient cycling efforts. In some aspects, thecycling module 118 processes the physiological parameter to determine a PMUS to detect patient cycling efforts. In further aspects, thecycling module 118 processes the physiological parameter to determine a PMUS-based metric to detect patient cycling efforts. - The
cycling module 118 calculates the PMUS based on measured flow and/or pressure and based on calculated resistance and/or compliance. During a PA breath type, the ventilator is configured to calculate resistance, compliance, and a PMUS utilizing non-invasive sensor measurements. Unlike other spontaneous breath types, the PA breath type can calculate compliance and resistance. Knowing compliance and resistance, an estimate of the diaphragmatic muscle pressure can be computed non-invasively. In other spontaneous breath types, an invasive sensor located in an esophageal balloon is needed to measure the diaphragmatic pressure. However, an esophageal balloon can easily become dislodged if the patient moves affecting sensor accuracy, is highly invasive to implant, and/or is uncomfortable for a spontaneously breathing patient. Due to the disruptive nature of the esophageal balloon, the esophageal balloon is rarely utilized during a spontaneous breath type. As such, other spontaneous breath types, such as TC, PS and VS, the ventilator is not configured to calculate resistance, compliance, and/or PMUS utilizing non-invasive sensor measurements. Accordingly, thecycling module 118 during a spontaneous breath type that is not a PA breath type will temporarily switch from the current breath type into the PA breath type for a predetermined number of breaths, time or measurements in order to calculate resistance and/or compliance and then estimate PMUS based on one or more non-invasive sensor measurements. - A PA breath type refers to a type of ventilation in which the ventilator acts as an inspiratory amplifier that provides pressure support based on the patient's effort. Usually, the degree of amplification (the “percent support setting”) during a PA breath type is set by an operator or clinician, for example as a percentage based on the patient's effort. However, during a temporary implementation of the PA breath type, the
cycling module 118 determines the percent support setting provided during the temporary PA breath type. - In one implementation of a PA breath type, the ventilator may continuously monitor the patient's instantaneous inspiratory flow and instantaneous net lung volume, which are indicators of the patient's inspiratory effort. These signals, together with ongoing estimates of the patient's lung compliance and lung/airway resistance and the Equation of Motion (Pmus=Pwye−Pend_exp−(Rtube+Rrs)×Qlung−∫Qlung dt/Crs), allow the ventilator to estimate/calculate a patient effort and derive therefrom a target airway pressure to provide the support that assists the patient's inspiratory muscles to the degree selected by the operator as the percent support setting. In this equation, the patient effort is estimated inspiratory muscle pressure and is negative.
- Due to the unique configuration of the PA breath type, the PA breath type is capable of determining a patient respiratory system compliance and/or resistance in an end inspiratory hold of 300 ms or 0.3 seconds, which will usually go unnoticed by a spontaneously breathing patient. In a typical PA breath type, this 300 ms end inspiratory hold is provided intermittently at random. During a temporary PA breath type, the 300 ms end inspiratory hold may be provided in the first, second, third, and/or fourth breath of the temporary PA breath type. Any additional 300 ms holds are provided after a predetermined number of breaths or after a set time period during the temporary PA breath type. In other words, the temporary PA breath type does not provide the 300 ms end inspiratory hold at random but instead at predetermined intervals. As such, the
cycling module 118 is able to calculate patient respiratory compliance and patient respiratory system resistance. Thecycling module 118 utilizes the following equation to determine patient respiratory system compliance: -
C RAW=(V LUNG/Pressure_delta). - The
cycling module 118 utilizes the following equation to determine patient respiratory system resistance: -
R RAW =R RAW+ET −R ET, -
- where:
- RRAW is patient respiratory system resistance;
- RRAW+ET is the combined resistance of the patient respiratory system and the endotracheal tube/tracheostomy tube resistance; and
- RET is endotracheal tube/tracheostomy tube resistance.
- RRAW+ET is the difference in lung pressure and wye pressure divided by the estimated lung flow. The lung pressure may be based upon the lung pressure at the beginning of exhalation minus exhaled volume times the elastance. Wye pressure is estimated as the measured pressure within the ventilator breathing system (VBS) at the circuit wye, which is compensated for breathing circuit limb resistance.
- During the temporary PA breath type, the
cycling module 118 calculates patient respiratory resistance and/or compliance based on non-invasive sensor output. Thecycling module 118 provides the temporary PA breath type for at least one breath. In some aspects, thecycling module 118 provides the temporary PA breath type for at least three breaths. In some aspects, thecycling module 118 provides the temporary PA breath type until a predetermined number of patient respiratory compliance and/or resistance measurements or calculations have been made by theventilator 100. In some aspects, thecycling module 118 provides the temporary PA breath type until at least two or three patient respiratory compliance and/or resistance measurements have been made by theventilator 100. In other aspects, thecycling module 118 provides the temporary PA breath type until at least one, two, three, four, or five patient respiratory compliance and/or resistance measurements have been made by theventilator 100. The predetermined number of patient respiratory compliance and/or resistance measurements can be completed in 1 breath, 2 breaths, 3 breaths, 5 breaths, 7 breaths, 8 breaths, 10 breaths, 12 breaths, 15 breaths, 20 breaths, 25 breaths or 30 breaths. In other aspects, a predetermined number of patient respiratory compliance and/or resistance measurements can be completed by thecycling module 118 in 4 to 12 breaths. - After the temporary PA breath type has been completed (e.g., the predetermined number of patient respiratory compliance and/or resistance measurements have been made by the ventilator 100), the
cycling module 118 switches the ventilation of the patient back to the previously utilized spontaneous breath type (TC, PS or VS). - After the return to the previously utilized spontaneous breath type, the
cycling module 118 monitors respiratory data of the patient, such as the non-invasive sensor output. In some aspects, thecycling module 118 calculates a PMUS of the patient during the spontaneous breath type utilizing the respiratory system compliance and/or the respiratory system resistance calculated during the temporary PA breath type, and the current respiratory data measured after the return to TC, VS or PS breath type. - The
cycling module 118 measures the PMUS repeatedly throughout a breath. In some aspects, thecycling module 118 measures PMUS every servo cycle, such as every 2 milliseconds, 5 millisecond, or 10 milliseconds. The servo cycle is a fixed, periodic amount of time during which sensor data fromsensors 107 are sampled, control calculations are made by theprocessor 116 orcontroller 110 of theventilator 100, and new valve or actuator commands are issued. In some aspects, thesensors 107 send output or measurements every servo cycle. Thecycling module 118 communicates the PMUS to other modules, such as thecontroller 110, thepneumatic system 102, and/or thedisplay 122. - During ventilation with a spontaneous breath type other than the PA breath type, when the PMUS-based metric is utilized to determine cycling, the
cycling module 118 determines when to perform the temporary switch into the PA breath type by monitoring input to determine the occurrence of one or more conditions. In some aspects, thecycling module 118 monitors the measurements from the non-invasive sensors. In other aspects, thecycling module 118 monitors other received ventilator data or calculations to determine the occurrence of the condition. - In some aspects, the condition may be any event that is indicative of a change in patient respiratory system compliance and/or patient respiratory system resistance, such as a predetermined pressure differential, volume differential, a tidal volume differential, a specific flow waveform shape, a specific volume waveform shape, a specific pressure waveform shape, a predetermined change in pressure, a predetermined change in flow, a predetermined change in tidal volume and/or etc. For example, the condition may be a change in non-invasively monitored flow, pressure, and/or of volume of at least 25%. In other aspects, the condition is an expiration of a set period or predetermined number of breaths, since the last temporary PA breath type switch or since the start of the last temporary PA breath type. For example, the condition may be the expiration of 30, 60, 90, or 120 minutes or the occurrence of 400, 300, or 200 breaths since the last temporary switch into the PA breath type or the start of the last temporary PA breath type. In other examples, the
cycling module 118 monitors for the following condition to occur: 1) expiration of 1 hour since the last temporary PA breath type; or 2) a 25% change in one of non-invasively measured pressure, flow, or tidal volume during the spontaneous breath type that is not a PA breath type. If the breath type was just initialized, the conditions discussed above may be monitored from the start of ventilation or the start of the breath type instead of since the last temporary switch into the PA breath type or the start of the last temporary PA breath type. If thecycling module 118 detects a condition, thecycling module 118 of thecontroller 110 determines a percent support setting and sends instructions to thepressure generating system 102 to provide a short temporary switch into a PA breath type utilizing the determined percent support setting. - In some aspects, the
cycling module 118 determines a percent support setting for the temporary PA breath by utilizing a predetermined or preset percent support setting. In other aspects, thecycling module 118 determines a percent support setting based on a target setting for the spontaneous breath type that is not the PA breath type. For example, if the target pressure for the PS breath type is 10 cm H2O, then thecycling module 118 will determine a percent supporting setting for the temporary PA breath to achieve approximately the same pressure level. In another example, if the target volume for a VS breath type is 400 ml, then thecycling module 118 will determine a percent support setting for the temporary PA breath to achieve approximately the same volume level. In other aspects, the percent setting is determined by thecycling module 118 based on outputs from the non-invasive sensor. For example, if inspiratory pressure measurement is 9.8 cm H2O from inspiratory pressure sensor, then thecycling module 118 will determine a percent support setting for the temporary PA breath to achieve approximately the same pressure level. In further aspects, thecycling module 118 may utilize additional ventilator parameters or inputs to the target setting and/or the outputs from the non-invasive sensor to determine a percent support setting for the temporary PA breath, such as mask type, patient circuit diameter, and etc. - The
cycling module 118 may compare the PMUS-based metric to a cycling threshold to form a comparison. If the PMUS-based metric meets the cycling threshold based on the comparison, thecycling module 118 determines that the patient is making an effort to end inhalation and start exhalation. If the PMUS-based metric does not meet the cycling threshold based on the comparison, thecycling module 118 determines that the patient is not making an effort to end inhalation and start exhalation. In response to determining that the patient is not making an effort to end inhalation and start exhalation, thecycling module 118 continues to the monitor the PMUS-based metric and compare it to the cycling threshold. The cycling threshold may be dynamic and/or dependent on the magnitude of PMUS-based metric. - In response to determining that the patient is making an effort to end inhalation and start exhalation, the
cycling module 118 performs one or more actions. The one or more actions may include cycling, providing a notification, providing a recommendation, determining cycling synchrony, displaying a detected cycling effort, recommending a parameter change, and/or automatically changing a parameter. - In some aspects, the one or more actions may include sending a command to end inspiration and begin exhalation. In these aspects, the spontaneous breath types may be adjusted to cycle in response meeting a PMUS-based metric threshold instead of based on ESENS (such as a percent of peak flow or a set flow value in Lpm) in PS, VS, TC or PA. In these aspects, the ventilator effectively identifies the end of patient inspiratory effort and determines the optimal time to trigger the expiratory phase. Based on this approach, cycling to the expiratory phase will be variable based on patient effort and will not be purely dependent upon exhaled flow. The
cycling module 118 minimizes the patient-to-ventilator asynchrony and provides a feature that is easy to use by the clinician since the clinician does not have to set an ESENS as a primary cycling mechanism. - The one or more actions may include determining if exhalation was provided by the breath type within an interval of time of the detected cycling effort. In these aspects, cycling is still controlled by ESENS in PS, VS, TC and PA and can be influenced by the percent support setting in PA and the rise-time setting in PS or VS. As such, the
cycling module 118 determines if the detected cycling effort occurred within a predetermined amount of time of the cycling effort delivered by the spontaneous breath type. In some aspects, the interval of time may be about 300 ms. If the detected effort is not within the interval of time from the delivered exhalation, thecycling module 118 determines asynchronous cycling. In response to determining asynchronous cycling, thecycling module 118 may provide a notification (such as a notification of an asynchronous cycling), provide a recommendation (such as a recommendation to adjust ESENS for a VS, PS, TC or PA breath type or percent support setting for PA breath type), automatically adjust a ventilator setting (such as automatically adjust ESENS for a VS, PS, TC or PA breath type or percent support setting for PA breath type). - In other aspects, the one or more actions may include displaying the detected cycling effort. In some aspects, the detected cycling effort may be displayed on a waveform. In other aspects, a prompt may indicate that a cycling effort was detected and/or missed. In further aspects, the one or more actions may include providing, such as displaying, a recommendation to change a percent support setting in PA, an ESENS setting in PS, VS, TC or PA, or a rise-time setting in PS or VS, as discussed above. For example, if the detected cycling effort happened before exhalation was delivered, the
cycling module 118 may recommend increasing the ESENS setting or decreasing the percent support setting. If the detected cycling effort happened after exhalation was delivered, thecycling module 118 may recommend decreasing the ESENS setting or increasing the percent support setting. In further aspects, the one or more actions may include automatically changing a percent support setting in PA, an ESENS setting in PS, VS, TC or PA, or a rise-time setting in PS or VS. For example, if the detected cycling effort happened before exhalation was delivered, thecycling module 118 may automatically increase the ESENS setting or decrease the percent support setting. For example, if the detected cycling effort happened after exhalation was delivered, thecycling module 118 may automatically decrease the ESENS setting or increase the percent support setting. - The
cycling module 118 ends inspiration by sending instructions and/or a command to apneumatic system 102, anexpiratory module 108, aninspiratory module 104, aprocessor 116, and/or acontroller 110. The instructions and/or commands cause the one or more ventilator components and/or modules to change the delivered flow and/or pressure and to adjust the valves as needed to end inspiration and start exhalation. - The
pneumatic system 102 may include a variety of other components, including mixing modules, valves, tubing, accumulators, filters, etc.Controller 110 is operatively coupled withpneumatic system 102, signal measurement and acquisition systems (e.g., sensor(s) 107), and anoperator interface 120 that may enable an operator to interact with the ventilator 100 (e.g., change ventilator settings, select operational modes, view monitored parameters, etc.). - In some aspects, the
operator interface 120 of theventilator 100 includes adisplay 122 communicatively coupled toventilator 100.Display 122 may provide various input screens, for receiving clinician input, and various display screens, for presenting useful information to the clinician. In aspects, thedisplay 122 is configured to include a graphical user interface (GUI). The GUI may be an interactive display, e.g., a touch-sensitive screen or otherwise, and may provide various windows and elements for receiving input and interface command operations. Alternatively, other suitable means of communication with theventilator 100 may be provided, for instance by a wheel, keyboard, mouse, or other suitable interactive device. Thus,operator interface 120 may accept commands and input throughdisplay 122. -
Display 122 may also provide useful information in the form of various ventilatory data regarding the physical condition of apatient 150. The useful information may be derived by theventilator 100, based on data collected by aprocessor 116, and the useful information may be displayed to the clinician in the form of graphs, wave representations, pie graphs, text, or other suitable forms of graphic display. For example, patient data may be displayed on the GUI and/ordisplay 122. Additionally or alternatively, patient data may be communicated to a remote monitoring system coupled via any suitable means to theventilator 100. In some aspects, thedisplay 122 illustrates a physiological parameter, a graph or waveform of the physiological parameter, a graph or waveform of PMUS, a detected patient cycle effort, an exhalation sensitivity, a cycle type, a recommendation, a notification, and/or any other information known, received, or stored by theventilator 100. - In some aspects,
controller 110 includesmemory 112, one ormore processors 116,storage 114, and/or other components of the type commonly found in command and control computing devices.Controller 110 may further include thecycling module 118 as illustrated inFIG. 1 . In alternative aspects, thecycling module 118 is located in other components of theventilator 100, such as in the pressure generating system 102 (also known as the pneumatic system 102) orinspiratory module 104. - The
memory 112 includes non-transitory, computer-readable storage media that stores and/or encodes software (or computer readable instructions) that is executed by theprocessor 116 and which controls the operation of theventilator 100. In an aspect, thememory 112 includes one or more solid-state storage devices such as flash memory chips. In an alternative aspect, thememory 112 may be mass storage connected to theprocessor 116 through a mass storage controller (not shown) and a communications bus (not shown). Although the description of computer-readable media contained herein refers to a solid-state storage, it should be appreciated by those skilled in the art that computer-readable storage media can be any available media that can be accessed by theprocessor 116. That is, computer-readable storage media includes non-transitory, volatile and non-volatile, removable and non-removable media implemented in any method or technology for storage of information such as computer-readable instructions, data structures, program modules or other data. For example, computer-readable storage media includes RAM, ROM, EPROM, EEPROM, flash memory or other solid state memory technology, CD-ROM, DVD, or other optical storage, magnetic cassettes, magnetic tape, magnetic disk storage or other magnetic storage devices, or any other medium which can be used to store the desired information and which can be accessed by the computer. -
FIG. 2 illustrates an example of amethod 200 for cycling from inspiration to exhalation during ventilation of a patient on a ventilator. In some aspects,method 200 cycles to exhalation based on the monitoring of a PMUS-based metric. As such,method 200 provides spontaneous ventilation utilizing a cycling setting.Method 200 begins at the start of spontaneous ventilation utilizing a cycling setting. As discussed above,method 200 can detect a patient's attempt to exhale. In other aspects,method 200 improves ventilator synchrony by detecting patient efforts to exhale and/or by changing or recommending setting changes to improve cycling. - As illustrated,
method 200 includes amonitor operation 202, aprocess operation 204, a compareoperation 206, athreshold decision operation 208, and anaction operation 214. In some aspects,method 200 also includes anoptional timing operation 210 and/or an optional missedcycling determination operation 212. - During the
monitor operation 202, the ventilator monitors a physiological parameter based on one or more sensor measurements for each sample period in a first set of sample periods during inspiration. In some aspects, the ventilator during themonitor operation 202 monitors flow, pressure, and/or other derived signals, such as a PMUS-based metric. Sensors suitable for this detection may include any suitable sensing device as known by a person of skill in the art for a ventilator, such as an inspiratory flow sensor, inspiratory pressure sensor, an exhalation flow sensor, an exhalation pressure sensor, and/or exhalation auxiliary pressure sensor. In further aspects, the one or more sensor measurements are from one or more non-invasive sensors. In further aspects, the ventilator during themonitor operation 202 is delivering inhalation. - During the
process operation 204, the ventilator processes the one or more received sensor measurements of the physiological patient parameter. In some aspects, the ventilator processes the received sensor measurements of the physiological parameter by calculating a PMUS or a PMUS-based metric based on the received sensor measurements. Accordingly, the one or more processed parameters include PMUS or a PMUS-based metric. - During the compare
operation 206, the ventilator compares the one or more processed parameters to a cycling threshold. For example, the PMUS-based metric is compared to a cycling threshold. In other aspects, the cycling threshold for the PMUS-based metric may be a dynamic function of its magnitude. - Next, during
threshold decision operation 208, the ventilator determines if the one or more processed parameters meet a cycling threshold based on the comparison of the one or more processed parameters to the cycling threshold performed duringoperation 206. In some aspects, the ventilator duringthreshold decision operation 208 determines a patient intention to cycle based on the comparison of a PMUS-based metric to a cycling threshold. For example, the ventilator may determine based on a shape of the PMUS curve a patient intention to cycle. Alternatively, the ventilator may compare one or more measured parameters to an ESENS setting to determine a patient intention to cycle. In other aspects, the ventilator duringthreshold decision operation 208 determines if a patient intends to cycle based on the comparison of a PMUS-based metric to a cycling threshold and scores or grades the asynchrony based on the comparison. An example of a score or grade of asynchrony includes an asynchrony index. - If a patient intention to cycle is detected, the method progresses to
cycling operation 216. Additionally, if a patient intention to cycle is detected, an optional evaluation of cycling characteristics may be performed atevaluation operation 210. Alternatively, if a patient intention to cycle is not detected, the method may return to monitoroperation 202. - At
optional evaluation operation 210, if the ventilator duringthreshold decision operation 208 determines or detects that a threshold has been met, then the ventilator may evaluate one or more cycling conditions associated with the patient intention to cycle. For instance, the ventilator may evaluate the shape of the PMUS curve. Additionally or alternatively, the ventilator may evaluate a timing of the ventilator cycling versus a timing of the patient intention to cycle. For instance, atevaluation operation 210, the ventilator may evaluate the shape of the PMUS curve to determine whether the curve is normal or abnormal. In other aspects, atevaluation operation 210, the ventilator may evaluate a timing of the detected patient intention to cycle to a timing of the cycling delivered by the ventilator. Based on the evaluation, the ventilator may determine whether characteristics of the patient intention to cycle are normal or abnormal. In aspects, when the PMUS curve is abnormal or the timing of the patient intention to cycle is abnormal, a percent support setting, a rise-time setting, or an ESENS setting may be inappropriate. - At
decision operation 212, the ventilator determines or detects if characteristics of the detected patient intention to cycle are normal or abnormal. For instance, if the shape of the PMUS curve is indicative of the patient actively exhaling (see e.g.,FIG. 5 ), the PMUS curve may be identified as “abnormal.” Additionally or alternatively, if the timing of the patient intention to cycle falls outside of a timing threshold, the timing may be identified as “abnormal.” In aspects, timing of ventilator cycling may be abnormal when the timing of ventilator cycling is too early (before the patient intention to cycle) or too late (after the patient intention to cycle). In some aspects, the timing of the ventilator cycling may be compared to a patient neural inspiratory time (e.g., a PMUS-based characteristic) to determine whether characteristics of the patient intention to cycle are abnormal. If the ventilator determines or detects duringdecision operation 212 that the characteristics of the patient intention to cycle (e.g., the PMUS curve, the timing, or the like) are not abnormal, the ventilator may return to monitoroperation 202. If the ventilator determines or detects duringdecision operation 212 that the characteristics of the patient intention to cycle (e.g., the PMUS curve, the timing, or the like) are not abnormal, the ventilator is in synchrony with the patient exhalation demand. Alternatively, if the ventilator determines or detects duringdecision operation 212 that the characteristics of the patient intention to cycle (e.g., the PMUS curve, the timing, or the like) are abnormal, the ventilator may progress tooptional action operation 214. If the ventilator determines or detects duringdecision operation 212 that the characteristics of the patient intention to cycle (e.g., the PMUS curve, the timing, or the like) are abnormal, the ventilator is not in synchrony with the patient exhalation demand. - At
optional action operation 214, the ventilator may performs an action. In some aspects, the action is performed in response to detection that characteristics of a patient intention to cycle are abnormal atdecision operation 208. In these aspects, the action may be one or more of: a notification of a missed cycling effort, display of a missed cycling effort, a recommendation to change a ventilator setting (e.g., a percent support setting or an ESENS setting), an automatic change of a ventilator setting, and/or notification of an automatic change of ventilator setting. In some aspects, the ventilator may recommend or automatically change percent support setting or an ESENS setting during a PA, TC, VS or PS breath type. In other aspects, the ventilator may additionally or alternatively recommend or automatically change a rise-time setting during a VS or PS breath type. - In some aspects, where the processed parameter is a PMUS-based metric and the set breath type is TC, PS or VS, the
process operation 204 includes several additional steps to determine the PMUS-based metric as illustrated inFIG. 3 . For example, in these aspects, theprocess operation 204 may include adetermination operation 302, asupport setting operation 304, aswitch operation 306, an analyzeoperation 308, a respiratorymechanics estimation operation 310, and areturn operation 312. -
FIG. 3 is a flow diagram illustrating a method for performingprocess operation 204 ofFIG. 2 when the spontaneous breath type is TC, PS or VS and the processed parameter is a PMUS-based metric during ventilation of a patient with a ventilator, in accordance with aspects of the disclosure. - At
determination operation 302, the ventilator determines if a condition occurred. In some aspects, the ventilator duringdetermination operation 302 monitors non-invasive sensor output to determine if the condition has occurred. In other aspects, the ventilator duringdetermination operation 302 monitors the number of delivered breaths or the passage of time to determine if a condition has occurred. If the ventilator determines that the condition occurred atdetermination operation 302, the ventilator selects to performsupport setting operation 304. If the ventilator determines that the condition did not occur duringdetermination operation 302, the ventilator selects to continue to monitor the non-invasive sensor output duringdetermination operation 302. The condition may be the expiration of a predetermined amount of time, the delivery of a predetermined number of breaths, and/or a change in one or more monitored parameters that indicates that a change in patient respiratory system compliance and/or resistance has occurred. In some aspects, the condition is a change in monitored pressure, monitored tidal volume, or monitored flow of at least 25%. In other aspects, the condition is expiration of 1 hour from the last use of a temporary PA breath type without a change in monitored pressure, monitored tidal volume, monitored flow by a specific value (such as 3 Lpm), or monitored flow of at least 25% since the last temporary PA breath type. In further aspects, the condition is the delivery of 200 breaths from the last use of the temporary PA breath type without a change in monitored pressure, monitored tidal volume, monitored flow by a specific value (such as 3 Lpm), or monitored flow of at least 25% since the last temporary PA breath type. - At
support setting operation 304 the ventilator determines a percent support setting for a temporary PA breath type. In some aspects, atsupport setting operation 304, the ventilator utilizes a predetermined support setting. In other aspects, atsupport setting operation 304 the ventilator selects a support setting based on at least one of a target setting from the spontaneous TC, PS or VS breath type or the non-invasively measured respiratory data collected during the TC, PS or VS spontaneous breath type. In further aspects, the ventilator duringsupport setting operation 304 determines other settings for the temporary PA breath type. For example, a PEEP level for the temporary PA breath type may be set based on a PEEP level utilized in the spontaneous TC, PS or VS breath type. - Next,
switch operation 306 is performed by the ventilator. Atswitch operation 306 the ventilator automatically and temporarily switches from the TC, PS or VS spontaneous breath type into a temporary PA breath type for at least one breath utilizing the determined or calculated percent support setting. In some aspects, atswitch operation 306 the ventilator automatically and temporarily switches from the spontaneous TC, PS or VS breath type into the temporary PA breath type for at least three breaths utilizing the determined or calculated percent support setting. The temporary PA breath type is performed for at least one breath, at least two breaths, or at least three breaths. In some aspects, the temporary PA breath type is delivered by the ventilator duringswitch operation 306 until at least one patient respiratory system compliance and/or resistance measurement has been obtained. In some aspects, the temporary PA breath type is delivered by the ventilator duringswitch operation 306 until at least two different patient respiratory system compliance and/or resistance measurements have been obtained. In some aspects, the temporary PA breath type is delivered by the ventilator during theswitch operation 306 until 5, 4, 3, or 2 patient respiratory system compliance and/or resistance measurements have been obtained. As such, the ventilator may deliver ventilation utilizing the temporary PA breath type for at most 4 breaths, 8 breaths, 10 breaths, 12 breaths, 15 breaths, 20 breaths, 30 breaths, 40 breaths, or 50 breaths. - The ventilator during the PA collect and analyze
operation 308, collects and analyzes the non-invasively measured respiratory data during the temporary PA breath type. Next, a respiratorymechanics estimation operation 310 is performed by the ventilator. During the respiratorymechanics estimation operation 310, the ventilator calculates or estimates the patient respiratory system compliance and/or resistance based on the non-invasively measured respiratory data taken during the temporary PA breath type during the PA collect and analyzeoperation 308. If multiple patient respiratory system compliance and/or resistance measurements are taken by the ventilator during respiratorymechanics estimation operation 310, the ventilator determines a compliance measurement and/or a resistance measurement based on these multiple measurements. For example, if multiple patient respiratory system compliance measurements are taken, the ventilator may average the measurements or select the middle or last obtained measurement to be utilized as the temporary PA breath type calculated compliance measurement for use duringprocess operation 204. - At
return operation 312 the ventilator switches from the temporary PA breath type back to the previously utilized spontaneous TC, PS or VS breath type. As discussed above, the ventilator returns to the spontaneous TC, VS or PS breath type after a predetermined number of patient respiratory system compliance or resistance measurements have been obtained during the temporary PA breath type, after a predetermined number of breaths, or after a predetermined amount of time. -
FIG. 4 is a graph illustrating a PMUS curve of a volunteer in response to additional externally applied resistance. In this example, PMUS ends coincident with cycling at 402 as indicated by the synchronicity with the ventilator phase signal. Upon application of external resistance of 10 (R=10), PMUS of the volunteer is elevated during exhalation, as shown by the upward slope of the PMUS curve at 404. In this case, active exhalation is indicated. -
FIG. 5 is a graph illustrating a missed cycle during ventilation of a volunteer in the laboratory with a ventilator based on PMUS monitoring, in accordance with aspects of the disclosure. In this example, the volunteer is being ventilated in a PA breath type with a plateau breath. The PA support setting was set to 95% to force the over-support condition and the volunteer was ventilated. In this case, the volunteer was intentionally over-supported. As shown byFIG. 5 , the PMUS shape pushed to positive pressure (as shown by reference circle 502), which indicates that the patient was actively exhaling in response to the over-support. The ventilator did not deliver exhalation until about a 1.5 seconds later, which is outside of a time interval of 300 ms. As such, in this example, the ventilator detects a missed exhalation attempt. Accordingly, the ventilator may perform an action in response to this determination, such as display a missed cycle, indicate that the percent support setting is set too high, recommend lowering the percent support setting, and/or automatically lower the percent support setting to eliminate over-support. Additionally or alternatively, the ventilator indicate that the ESENS setting is too low, may recommend increasing the ESENS setting, or may automatically increase the ESENS setting to improve cycling synchrony. -
FIG. 6 illustrates the tidal volume and flow curves for ventilation of the volunteer inFIG. 5 . At just after time of 37 s, the flow waveform peaks in response to the volunteer pushing back against the ventilator's over-support, that is, actively exhaling to avoid over-delivery. This peak is in synchrony with the pressure waveform peak ofFIG. 5 . The volume waveform shows the high inspired volume (nearly 1800 mL) in response to this self-truncated breath. -
FIG. 7 is a graph illustrating PMUS of an intubated volunteer as measured by an esophageal catheter during a PA breath type. In this example, the inverted PMUS shape 702 is due to the sign of the catheter pressures. This waveform shows the relationship between the ventilator pressure at the patient connection port or “wye” and the measured PMUS curve or the difference between the gastric and esophageal pressures that cross the diaphragm muscle (lower large dashed line). In this case, there is late ventilator triggering that might have been created by a trigger sensitivity that was too high. However, the cycling was reasonably synchronous with the end of the PMUS effort. This demonstrates good cycling synchrony. -
FIG. 8 is a graph illustrating PMUS of an intubated volunteer as measured by an esophageal catheter during high-percentage support. In this example, percent support is set to 80% and the patient appears to be pushing against the ventilator due to the rise in gastric pressure at 802. For comparison, see the flat gastric curve at 704 inFIG. 7 . Additionally, there is a late rise in Pwye at 804 and an early reversal of PMUS at 806 indicating that the volunteer is actively exhaling in the middle of the inspiratory phase. The PMUS curve also shows aflat push 808 at the end of inhalation to a lower pressure than at the start of the inhalation. Based on the indications associated with over-support illustrated byFIG. 8 , the ventilator may indicate that the percent support setting is set too high, may recommend lowering the percent support setting, and/or may automatically lower the percent support setting to eliminate over-support. Additionally or alternatively, the ventilator indicate that the ESENS setting is too low, may recommend increasing the ESENS setting, or may automatically increase the ESENS setting to improve cycling synchrony. - Those skilled in the art will recognize that the methods and systems of the present disclosure may be implemented in many manners and as such are not to be limited by the foregoing exemplary aspects and examples. In other words, functional elements being performed by a single or multiple components, in various combinations of hardware and software or firmware, and individual functions, can be distributed among software applications at either the client or server level or both. In this regard, any number of the features of the different aspects described herein may be combined into single or multiple aspects, and alternate aspects having fewer than or more than all of the features herein described are possible. Functionality may also be, in whole or in part, distributed among multiple components, in manners now known or to become known. Thus, myriad software/hardware/firmware combinations are possible in achieving the functions, features, interfaces and preferences described herein. Moreover, the scope of the present disclosure covers conventionally known manners for carrying out the described features and functions and interfaces, and those variations and modifications that may be made to the hardware or software firmware components described herein as would be understood by those skilled in the art now and hereafter.
- Numerous other changes may be made which will readily suggest themselves to those skilled in the art and which are encompassed in the spirit of the disclosure and as defined in the appended claims. While various aspects have been described for purposes of this disclosure, various changes and modifications may be made which are well within the scope of the disclosure. Numerous other changes may be made which will readily suggest themselves to those skilled in the art and which are encompassed in the spirit of the disclosure and as defined in the claims.
Claims (20)
1. A ventilator system comprising:
at least one sensor;
a gas-delivery system configured to deliver ventilation gases to a patient;
at least one processor; and
at least one memory comprising computer-executable instructions that when executed by the at least one processor cause the ventilator system to:
receive one or more sensor measurements from the at least one sensor during inhalation of the patient;
based on the one or more sensor measurements, estimate a physiological parameter of the patient during the inhalation of the patient;
in response to determining that the physiological parameter meets a cycling threshold, determine a patient intention to cycle from inhalation to exhalation;
evaluate one or more characteristics of the patient intention to cycle from inhalation to exhalation;
when the one or more characteristics of the patient intention to cycle from inhalation to exhalation are abnormal, determine a missed cycling effort; and
perform an action in response to the missed cycling effort.
2. The ventilator system of claim 1 , wherein ventilation is delivered to the patient based on one of: a volume support (VS) breath type, a pressure support (PS) breath type, or a tube compensated (TC) breath type.
3. The ventilator system of claim 2 , wherein the computer-executable instructions further causing the ventilator system to:
temporarily switch to a proportional assist (PA) breath type; and
while delivering the temporary PA breath type, receive the one or more sensor measurements from the at least one sensor during the inhalation of the patient.
4. The ventilator system of claim 3 , wherein the computer-executable instructions further causing the ventilator system to:
estimate a respiratory mechanics parameter based on the one or more sensor measurements received while delivering the temporary PA breath type; and
based on the estimated respiratory mechanics parameter, estimate the physiological parameter of the patient during the inhalation of the patient.
5. The ventilator system of claim 4 , wherein the estimated respiratory mechanics parameter is at least one of: a resistance or a compliance of the patient.
6. The ventilator system of claim 2 , wherein the computer-executable instructions further causing the ventilator system to:
determine a percent support setting based on one of a pressure support setting or a volume support setting.
7. The ventilator system of claim 1 , wherein the physiological parameter is an estimate of a muscle pressure (PMUS).
8. The ventilator system of claim 1 , wherein the computer-executable instructions further causing the ventilator system to determine a percent support setting based on one of a pressure support setting or a volume support setting.
9. The ventilator system of claim 8 , wherein the computer-executable instructions further causing the ventilator system to:
temporarily switch to a proportional assist (PA) breath type; and
deliver at least one breath based on the determined percent support setting.
10. The ventilator system of claim 1 , wherein the action is at least one of displaying a notification or automatically adjusting a target setting for spontaneous ventilation.
11. A ventilator system comprising:
at least one sensor;
a gas-delivery system configured to deliver ventilation gases to a patient;
at least one processor; and
at least one memory comprising computer-executable instructions that when executed by the at least one processor cause the ventilator system to:
receive one or more sensor measurements from the at least one sensor during inhalation of the patient;
based on the one or more sensor measurements, estimate a muscle pressure (PMUS) of the patient during the inhalation of the patient;
determine a PMUS-based metric based on the estimate of PMUS; and
in response to determining that the PMUS-based metric meets a cycling threshold, determine a patient intent to cycle from inhalation to exhalation.
12. The ventilator system of claim 11 , wherein the computer-executable instructions further causing the ventilator system to:
in response to determining the patient intent to cycle, compare a timing of the patient intent to cycle to a timing of exhalation delivery by the ventilator system; and
when the timing of the patient intent to cycle exceeds a timing threshold, determine a missed cycling effort.
13. The ventilator system of claim 12 , wherein the computer-executable instructions further causing the ventilator system to:
in response to the missed cycling effort, perform at least one of: displaying a notification or automatically adjusting a target setting for spontaneous ventilation.
14. The ventilator system of claim 11 , wherein the computer-executable instructions further causing the ventilator system to:
in response to determining that the PMUS-based metric meets a cycling threshold, cycle from inhalation to exhalation.
15. The ventilator system of claim 11 , wherein ventilation is delivered based on one of: a volume support (VS) breath type, a pressure support (PS) breath type, or a tube compensated (TC) breath type.
16. A method for detecting a patient intention to cycle during spontaneous ventilation of a patient on a ventilator, comprising:
receiving one or more sensor measurements from at least one sensor during inhalation of the patient;
based on the one or more sensor measurements, estimating a physiological parameter of the patient during the inhalation of the patient;
in response to determining that the physiological parameter meets a cycling threshold, determining a patient intention to cycle from inhalation to exhalation;
evaluating one or more characteristics of the patient intention to cycle from inhalation to exhalation;
when the one or more characteristics of the patient intention to cycle from inhalation to exhalation are abnormal, determining a missed cycling effort; and
perform an action in response to the missed cycling effort.
17. The method of claim 16 , wherein the action is one of displaying a notification or automatically adjusting a target setting for spontaneous ventilation.
18. The method of claim 16 , wherein the physiological parameter is an estimate of a muscle pressure (PMUS).
19. The method of claim 16 , wherein ventilation is delivered based on one of: a volume support (VS) breath type, a pressure support (PS) breath type, or a tube compensated (TC) breath type.
20. The method of claim 16 , further comprising:
temporarily switching to a proportional assist (PA) breath type; and
while delivering the temporary PA breath type, receiving the one or more sensor measurements from the at least one sensor during the inhalation of the patient.
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Family Cites Families (454)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
GB862795A (en) | 1958-06-12 | 1961-03-15 | Bodin Girin & Cie Tissus Ind | Tubular members provided with corrugated walls and method for producing same |
GB1203767A (en) | 1966-09-30 | 1970-09-03 | Siebe Gorman & Co Ltd | Improvements in or relating to closed-circuit breathing apparatus |
US3575167A (en) | 1968-06-06 | 1971-04-20 | Charles E Michielsen | Multipurpose breathing apparatus |
US4095592A (en) | 1976-12-27 | 1978-06-20 | Delphia John B | Double breath divers valve |
SE434799B (en) | 1980-06-18 | 1984-08-20 | Gambro Engstrom Ab | SET AND DEVICE FOR CONTROL OF A LUNG FAN |
JPS5948106B2 (en) | 1980-08-27 | 1984-11-24 | 株式会社東芝 | respiratory monitoring device |
US4401116A (en) | 1980-12-04 | 1983-08-30 | Bear Medical Systems, Inc. | Gas flow rate control device for medical ventilator |
US4790832A (en) | 1986-06-06 | 1988-12-13 | Icu Medical, Inc. | System for administering medication nasally to a patient |
US4721060A (en) | 1986-07-17 | 1988-01-26 | Battelle Memorial Institute | Nose-only exposure system |
US4702240A (en) | 1986-07-22 | 1987-10-27 | Bear Medical Systems, Inc. | Demand-responsive gas blending system for medical ventilator |
US4870961A (en) | 1986-09-22 | 1989-10-03 | Barnard Gordon D | Medical ventilator tube and manifold assembly |
EP0282675A3 (en) | 1986-11-04 | 1990-01-03 | Bird Products Corporation | Flow control valve for a medical ventilator |
US5322057A (en) | 1987-07-08 | 1994-06-21 | Vortran Medical Technology, Inc. | Intermittent signal actuated nebulizer synchronized to operate in the exhalation phase, and its method of use |
US5080093A (en) | 1987-07-08 | 1992-01-14 | Vortran Medical Technology, Inc. | Intermittant signal actuated nebulizer |
US5474062A (en) | 1987-11-04 | 1995-12-12 | Bird Products Corporation | Medical ventilator |
FR2624744B1 (en) | 1987-12-18 | 1993-09-17 | Inst Nat Sante Rech Med | METHOD FOR REGULATING AN ARTIFICIAL VENTILATION DEVICE AND SUCH A DEVICE |
US5117818A (en) | 1988-03-23 | 1992-06-02 | Palfy Christa Ursula | Nasal tube holder |
GB8812128D0 (en) | 1988-05-23 | 1988-06-29 | Instr & Movements Ltd | Improvements in ventilators |
US5127398A (en) | 1989-04-19 | 1992-07-07 | Cis-Lunar Development Laboratories, Inc. | Breathing apparatus mouthpiece |
US5632269A (en) | 1989-09-22 | 1997-05-27 | Respironics Inc. | Breathing gas delivery method and apparatus |
US5148802B1 (en) | 1989-09-22 | 1997-08-12 | Respironics Inc | Method and apparatus for maintaining airway patency to treat sleep apnea and other disorders |
US5239995A (en) | 1989-09-22 | 1993-08-31 | Respironics, Inc. | Sleep apnea treatment apparatus |
US5419314A (en) | 1989-11-02 | 1995-05-30 | Christopher; Kent L. | Method and apparatus for weaning ventilator-dependent patients |
DE69024972T2 (en) | 1989-12-01 | 1996-07-04 | Borody Thomas J | ORAL MEDICAL DEVICE FOR OXYGENATION |
US5165398A (en) | 1989-12-08 | 1992-11-24 | Bird F M | Ventilator and oscillator for use therewith and method |
US5074297A (en) | 1989-12-19 | 1991-12-24 | The General Hospital Corporation | Self-sealing mask for delivering intermittent positive pressure ventilation |
US5134994A (en) | 1990-02-12 | 1992-08-04 | Say Sam L | Field aspirator in a soft pack with externally mounted container |
US5596983A (en) | 1990-03-21 | 1997-01-28 | Zander; Rolf | Apparatus for oxygenating a patient |
US5086767A (en) | 1990-09-26 | 1992-02-11 | Canadian Aging & Rehabilitation Product Development Corporation | Ventilator for assisting the breathing of a patient |
ES2075875T3 (en) | 1990-12-20 | 1995-10-16 | Siemens Ag | BREATHING APPARATUS WITH PATIENT GAS FLOW DEPENDENT SENSITIVITY. |
US5320093A (en) | 1990-12-21 | 1994-06-14 | Brigham And Women's Hospital | Rapid anesthesia emergence system using closed-loop PCO2 control |
US5279549A (en) | 1991-01-04 | 1994-01-18 | Sherwood Medical Company | Closed ventilation and suction catheter system |
US5211170A (en) | 1991-04-01 | 1993-05-18 | Press Roman J | Portable emergency respirator |
GB9106960D0 (en) | 1991-04-03 | 1991-05-22 | Bnos Electronics Ltd | Breathing apparatus |
US5542415A (en) | 1991-05-07 | 1996-08-06 | Infrasonics, Inc. | Apparatus and process for controlling the ventilation of the lungs of a patient |
US5235973A (en) | 1991-05-15 | 1993-08-17 | Gary Levinson | Tracheal tube cuff inflation control and monitoring system |
DE69130979T2 (en) | 1991-06-12 | 2000-05-04 | Tradotec Sa | Ergometric device |
US6085747A (en) | 1991-06-14 | 2000-07-11 | Respironics, Inc. | Method and apparatus for controlling sleep disorder breathing |
EP0520082A1 (en) | 1991-06-28 | 1992-12-30 | Siemens-Elema AB | Ventilator in which the inspiratory flow rate is controlled by the expiratory flow rate |
DE4122069A1 (en) | 1991-07-04 | 1993-01-07 | Draegerwerk Ag | METHOD FOR DETECTING A PATIENT'S BREATHING PHASES IN ASSISTANT VENTILATION METHODS |
JP2582010B2 (en) | 1991-07-05 | 1997-02-19 | 芳嗣 山田 | Monitoring device for respiratory muscle activity |
US5303698A (en) | 1991-08-27 | 1994-04-19 | The Boc Group, Inc. | Medical ventilator |
US5174284A (en) | 1991-09-05 | 1992-12-29 | G.I. Supply, Inc. | Endoscopic bite block |
US7013892B2 (en) | 1991-11-01 | 2006-03-21 | Ric Investments, Llc | Sleep apnea treatment apparatus |
US5687713A (en) | 1991-11-29 | 1997-11-18 | Bahr; Erik W. | Breathing mask |
US5195512A (en) | 1991-12-31 | 1993-03-23 | Sunny Rosso | Apparatus for evacuating excess gases from surgery patient's face |
US5395301A (en) | 1992-03-30 | 1995-03-07 | Russek; Linda G. | Kinesthetic system for promoting rhythmic breathing by tactile stimulation |
US5307794A (en) | 1992-04-01 | 1994-05-03 | Sensormedics Corporation | Oscillating ventilator apparatus and method and patient isolation apparatus |
US5385142A (en) | 1992-04-17 | 1995-01-31 | Infrasonics, Inc. | Apnea-responsive ventilator system and method |
US5490502A (en) | 1992-05-07 | 1996-02-13 | New York University | Method and apparatus for optimizing the continuous positive airway pressure for treating obstructive sleep apnea |
EP0570612B1 (en) | 1992-05-21 | 1997-08-13 | Siemens-Elema AB | Method and device for controlling and monitoring the flow of a small quantity of gas |
US5259374A (en) | 1992-06-12 | 1993-11-09 | Miller Russell L | Diver adjustable control for underwater breathing apparatus |
DE4221931C1 (en) | 1992-07-03 | 1993-07-08 | Harald Dr. 8521 Moehrendorf De Mang | |
EP0661947B1 (en) | 1992-08-19 | 2002-05-22 | Lawrence A. Lynn | Apparatus for the diagnosis of sleep apnea |
GB2270293A (en) | 1992-09-05 | 1994-03-09 | Medix Ltd | Drug dispensing system |
US5335650A (en) | 1992-10-13 | 1994-08-09 | Temple University - Of The Commonwealth System Of Higher Education | Process control for liquid ventilation and related procedures |
FI95873C (en) | 1992-10-15 | 1996-04-10 | Orion Yhtymae Oy | Valve for use with an inhaler |
US5318017A (en) | 1992-11-05 | 1994-06-07 | Ellison Lee H | Guide for transesophageal echo probe |
CA2109017A1 (en) | 1992-12-16 | 1994-06-17 | Donald M. Smith | Method and apparatus for the intermittent delivery of oxygen therapy to a person |
JPH06191481A (en) | 1992-12-22 | 1994-07-12 | Zexel Corp | Mouth piece for semi-closed type breather |
US5435305A (en) | 1993-05-24 | 1995-07-25 | Rankin, Sr.; Pleasant P. | Emergency air supply pack |
EP0645119A3 (en) | 1993-09-27 | 1998-04-15 | Ohmeda Inc. | Disabling apnoea volume software |
US5398676A (en) | 1993-09-30 | 1995-03-21 | Press; Roman J. | Portable emergency respirator |
GB2282542B (en) | 1993-10-06 | 1997-06-25 | Instruments & Movements Ltd | Ventilators for promoting lung function |
US6604523B2 (en) | 1993-11-09 | 2003-08-12 | Cprx Llc | Apparatus and methods for enhancing cardiopulmonary blood flow and ventilation |
BR9304638A (en) | 1993-12-06 | 1995-07-25 | Intermed Equipamento Medico Ho | Respiratory cycle control system |
US5429123A (en) | 1993-12-15 | 1995-07-04 | Temple University - Of The Commonwealth System Of Higher Education | Process control and apparatus for ventilation procedures with helium and oxygen mixtures |
ES2131778T3 (en) | 1994-01-12 | 1999-08-01 | Saime Sarl | APPARATUS TO HELP VENTILATION OF A PATIENT WHO SPECIALLY UNDERSTANDS A METHOD OF INSPIRATORY ASSISTANCE WITH REDUCED PRESSURE. |
WO1995033184A1 (en) | 1994-05-26 | 1995-12-07 | Astra Aktiebolag | Measurement system and method |
US6105575A (en) | 1994-06-03 | 2000-08-22 | Respironics, Inc. | Method and apparatus for providing positive airway pressure to a patient |
US6932084B2 (en) | 1994-06-03 | 2005-08-23 | Ric Investments, Inc. | Method and apparatus for providing positive airway pressure to a patient |
US5906203A (en) | 1994-08-01 | 1999-05-25 | Safety Equipment Sweden Ab | Breathing apparatus |
DE4432219C1 (en) | 1994-09-10 | 1996-04-11 | Draegerwerk Ag | Automatic breathing system for patients |
EP1491227B1 (en) | 1994-10-14 | 2008-09-10 | Bird Products Corporation | Portable rotary compressor powered mechnical ventilator |
US5642726A (en) | 1994-10-18 | 1997-07-01 | Alcove Medical, Inc. | Reduced internal volume neonatal suction adaptor |
US5540220A (en) | 1994-12-08 | 1996-07-30 | Bear Medical Systems, Inc. | Pressure-limited, time-cycled pulmonary ventilation with volume-cycle override |
US5590651A (en) | 1995-01-17 | 1997-01-07 | Temple University - Of The Commonwealth System Of Higher Education | Breathable liquid elimination analysis |
US5598838A (en) | 1995-04-07 | 1997-02-04 | Healthdyne Technologies, Inc. | Pressure support ventilatory assist system |
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 |
SE506208C2 (en) | 1995-07-05 | 1997-11-24 | Aerocrine Systems Kb | Device for collecting gas from the upper respiratory tract and delivering this gas to the inhalation air in a respirator |
US5513631A (en) | 1995-07-21 | 1996-05-07 | Infrasonics, Inc. | Triggering of patient ventilator responsive to a precursor signal |
US6000396A (en) | 1995-08-17 | 1999-12-14 | University Of Florida | Hybrid microprocessor controlled ventilator unit |
DE69618133T2 (en) | 1995-10-13 | 2002-07-11 | Siemens Elema Ab | Tracheal tube and device for ventilation systems |
US6135105A (en) | 1995-10-20 | 2000-10-24 | University Of Florida | Lung classification scheme, a method of lung class identification and inspiratory waveform shapes |
AUPN616795A0 (en) | 1995-10-23 | 1995-11-16 | Rescare Limited | Ipap duration in bilevel cpap or assisted respiration treatment |
US5655519A (en) | 1995-11-14 | 1997-08-12 | Alfery; David D. | Patient airway bite block |
SE9504120D0 (en) | 1995-11-16 | 1995-11-16 | Siemens Elema Ab | Ventilator for respiratory treatment |
SE504285C2 (en) | 1995-12-01 | 1996-12-23 | Siemens Elema Ab | When controlling a breathing apparatus and a breathing apparatus |
US6463930B2 (en) | 1995-12-08 | 2002-10-15 | James W. Biondi | System for automatically weaning a patient from a ventilator, and method thereof |
US6158432A (en) | 1995-12-08 | 2000-12-12 | Cardiopulmonary Corporation | Ventilator control system and method |
US5931160A (en) | 1995-12-08 | 1999-08-03 | Cardiopulmonary Corporation | Ventilator control system and method |
US6148814A (en) | 1996-02-08 | 2000-11-21 | Ihc Health Services, Inc | Method and system for patient monitoring and respiratory assistance control through mechanical ventilation by the use of deterministic protocols |
US5740797A (en) | 1996-02-23 | 1998-04-21 | University Of Massachusetts | Cardiac synchronized ventilation |
US6860264B2 (en) | 1996-02-26 | 2005-03-01 | Evergreen Medical Incorporated | Method and apparatus for endotracheal intubation using a light wand and curved guide |
DE59700422D1 (en) | 1996-03-08 | 1999-10-14 | Medisize Bv | DEVICE AND METHOD FOR MONITORING THE BREATHING VALUES OF A VENTILATION SYSTEM |
US5669379A (en) | 1996-03-29 | 1997-09-23 | Ohmeda Inc. | Waveform display for medical ventilator |
US5735267A (en) | 1996-03-29 | 1998-04-07 | Ohmeda Inc. | Adaptive control system for a medical ventilator |
US5692497A (en) | 1996-05-16 | 1997-12-02 | Children's Medical Center Corporation | Microprocessor-controlled ventilator system and methods |
SE9602199D0 (en) | 1996-06-03 | 1996-06-03 | Siemens Ag | ventilator |
US5944680A (en) | 1996-06-26 | 1999-08-31 | Medtronic, Inc. | Respiratory effort detection method and apparatus |
SE9602913D0 (en) | 1996-08-02 | 1996-08-02 | Siemens Elema Ab | Fan system and method of operating a fan system |
US6689091B2 (en) | 1996-08-02 | 2004-02-10 | Tuan Bui | Medical apparatus with remote control |
AUPO163896A0 (en) | 1996-08-14 | 1996-09-05 | Resmed Limited | Determination of respiratory airflow |
DE19654910C2 (en) | 1996-09-10 | 2003-03-27 | Fred Goebel Patentverwaltung G | feeding tube |
AUPO247496A0 (en) | 1996-09-23 | 1996-10-17 | Resmed Limited | Assisted ventilation to match patient respiratory need |
US5813401A (en) | 1996-10-15 | 1998-09-29 | Radcliff; Janet H. | Nebulizer automatic control valve |
SE9603841D0 (en) | 1996-10-18 | 1996-10-18 | Pacesetter Ab | A tissue stimulating apparatus |
US5806512A (en) | 1996-10-24 | 1998-09-15 | Life Support Technologies, Inc. | Cardiac/pulmonary resuscitation method and apparatus |
AUPO322396A0 (en) | 1996-10-25 | 1996-11-21 | Robinson, Gavin J.B. Dr | A method of measuring cardiac output by pulmonary exchange of oxygen and an inert gas with the blood utilising a divided airway |
SE507617C2 (en) | 1996-12-20 | 1998-06-29 | Siemens Elema Ab | Device intended for use in a fluid treatment respiratory care system |
JP2001517108A (en) | 1997-01-17 | 2001-10-02 | メッサー オーストリア ゲゼルシャフト ミット ベシュレンクテル ハフツング | Controlled gas supply system |
DE69839008D1 (en) | 1997-03-17 | 2008-03-06 | Vivometrics Inc | F INFLUENCE ON NEUROMUSCULAR BREATHING |
US6131571A (en) | 1997-04-30 | 2000-10-17 | University Of Florida | Ventilation apparatus and anesthesia delivery system |
EP0983019A4 (en) | 1997-05-16 | 2000-08-16 | Resmed Ltd | Respiratory-analysis systems |
SE513969C2 (en) | 1997-05-17 | 2000-12-04 | Draegerwerk Ag | Apparatus and method for determining the mechanical properties of the respiratory system |
US6371114B1 (en) | 1998-07-24 | 2002-04-16 | Minnesota Innovative Technologies & Instruments Corporation | Control device for supplying supplemental respiratory oxygen |
US5881725A (en) | 1997-08-19 | 1999-03-16 | Victor Equipment Company | Pneumatic oxygen conserver |
US6068602A (en) | 1997-09-26 | 2000-05-30 | Ohmeda Inc. | Method and apparatus for determining airway resistance and lung compliance |
US5810000A (en) | 1997-12-22 | 1998-09-22 | Stevens; Erin | Endotracheal tube pacifier |
US5996580A (en) | 1998-01-06 | 1999-12-07 | Brookdale International Systems, Inc. | Personal emergency breathing system with locator for supplied air respirators and shock resistant filter mounting |
US6109260A (en) | 1998-02-18 | 2000-08-29 | Datex-Ohmeda, Inc. | Nitric oxide administration device with timed pulse |
US6588423B1 (en) | 1998-02-27 | 2003-07-08 | Universite De Montreal | Method and device responsive to myoelectrical activity for triggering ventilatory support |
US6269810B1 (en) | 1998-03-05 | 2001-08-07 | Battelle Memorial Institute | Pulmonary dosing system and method |
US6196222B1 (en) | 1998-03-10 | 2001-03-06 | Instrumentarium Corporation | Tracheal gas insufflation delivery system for respiration equipment |
SE9800855D0 (en) | 1998-03-16 | 1998-03-16 | Siemens Elema Ab | Apparatus for improving gas distribution |
SE9801175D0 (en) | 1998-04-03 | 1998-04-03 | Innotek Ab | Method and apparatus for optimizing mechanical ventilation based on simulation of the ventilation process after studying the physiology of the respiratory organs |
US6095140A (en) | 1998-04-09 | 2000-08-01 | Massachusetts Institute Of Technology | Ventilator triggering device |
US6131572A (en) | 1998-05-20 | 2000-10-17 | Instrumentarium Oy | Medical dosing device having dosing chamber with a pressure sensor |
AUPP366398A0 (en) | 1998-05-22 | 1998-06-18 | Resmed Limited | Ventilatory assistance for treatment of cardiac failure and cheyne-stokes breathing |
AUPP370198A0 (en) | 1998-05-25 | 1998-06-18 | Resmed Limited | Control of the administration of continuous positive airway pressure treatment |
SE9802121D0 (en) | 1998-06-15 | 1998-06-15 | Siemens Elema Ab | Method for controlling an expiratory valve in a fan |
US6260549B1 (en) | 1998-06-18 | 2001-07-17 | Clavius Devices, Inc. | Breath-activated metered-dose inhaler |
SE9802335D0 (en) | 1998-06-30 | 1998-06-30 | Siemens Elema Ab | Breathing Help System |
SE9802568D0 (en) | 1998-07-17 | 1998-07-17 | Siemens Elema Ab | Anaesthetic delivery system |
US6631716B1 (en) | 1998-07-17 | 2003-10-14 | The Board Of Trustees Of The Leland Stanford Junior University | Dynamic respiratory control |
WO2000010633A1 (en) | 1998-08-19 | 2000-03-02 | MAP Medizintechnik für Arzt und Patient GmbH & Co. KG | Method and device for switching the inspiration or expiration phase during cpap therapy |
US6257234B1 (en) | 1998-08-21 | 2001-07-10 | Respironics, Inc. | Apparatus and method for determining respiratory mechanics of a patient and for controlling a ventilator based thereon |
SE9802827D0 (en) | 1998-08-25 | 1998-08-25 | Siemens Elema Ab | ventilator |
US6155257A (en) | 1998-10-07 | 2000-12-05 | Cprx Llc | Cardiopulmonary resuscitation ventilator and methods |
US6343603B1 (en) | 1998-10-09 | 2002-02-05 | Fisher & Paykel Limited | Connector |
AU6418399A (en) | 1998-10-09 | 2000-05-01 | Brigham And Women's Hospital | Method and apparatus for delivering a measured amount of a gas |
SE9803508D0 (en) | 1998-10-14 | 1998-10-14 | Siemens Elema Ab | Assisted Breathing System |
US6575164B1 (en) | 1998-10-15 | 2003-06-10 | Ntc Technology, Inc. | Reliability-enhanced apparatus operation for re-breathing and methods of effecting same |
US6152135A (en) | 1998-10-23 | 2000-11-28 | Pulmonetic Systems, Inc. | Ventilator system |
US6230708B1 (en) | 1998-10-30 | 2001-05-15 | Sechrist Industries, Inc. | Ventilator triggering device |
US6158433A (en) | 1998-11-06 | 2000-12-12 | Sechrist Industries, Inc. | Software for finite state machine driven positive pressure ventilator control system |
US6279574B1 (en) | 1998-12-04 | 2001-08-28 | Bunnell, Incorporated | Variable flow and pressure ventilation system |
AU764874B2 (en) | 1999-01-15 | 2003-09-04 | ResMed Pty Ltd | Method and apparatus to counterbalance intrinsic positive end expiratory pressure |
US6390091B1 (en) | 1999-02-03 | 2002-05-21 | University Of Florida | Method and apparatus for controlling a medical ventilator |
GB2362108A (en) | 1999-02-03 | 2001-11-14 | Univ Florida | Method and apparatus for nullifying the imposed work of breathing |
US6467477B1 (en) | 1999-03-26 | 2002-10-22 | Respironics, Inc. | Breath-based control of a therapeutic treatment |
AUPP996499A0 (en) | 1999-04-23 | 1999-05-20 | Australian Centre For Advanced Medical Technology Ltd | A treatment for hypertension caused by pre-eclampsia |
US6748275B2 (en) | 1999-05-05 | 2004-06-08 | Respironics, Inc. | Vestibular stimulation system and method |
AUPQ019899A0 (en) | 1999-05-06 | 1999-06-03 | Resmed Limited | Control of supplied pressure in assisted ventilation |
US6920875B1 (en) | 1999-06-15 | 2005-07-26 | Respironics, Inc. | Average volume ventilation |
CA2377559A1 (en) | 1999-06-18 | 2000-12-28 | Powerlung,Inc | Pulmonary exercise device |
US20070000494A1 (en) | 1999-06-30 | 2007-01-04 | Banner Michael J | Ventilator monitor system and method of using same |
ATE483490T1 (en) | 1999-06-30 | 2010-10-15 | Univ Florida | MONITORING SYSTEM FOR FAN |
SE9902709D0 (en) | 1999-07-15 | 1999-07-15 | Siemens Elema Ab | Method for controlling an expiratory valve in a fan |
SE9903192D0 (en) | 1999-09-09 | 1999-09-09 | Siemens Elema Ab | Procedure for determination of gas content |
US6910480B1 (en) | 1999-09-15 | 2005-06-28 | Resmed Ltd. | Patient-ventilator synchronization using dual phase sensors |
DE60043362D1 (en) | 1999-09-15 | 2009-12-31 | Resmed Ltd | Synchronization of a ventilation device by means of double-phase sensors |
US6758216B1 (en) | 1999-09-15 | 2004-07-06 | Resmed Limited | Ventilatory assistance using an external effort sensor |
SE9903467D0 (en) | 1999-09-24 | 1999-09-24 | Siemens Elema Ab | Feedback control of mechanical breathing aid gas flow |
US6631717B1 (en) | 1999-10-21 | 2003-10-14 | Ntc Technology Inc. | Re-breathing apparatus for non-invasive cardiac output, method of operation, and ventilator circuit so equipped |
US7225809B1 (en) | 1999-11-01 | 2007-06-05 | Ric Investments, Llc | Method and apparatus for monitoring and controlling a medical device |
US6581599B1 (en) | 1999-11-24 | 2003-06-24 | Sensormedics Corporation | Method and apparatus for delivery of inhaled nitric oxide to spontaneous-breathing and mechanically-ventilated patients |
SE9904382D0 (en) | 1999-12-02 | 1999-12-02 | Siemens Elema Ab | High Frequency Oscillation Patient Fan System |
DE19960404A1 (en) | 1999-12-15 | 2001-07-05 | Messer Austria Gmbh Gumpoldski | Expiration-dependent gas metering |
SE9904643D0 (en) | 1999-12-17 | 1999-12-17 | Siemens Elema Ab | Method for assessing pulmonary stress and a breathing apparatus |
DE19961253C1 (en) | 1999-12-18 | 2001-01-18 | Draeger Medizintech Gmbh | Respiration apparatus has respiration pressure and respiration gas flow measured values used as setting parameters for new respiration pattern upon switching respiration pattern |
DE19961206A1 (en) | 1999-12-18 | 2001-07-05 | Messer Austria Gmbh Gumpoldski | Tidal volume-dependent gas dosing |
US6523538B1 (en) | 2000-01-05 | 2003-02-25 | Instrumentarium Corp. | Breathing circuit having improved water vapor removal |
DE20000379U1 (en) | 2000-01-11 | 2000-03-23 | Stumpf Willi | Probe |
US20020195105A1 (en) | 2000-01-13 | 2002-12-26 | Brent Blue | Method and apparatus for providing and controlling oxygen supply |
US6412482B1 (en) | 2000-01-24 | 2002-07-02 | Carl D. Rowe | Avalanche survival pack assembly |
SE0000205D0 (en) | 2000-01-25 | 2000-01-25 | Siemens Elema Ab | ventilator |
SE0000206D0 (en) | 2000-01-25 | 2000-01-25 | Siemens Elema Ab | High frequency oscillator fan |
US6553992B1 (en) | 2000-03-03 | 2003-04-29 | Resmed Ltd. | Adjustment of ventilator pressure-time profile to balance comfort and effectiveness |
US6532956B2 (en) | 2000-03-30 | 2003-03-18 | Respironics, Inc. | Parameter variation for proportional assist ventilation or proportional positive airway pressure support devices |
JP3713240B2 (en) | 2000-04-26 | 2005-11-09 | ユニヴァーシティ オブ マニトーバ | Device for determining the resistance of the respiratory system during ventilation support |
US6589188B1 (en) | 2000-05-05 | 2003-07-08 | Pacesetter, Inc. | Method for monitoring heart failure via respiratory patterns |
US6494201B1 (en) | 2000-05-11 | 2002-12-17 | Ralph Welik | Portable oxygen dispenser |
US20020023640A1 (en) | 2000-05-12 | 2002-02-28 | Chris Nightengale | Respiratory apparatus including liquid ventilator |
US6355002B1 (en) | 2000-05-22 | 2002-03-12 | Comedica Technologies Incorporated | Lung inflection point monitor apparatus and method |
US20030034031A1 (en) | 2000-05-22 | 2003-02-20 | Sleep Up Ltd. | Pacifier and method of use thereof |
WO2001095786A2 (en) | 2000-06-16 | 2001-12-20 | Rajiv Doshi | Methods and devices for improving breathing in patients with pulmonary disease |
SE0002449D0 (en) | 2000-06-29 | 2000-06-29 | Siemens Elema Ab | Method and arrangement for evaluating effective flow resistance of a patient breathing circuit |
DE10031079A1 (en) | 2000-06-30 | 2002-02-07 | Map Gmbh | Measuring patient breathing and state, correlates present respiration signals with prior reference measurements, to adjust CPAP therapy pressure accordingly |
FR2811577B1 (en) | 2000-07-11 | 2003-05-23 | Taema | INSTALLATION FOR GAS VENTILATION OF A PATIENT |
SE0002849D0 (en) | 2000-08-08 | 2000-08-08 | Siemens Elema Ab | ventilator |
US6439229B1 (en) | 2000-08-08 | 2002-08-27 | Newport Medical Instruments, Inc. | Pressure support ventilation control system and method |
US7051736B2 (en) | 2000-08-17 | 2006-05-30 | University Of Florida | Endotracheal tube pressure monitoring system and method of controlling same |
US6516800B1 (en) | 2000-08-25 | 2003-02-11 | O-Two Systems International Inc. | Neonatal patient ventilator circuit |
US6814073B2 (en) | 2000-08-29 | 2004-11-09 | Resmed Limited | Respiratory apparatus with improved flow-flattening detection |
US6408847B1 (en) | 2000-08-29 | 2002-06-25 | Marshall L. Nuckols | Rebreather system that supplies fresh make-up gas according to a user's respiratory minute volume |
US6557553B1 (en) | 2000-09-05 | 2003-05-06 | Mallinckrodt, Inc. | Adaptive inverse control of pressure based ventilation |
GB0022285D0 (en) | 2000-09-09 | 2000-10-25 | Viamed Ltd | Breathing aid device |
US6752151B2 (en) | 2000-09-25 | 2004-06-22 | Respironics, Inc. | Method and apparatus for providing variable positive airway pressure |
EP1322367A4 (en) | 2000-09-28 | 2009-08-26 | Invacare Corp | Carbon dioxide-based bi-level cpap control |
US6644310B1 (en) | 2000-09-29 | 2003-11-11 | Mallinckrodt Inc. | Apparatus and method for providing a breathing gas employing a bi-level flow generator with an AC synchronous motor |
US6626175B2 (en) | 2000-10-06 | 2003-09-30 | Respironics, Inc. | Medical ventilator triggering and cycling method and mechanism |
US6622726B1 (en) | 2000-10-17 | 2003-09-23 | Newport Medical Instruments, Inc. | Breathing apparatus and method |
SE0004141D0 (en) | 2000-11-13 | 2000-11-13 | Siemens Elema Ab | Method of adaptive triggering of breathing devices and a breathing device |
AU2036902A (en) | 2000-12-11 | 2002-06-24 | Resmed Ltd | Methods and apparatus for stroke patient treatment |
US6539938B2 (en) | 2000-12-15 | 2003-04-01 | Dhd Healthcare Corporation | Maximum expiratory pressure device |
SE0100064D0 (en) | 2001-01-10 | 2001-01-10 | Siemens Elema Ab | Anaesthetic filter arrangement |
DE10103810A1 (en) | 2001-01-29 | 2002-08-01 | Map Gmbh | Device for supplying a breathing gas |
DE10103973A1 (en) | 2001-01-30 | 2002-08-01 | Peter L Kowallik | Method and device for monitoring sleep |
EP1228779A1 (en) | 2001-02-01 | 2002-08-07 | Instrumentarium Corporation | Method and apparatus for determining a zero gas flow state in a bidirectional gas flow conduit |
US6571796B2 (en) | 2001-02-08 | 2003-06-03 | University Of Florida | Tracheal pressure ventilation respiratory system |
SE522948C2 (en) | 2001-03-14 | 2004-03-16 | Bjoern Flodin | Device for a respirator |
US7001340B2 (en) | 2001-03-16 | 2006-02-21 | Chung-Yuan Lin | Assessment of concentration of inhalational compounds in the brain |
US6579511B2 (en) | 2001-03-16 | 2003-06-17 | Chung-Yuan Lin | Assessment of concentration of inhalational compounds in the brain |
US7135001B2 (en) | 2001-03-20 | 2006-11-14 | Ric Investments, Llc | Rebreathing methods including oscillating, substantially equal rebreathing and nonrebreathing periods |
US7040321B2 (en) | 2001-03-30 | 2006-05-09 | Microcuff Gmbh | Method for controlling a ventilator, and system therefor |
US6860858B2 (en) | 2001-05-23 | 2005-03-01 | Resmed Limited | Ventilator patient synchronization |
CA2351217C (en) | 2001-06-19 | 2008-12-02 | Teijin Limited | An apparatus for supplying a therapeutic oxygen gas |
US7246618B2 (en) | 2001-06-21 | 2007-07-24 | Nader Maher Habashi | Ventilation method and control of a ventilator based on same |
WO2003008027A1 (en) | 2001-07-19 | 2003-01-30 | Resmed Ltd. | Pressure support ventilation of patients |
US6834647B2 (en) | 2001-08-07 | 2004-12-28 | Datex-Ohmeda, Inc. | Remote control and tactile feedback system for medical apparatus |
WO2003024514A1 (en) | 2001-09-19 | 2003-03-27 | Advent Pharmaceuticals Pty Ltd | An inhaler |
SE0103182D0 (en) | 2001-09-25 | 2001-09-25 | Siemens Elema Ab | Procedure for lung mechanical examination and respiratory system |
US7168429B2 (en) | 2001-10-12 | 2007-01-30 | Ric Investments, Llc | Auto-titration pressure support system and method of using same |
US7938114B2 (en) | 2001-10-12 | 2011-05-10 | Ric Investments Llc | Auto-titration bi-level pressure support system and method of using same |
FR2831824B1 (en) | 2001-11-06 | 2004-01-23 | Georges Boussignac | DEVICE FOR RESPIRATORY ASSISTANCE |
US20030125662A1 (en) | 2002-01-03 | 2003-07-03 | Tuan Bui | Method and apparatus for providing medical treatment therapy based on calculated demand |
WO2003059425A1 (en) | 2002-01-09 | 2003-07-24 | The Brigham And Women's Hospital, Inc. | Method for altering the body temperature of a patient using a nebulized mist |
US7086098B2 (en) | 2002-03-05 | 2006-08-08 | Maquet Critical Care Ab | Mechanical breathing aid with adaptive expiration control |
CA2379353C (en) | 2002-03-28 | 2012-07-31 | Joseph Fisher | A new method for continuous measurement of flux of gases in the lungs during breathing |
US6752772B2 (en) | 2002-04-03 | 2004-06-22 | Rocky Kahn | Manipulation device with dynamic intensity control |
DE10217762C1 (en) | 2002-04-20 | 2003-04-10 | Draeger Medical Ag | Respiration gas supply control method for artificial respirator compares actual respiration path pressure with intial respiration path pressure for regulation of respiration gas supply parameter |
WO2004002561A2 (en) | 2002-06-27 | 2004-01-08 | Yrt Limited | Method and device for monitoring and improving patient-ventilator interaction |
DE10230165A1 (en) | 2002-07-04 | 2004-01-15 | Ino Therapeutics Gmbh | Method and device for the administration of carbon monoxide |
US7721736B2 (en) | 2002-08-26 | 2010-05-25 | Automedx, Inc. | Self-contained micromechanical ventilator |
US7080646B2 (en) | 2002-08-26 | 2006-07-25 | Sekos, Inc. | Self-contained micromechanical ventilator |
US7891353B2 (en) | 2002-08-29 | 2011-02-22 | Resmed Paris | Breathing assistance device with several secure respirator modes and associated method |
WO2004019766A2 (en) | 2002-08-30 | 2004-03-11 | University Of Florida | Method and apparatus for predicting work of breathing |
US8672858B2 (en) | 2002-08-30 | 2014-03-18 | University Of Florida Research Foundation, Inc. | Method and apparatus for predicting work of breathing |
US20060201507A1 (en) | 2002-10-11 | 2006-09-14 | The Regents Of The University Of California | Stand-alone circle circuit with co2 absorption and sensitive spirometry for measurement of pulmonary uptake |
DE10248590B4 (en) | 2002-10-17 | 2016-10-27 | Resmed R&D Germany Gmbh | Method and device for carrying out a signal-processing observation of a measurement signal associated with the respiratory activity of a person |
GB0227109D0 (en) | 2002-11-20 | 2002-12-24 | Air Prod & Chem | Volume flow controller |
CA2506677A1 (en) | 2002-11-26 | 2004-06-10 | Vasogen Ireland Limited | Medical treatment control system |
GB2396426B (en) | 2002-12-21 | 2005-08-24 | Draeger Medical Ag | Artificial respiration system |
JP5183924B2 (en) | 2003-01-30 | 2013-04-17 | コンピュメディクス・リミテッド | Algorithm for automatic positive air pressure titration |
WO2004077085A2 (en) | 2003-02-26 | 2004-09-10 | Medi-Physics Inc. | Mri/nmr compatible hyperpolarized gas delivery valves for ventilators and associated gas delivery methods |
JP4602643B2 (en) | 2003-02-28 | 2010-12-22 | 帝人株式会社 | Respiratory gas supply device |
AU2003901042A0 (en) | 2003-03-07 | 2003-03-20 | Resmed Limited | Back-up rate for a ventilator |
US7819815B2 (en) | 2003-03-14 | 2010-10-26 | Yrt Limited | Synchrony between end of ventilator cycles and end of patient efforts during assisted ventilation |
US20040187864A1 (en) | 2003-03-24 | 2004-09-30 | Cindet, Llc | Inhalation device and method |
AU2004224573B2 (en) | 2003-03-24 | 2010-07-08 | Resmed Paris | Breathing assistance apparatus |
FR2852854B1 (en) | 2003-03-26 | 2005-10-07 | Taema | PORTABLE EMERGENCY VENTILATION ASSEMBLY |
US7694682B2 (en) | 2003-04-11 | 2010-04-13 | Ambu A/S | Laryngeal mask and a method manufacturing same |
US7275540B2 (en) | 2003-04-22 | 2007-10-02 | Medi-Physics, Inc. | MRI/NMR-compatible, tidal volume control and measurement systems, methods, and devices for respiratory and hyperpolarized gas delivery |
US8082921B2 (en) | 2003-04-25 | 2011-12-27 | Anthony David Wondka | Methods, systems and devices for desufflating a lung area |
US6874502B1 (en) | 2003-05-02 | 2005-04-05 | Ramses Nashed | Breathing circuit disconnect warning system and method for using a disconnect system |
US7226427B2 (en) | 2003-05-12 | 2007-06-05 | Jolife Ab | Systems and procedures for treating cardiac arrest |
EP1477199A1 (en) | 2003-05-15 | 2004-11-17 | Azienda Ospedaliera Pisana | Apparatus for non-invasive mechanical ventilation |
US7588033B2 (en) | 2003-06-18 | 2009-09-15 | Breathe Technologies, Inc. | Methods, systems and devices for improving ventilation in a lung area |
US7559326B2 (en) | 2003-06-18 | 2009-07-14 | Resmed Limited | Vent and/or diverter assembly for use in breathing apparatus |
US8020555B2 (en) | 2003-06-18 | 2011-09-20 | New York University | System and method for improved treatment of sleeping disorders using therapeutic positive airway pressure |
DE10337138A1 (en) | 2003-08-11 | 2005-03-17 | Freitag, Lutz, Dr. | Method and arrangement for the respiratory assistance of a patient as well as tracheal prosthesis and catheter |
AU2003903138A0 (en) | 2003-06-20 | 2003-07-03 | Resmed Limited | Method and apparatus for improving the comfort of cpap |
US7152598B2 (en) | 2003-06-23 | 2006-12-26 | Invacare Corporation | System and method for providing a breathing gas |
ITFI20030071U1 (en) | 2003-07-25 | 2005-01-26 | Cressi Sub Spa | CLOSING DEVICE FOR A SECONDARY VALVE FOR A LOOPER |
FR2858236B1 (en) | 2003-07-29 | 2006-04-28 | Airox | DEVICE AND METHOD FOR SUPPLYING RESPIRATORY GAS IN PRESSURE OR VOLUME |
US20050027252A1 (en) | 2003-07-31 | 2005-02-03 | Alexander Boukas | Fluid removal apparatus for patient treatment |
AU2003904278A0 (en) | 2003-08-13 | 2003-08-28 | Thomas J. Borody | Improved oral oxygenating device |
GB2404866B (en) | 2003-08-15 | 2008-02-27 | Shahar Hayek | Respiratory apparatus |
US7967756B2 (en) | 2003-09-18 | 2011-06-28 | Cardiac Pacemakers, Inc. | Respiratory therapy control based on cardiac cycle |
US7572225B2 (en) | 2003-09-18 | 2009-08-11 | Cardiac Pacemakers, Inc. | Sleep logbook |
US7678061B2 (en) | 2003-09-18 | 2010-03-16 | Cardiac Pacemakers, Inc. | System and method for characterizing patient respiration |
EP1662996B1 (en) | 2003-09-03 | 2014-11-19 | ResMed R&D Germany GmbH | Detection appliance and method for observing sleep-related breathing disorders |
US6860265B1 (en) | 2003-09-08 | 2005-03-01 | J.H. Emerson Company | Insufflation-exsufflation system for removal of broncho-pulmonary secretions with automatic triggering of inhalation phase |
US8011367B2 (en) | 2003-09-11 | 2011-09-06 | Advanced Circulatory Systems, Inc. | CPR devices and methods utilizing a continuous supply of respiratory gases |
US7549421B2 (en) | 2003-09-17 | 2009-06-23 | Datex-Ohmeda Inc. | Method and system for integrating ventilator and medical device activities |
US7191780B2 (en) | 2003-09-22 | 2007-03-20 | Comedica Incorporated | Continuous high-frequency oscillation breathing treatment apparatus |
US7909034B2 (en) | 2003-10-23 | 2011-03-22 | Maquet Critical Care Ab | Combined positive and negative pressure assist ventilation |
US20050098179A1 (en) | 2003-11-06 | 2005-05-12 | Steve Burton | Multi-level positive air pressure method and delivery apparatus |
US8464709B2 (en) | 2003-11-17 | 2013-06-18 | Lowell R. Wedemeyer | Cheek path airway and cheek pouch anchor |
US7802571B2 (en) | 2003-11-21 | 2010-09-28 | Tehrani Fleur T | Method and apparatus for controlling a ventilator |
WO2005051469A1 (en) | 2003-11-26 | 2005-06-09 | Resmed Limited | Methods and apparatus for the systemic control of ventilatory support in the presence of respiratory insufficiency |
TWM262202U (en) | 2003-12-12 | 2005-04-21 | Shang-Lung Huang | Emergency auxiliary breather pipe for use during fire |
GB0329297D0 (en) | 2003-12-18 | 2004-01-21 | Smiths Group Plc | Gas-treatment devices |
EP2417993B1 (en) | 2004-01-07 | 2021-05-19 | ResMed Pty Ltd | Apparatus for providing expiratory pressure relief in positive airway pressure therapy |
BRPI0509991A (en) | 2004-04-20 | 2007-10-16 | Aerogen Inc | aerosol delivery apparatus, methods and compositions for pressure-assisted breathing systems |
US20050263152A1 (en) | 2004-05-26 | 2005-12-01 | Walter Fong | Method for treating sleep apnea and snoring |
EP1776152A2 (en) | 2004-06-04 | 2007-04-25 | Inogen, Inc. | Systems and methods for delivering therapeutic gas to patients |
US8826906B2 (en) | 2004-06-23 | 2014-09-09 | Resmed Limited | Methods and apparatus with improved ventilatory support cycling |
US20050284469A1 (en) | 2004-06-25 | 2005-12-29 | Tobia Ronald L | Integrated control of ventilator and nebulizer operation |
WO2006005433A1 (en) | 2004-07-08 | 2006-01-19 | Breas Medical Ab | Energy trigger |
US20060011195A1 (en) | 2004-07-14 | 2006-01-19 | Ric Investments, Llc. | Method and apparatus for non-rebreathing positive airway pressure ventilation |
US7850619B2 (en) | 2004-07-23 | 2010-12-14 | Intercure Ltd. | Apparatus and method for breathing pattern determination using a non-contact microphone |
DE102004039711B3 (en) | 2004-08-17 | 2006-05-11 | Dräger Medical AG & Co. KG | Method for automatic recording of pressure-volume curves in artificial respiration and apparatus for carrying out the method |
JP4884390B2 (en) | 2004-09-03 | 2012-02-29 | レスメド・リミテッド | Adjustment of target ventilation of servo ventilator |
US8413654B2 (en) | 2004-09-28 | 2013-04-09 | Resmed Limited | Method and apparatus for resolving upper airway obstruction, resistance or instability |
US7717110B2 (en) | 2004-10-01 | 2010-05-18 | Ric Investments, Llc | Method and apparatus for treating Cheyne-Stokes respiration |
AU2005291858B2 (en) | 2004-10-06 | 2011-07-28 | Resmed Limited | Method and apparatus for non-invasive monitoring of respiratory parameters in sleep disordered breathing |
US8603006B2 (en) | 2004-10-20 | 2013-12-10 | Resmed Limited | Method and apparatus for detecting ineffective inspiratory efforts and improving patient-ventilator interaction |
DE102004051373A1 (en) | 2004-10-21 | 2006-04-27 | Map Medizin-Technologie Gmbh | Device and method for evaluating a signal indicative of the respiration of a person |
US7984712B2 (en) | 2004-10-25 | 2011-07-26 | Bird Products Corporation | Patient circuit disconnect system for a ventilator and method of detecting patient circuit disconnect |
US8024029B2 (en) | 2004-11-02 | 2011-09-20 | Medtronic, Inc. | Techniques for user-activated data retention in an implantable medical device |
US8041419B2 (en) | 2004-12-17 | 2011-10-18 | Medtronic, Inc. | System and method for monitoring or treating nervous system disorders |
US20060178245A1 (en) | 2005-02-07 | 2006-08-10 | Sage Dynamics, L.P. | Breathing exerciser and method of forming thereof |
DE102005010488A1 (en) | 2005-03-04 | 2006-09-07 | Map Medizin-Technologie Gmbh | Apparatus for administering a breathing gas and method for adjusting at least temporarily alternating breathing gas pressures |
US7207331B2 (en) | 2005-03-22 | 2007-04-24 | The General Electric Company | Arrangement and method for controlling operational characteristics of medical equipment |
US7445006B2 (en) | 2005-05-03 | 2008-11-04 | Dhuper Sunil K | Aerosol inhalation system and interface accessory for use therewith |
US20060249155A1 (en) | 2005-05-03 | 2006-11-09 | China Resource Group, Inc. | Portable non-invasive ventilator with sensor |
ITRM20050217A1 (en) | 2005-05-06 | 2006-11-07 | Ginevri S R L | PROCEDURE FOR NASAL VENTILATION AND ITS APPARATUS, IN PARTICULAR FOR NEONATAL FLOW-SYNCHRONIZED ASSISTED VENTILATION. |
DE102005022896B3 (en) | 2005-05-18 | 2006-05-11 | Dräger Medical AG & Co. KG | Method for controlling respirator involves receiving measuring signals with the help of electrical impedance measuring instrument fitted with electrode application at test person |
US8496001B2 (en) | 2005-06-08 | 2013-07-30 | Dräger Medical GmbH | Process and device for the automatic identification of breathing tubes |
US7909031B2 (en) | 2005-06-09 | 2011-03-22 | Temple Univesity - Of The Commonwealth System of Higher Education | Process for transient and steady state delivery of biological agents to the lung via breathable liquids |
US8561611B2 (en) | 2005-06-21 | 2013-10-22 | Ric Investments, Llc | Respiratory device measurement system |
US7634998B1 (en) | 2005-07-15 | 2009-12-22 | Fenley Robert C | HME shuttle system |
US7487774B2 (en) | 2005-08-05 | 2009-02-10 | The General Electric Company | Adaptive patient trigger threshold detection |
US7347205B2 (en) | 2005-08-31 | 2008-03-25 | The General Electric Company | Method for use with the pressure triggering of medical ventilators |
US8522782B2 (en) | 2005-09-12 | 2013-09-03 | Mergenet Medical, Inc. | High flow therapy device utilizing a non-sealing respiratory interface and related methods |
US7731663B2 (en) | 2005-09-16 | 2010-06-08 | Cardiac Pacemakers, Inc. | System and method for generating a trend parameter based on respiration rate distribution |
US7523752B2 (en) | 2005-09-21 | 2009-04-28 | Ino Therapeutics, Llc | System and method of administering a pharmaceutical gas to a patient |
US8893717B2 (en) | 2005-09-21 | 2014-11-25 | Ino Therapeutics Llc | Systems and methods of administering a pharmaceutical gas to a patient |
US7530353B2 (en) | 2005-09-21 | 2009-05-12 | The General Electric Company | Apparatus and method for determining and displaying functional residual capacity data and related parameters of ventilated patients |
DE102005045127B3 (en) | 2005-09-22 | 2006-10-19 | Dräger Medical AG & Co. KG | Breathing apparatus, for patient, comprises breathing gas source, exhaling valve, inhaling line, exhaling line, feed for gas, flow sensor, pressure sensor, control unit, control circuit and control device |
JP2009509610A (en) | 2005-09-26 | 2009-03-12 | イノヴェント メディカル ソルーションズ,インク. | Forced inspiration exhalation device with ventilator |
US8025052B2 (en) | 2005-11-21 | 2011-09-27 | Ric Investments, Llc | System and method of monitoring respiratory events |
US7422015B2 (en) | 2005-11-22 | 2008-09-09 | The General Electric Company | Arrangement and method for detecting spontaneous respiratory effort of a patient |
US7305988B2 (en) | 2005-12-22 | 2007-12-11 | The General Electric Company | Integrated ventilator nasal trigger and gas monitoring system |
US7617821B2 (en) | 2005-11-23 | 2009-11-17 | Vibralung, Inc. | Acoustic respiratory therapy apparatus |
US8424524B2 (en) | 2005-12-02 | 2013-04-23 | General Electric Company | Method and apparatus for producing an average signal characteristic profile from cyclically recurring signals |
US20070151563A1 (en) | 2005-12-23 | 2007-07-05 | Kenji Ozaki | Apparatus and method for controlling gas-delivery mechanism for use in respiratory ventilators |
US20070181122A1 (en) | 2006-02-05 | 2007-08-09 | Mulier Jan P | Intubation positioning, breathing facilitator and non-invasive assist ventilation device |
US8105249B2 (en) | 2006-02-16 | 2012-01-31 | Zoll Medical Corporation | Synchronizing chest compression and ventilation in cardiac resuscitation |
US7509957B2 (en) | 2006-02-21 | 2009-03-31 | Viasys Manufacturing, Inc. | Hardware configuration for pressure driver |
DE102006010008B3 (en) | 2006-03-04 | 2007-03-01 | Dräger Medical AG & Co. KG | Respiration monitoring apparatus has tone generator controlled by flow rate sensor, microphone connected to processor producing signals representing background noise which adjust sound produced by tone generator |
NZ607280A (en) | 2006-03-06 | 2014-06-27 | Resmed Ltd | Method and apparatus for improved flow limitation detection of obstructive sleep apnea |
DE102007011924A1 (en) | 2006-03-08 | 2007-12-27 | Weinmann Geräte für Medizin GmbH & Co. KG | Method and device for controlling a ventilator |
EP1996284A2 (en) | 2006-03-09 | 2008-12-03 | Synapse Biomedical, Inc. | Ventilatory assist system and method to improve respiratory function |
US7810497B2 (en) | 2006-03-20 | 2010-10-12 | Ric Investments, Llc | Ventilatory control system |
DE102007006689B4 (en) | 2006-03-31 | 2021-07-29 | Löwenstein Medical Technology S.A. | Device and method for detecting obstruction during apnea phases by means of an additional pressure level |
US8074645B2 (en) | 2006-04-10 | 2011-12-13 | Somnetics Global Pte. Ltd. | Apparatus and methods for providing humidity in respiratory therapy |
US8021310B2 (en) | 2006-04-21 | 2011-09-20 | Nellcor Puritan Bennett Llc | Work of breathing display for a ventilation system |
US20080035146A1 (en) | 2006-05-05 | 2008-02-14 | Jerry Crabb | Methods, systems and computer products for filling lungs |
EP2018202A4 (en) | 2006-05-12 | 2018-01-10 | YRT Limited | Method and device for generating a signal that reflects respiratory efforts in patients on ventilatory support |
US8667963B2 (en) | 2006-05-16 | 2014-03-11 | Impact Instrumentation, Inc. | Ventilator circuit for oxygen generating system |
DE102006043637A1 (en) | 2006-05-18 | 2007-11-22 | Boehringer Ingelheim Pharma Gmbh & Co. Kg | atomizer |
US8443801B2 (en) | 2006-06-07 | 2013-05-21 | Carefusion 207, Inc. | System and method for adaptive high frequency flow interrupter control in a patient respiratory ventilator |
DE102006030520B3 (en) | 2006-07-01 | 2007-06-21 | Dräger Medical AG & Co. KG | Respiratory gas supplying device for patient, has control device that is provided for controlling inspiration pressure based on pulmonary inner pressure and pulmonary target pressure |
US7594508B2 (en) | 2006-07-13 | 2009-09-29 | Ric Investments, Llc. | Ventilation system employing synchronized delivery of positive and negative pressure ventilation |
DE102006032860B4 (en) | 2006-07-14 | 2011-07-14 | Dräger Medical GmbH, 23558 | Monitoring device for anesthesia device and method |
US8083682B2 (en) | 2006-07-19 | 2011-12-27 | Cardiac Pacemakers, Inc. | Sleep state detection |
US20080029096A1 (en) | 2006-08-02 | 2008-02-07 | Kollmeyer Phillip J | Pressure targeted ventilator using an oscillating pump |
JP2009545384A (en) | 2006-08-03 | 2009-12-24 | ブリーズ テクノロジーズ, インコーポレイテッド | Method and apparatus for minimally invasive respiratory assistance |
US7556038B2 (en) | 2006-08-11 | 2009-07-07 | Ric Investments, Llc | Systems and methods for controlling breathing rate |
US8316847B2 (en) | 2006-09-01 | 2012-11-27 | Ventific Holdings Pty Ltd | Automatic positive airway pressure therapy through the nose or mouth for treatment of sleep apnea and other respiratory disorders |
FR2906474B3 (en) | 2006-09-29 | 2009-01-09 | Nellcor Puritan Bennett Incorp | SYSTEM AND METHOD FOR CONTROLLING RESPIRATORY THERAPY BASED ON RESPIRATORY EVENTS |
FR2906450B3 (en) | 2006-09-29 | 2009-04-24 | Nellcor Puritan Bennett Incorp | SYSTEM AND METHOD FOR DETECTING RESPIRATORY EVENTS |
EP3527255B1 (en) | 2006-10-13 | 2020-08-05 | Cyberonics, Inc. | Obstructive sleep apnea treatment devices and systems |
US8312879B2 (en) | 2006-10-16 | 2012-11-20 | General Electric Company | Method and apparatus for airway compensation control |
US8646447B2 (en) | 2006-11-13 | 2014-02-11 | Resmed Limited | Systems, methods, and/or apparatuses for non-invasive monitoring of respiratory parameters in sleep disordered breathing |
WO2008058417A2 (en) | 2006-11-16 | 2008-05-22 | Hamilton Medical Ag | Method and device for determining the peep during the respiration of a patient |
US8100836B2 (en) | 2006-12-06 | 2012-01-24 | Texas Christian University | Augmented RIC model of respiratory systems |
EP2099361A4 (en) | 2007-01-04 | 2013-03-06 | Oridion Medical 1987 Ltd | Capnography device and method |
US8020558B2 (en) | 2007-01-26 | 2011-09-20 | Cs Medical, Inc. | System for providing flow-targeted ventilation synchronized to a patient's breathing cycle |
US20080216833A1 (en) | 2007-03-07 | 2008-09-11 | Pujol J Raymond | Flow Sensing for Gas Delivery to a Patient |
DE102009013205A1 (en) | 2009-03-17 | 2010-09-23 | Dolphys Technologies B.V. | Jet ventilation catheter, in particular for the ventilation of a patient |
DE102007013385A1 (en) | 2007-03-16 | 2008-09-18 | Enk, Dietmar, Dr.med. | Gas flow reversing element |
EP1972274B1 (en) | 2007-03-20 | 2015-12-30 | Drägerwerk AG & Co. KGaA | Method and apparatus for determining the resistance of the respiratory system of a patient |
US8276585B2 (en) | 2007-04-10 | 2012-10-02 | Resmed Limited | Systems and methods for visualizing pressures and pressure responses to sleep-related triggering events |
US7918226B2 (en) | 2007-04-10 | 2011-04-05 | General Electric Company | Method and system for detecting breathing tube occlusion |
US20080281219A1 (en) | 2007-04-11 | 2008-11-13 | Deepbreeze Ltd. | Method and System for Assessing Lung Condition and Managing Mechanical Respiratory Ventilation |
US8371299B2 (en) | 2007-04-19 | 2013-02-12 | Respironics Respiratory Drug Delivery | Ventilator aerosol delivery |
EP2150302A1 (en) | 2007-05-08 | 2010-02-10 | The Research Foundation Of State University Of New York | Breathing-gas delivery system with exhaust gas filter body and method of operating a breathing-gas delivery system |
US20080294060A1 (en) | 2007-05-21 | 2008-11-27 | Cardiac Pacemakers, Inc. | Devices and methods for disease detection, monitoring and/or management |
US20080295839A1 (en) | 2007-06-01 | 2008-12-04 | Habashi Nader M | Ventilator Apparatus and System of Ventilation |
DE102007026035B3 (en) | 2007-06-04 | 2008-03-27 | Dräger Medical AG & Co. KG | Operating breathing and/or anaesthetizing apparatus in APRV mode involves detecting spontaneous expiration effort, initiating pressure release phase if detected spontaneous expiration effort occurs in predefined trigger window |
DE102007033546B3 (en) | 2007-07-19 | 2008-06-05 | Dräger Medical AG & Co. KG | Artificial respiration device operating method for e.g. human patient, involves obtaining target-respiratory pressure by pressure time characteristics based on start-respiratory pressure that is greater than positive end expiratory pressure |
AU2008203812B2 (en) | 2007-08-17 | 2014-10-02 | ResMed Pty Ltd | Methods and Apparatus for Pressure Therapy in the Treatment of Sleep Disordered Breathing |
WO2009026582A1 (en) | 2007-08-23 | 2009-02-26 | Invacare Corporation | Method and apparatus for adjusting desired pressure in positive airway pressure devices |
US8088120B2 (en) | 2007-09-05 | 2012-01-03 | Maya Worsoff | Method and apparatus for alleviating nasal congestion |
CN101380233B (en) | 2007-09-05 | 2010-12-22 | 深圳迈瑞生物医疗电子股份有限公司 | Breathing work real-time monitoring method and device based on breathing mechanics module |
JP5513392B2 (en) | 2007-09-26 | 2014-06-04 | ブリーズ・テクノロジーズ・インコーポレーテッド | Method and apparatus for treating sleep apnea |
US8186344B2 (en) | 2007-11-01 | 2012-05-29 | Intermed-Equipamento Medico Hospitalar Ltda. | Method and system to control mechanical lung ventilation |
US20090120439A1 (en) | 2007-11-08 | 2009-05-14 | Fred Goebel | Method of triggering a ventilator |
GB0722247D0 (en) | 2007-11-13 | 2007-12-27 | Intersurgical Ag | Improvements relating to anti-asphyxiation valves |
CN101467880B (en) | 2007-12-28 | 2012-06-27 | 北京谊安医疗系统股份有限公司 | Method for improving tidal volume control and detection accuracy by introducing R value for calculation |
US9078984B2 (en) | 2008-01-31 | 2015-07-14 | Massachusetts Institute Of Technology | Mechanical ventilator |
FR2930165B1 (en) | 2008-04-21 | 2010-08-20 | Air Liquide | DEVICE FOR DETECTING PATIENT OBSERVANCE OF OXYGEN THERAPY TREATMENT |
EP2320790B1 (en) | 2008-06-06 | 2017-10-04 | Covidien LP | Systems for determining patient effort and/or respiratory parameters in a ventilation system |
WO2010021556A1 (en) | 2008-08-19 | 2010-02-25 | Fisher & Paykel Healthcare Limited | Breathing transition detection |
CN102159272A (en) | 2008-09-17 | 2011-08-17 | 雷斯梅德有限公司 | Display and controls for cpap device |
US8424520B2 (en) | 2008-09-23 | 2013-04-23 | Covidien Lp | Safe standby mode for ventilator |
FR2937850B1 (en) | 2008-11-03 | 2011-12-09 | Assistance Publique Hopitaux Paris | SYSTEM FOR DETECTING THE RESPIRATORY MUSCLE ACTIVITY OF A PATIENT UNDER RESPIRATORY ASSISTANCE. |
JP2012508074A (en) | 2008-11-10 | 2012-04-05 | チャート・シークワル・テクノロジーズ・インコーポレイテッド | Medical ventilator system and method using an oxygen concentrator |
US8347883B2 (en) | 2008-11-17 | 2013-01-08 | Bird F M | Manual controlled bi-phasic intrapulmonary percussive ventilation and methods |
WO2010070492A2 (en) | 2008-12-16 | 2010-06-24 | Koninklijke Philips Electronics, N.V. | Phasic respiratory therapy |
US8783247B2 (en) | 2009-02-04 | 2014-07-22 | Wet Nose Technologies, Llc. | Pressure release systems, apparatus and methods |
JP5802559B2 (en) | 2009-02-25 | 2015-10-28 | コーニンクレッカ フィリップス エヌ ヴェ | Detection of patient-ventilator dyssynchrony |
AU2010217313B2 (en) | 2009-02-25 | 2015-02-19 | Koninklijke Philips Electronics, N.V. | Pressure support system with machine delivered breaths |
EP2411075B1 (en) | 2009-03-27 | 2019-02-27 | Maquet Critical Care AB | Peep regulation for a breathing apparatus |
EP2421589A4 (en) | 2009-04-22 | 2015-03-25 | Resmed Ltd | Detection of asynchrony |
US8550077B2 (en) | 2009-05-19 | 2013-10-08 | The Cleveland Clinic Foundation | Ventilator control system utilizing a mid-frequency ventilation pattern |
US8701665B2 (en) | 2009-07-25 | 2014-04-22 | Fleur T Tehrani | Automatic control system for mechanical ventilation for active or passive subjects |
DE102009046541A1 (en) | 2009-11-09 | 2011-05-12 | Medin Medical Innovations Gmbh | Compressed air control device for a CPAP device and corresponding CPAP system |
CN107307866A (en) | 2009-11-16 | 2017-11-03 | 瑞思迈有限公司 | Method and apparatus for the adaptability therapeutic compression of sleep disordered breathing |
CN103052420B (en) | 2010-05-22 | 2015-07-15 | 马奎特紧急护理公司 | Breathing system with flow estimation |
EP2397074B1 (en) | 2010-06-19 | 2012-10-24 | M Stenqvist AB | A system and computer readable medium for determination of transpulmonary pressure in a patient connected to a breathing apparatus |
CN103079621B (en) | 2010-06-30 | 2015-09-16 | 圣米高医院 | For the method and system that the ventilation synchronous with patient by tracheal strips through-flow is auxiliary |
US8555880B2 (en) | 2010-07-28 | 2013-10-15 | Devilbiss Healthcare, Llc | Variable transition pressure profiles for a bi-level breathing therapy machine |
EP4112110A1 (en) | 2010-08-27 | 2023-01-04 | ResMed Pty Ltd | Adaptive cycling for respiratory treatment apparatus |
WO2012032445A1 (en) | 2010-09-10 | 2012-03-15 | Koninklijke Philips Electronics N.V. | System and method for identifying breathing transitions |
US9295797B2 (en) | 2010-09-10 | 2016-03-29 | Koninklijke Philips N.V. | System and method of detecting and responding to spontaneous respiration subsequent to a respiratory event |
US20110011403A1 (en) | 2010-09-26 | 2011-01-20 | Richard William Heim | Crew Mask Regulator Mechanical Curve Matching Dilution Valve |
US8573207B2 (en) | 2010-09-28 | 2013-11-05 | Guillermo Gutierrez | Method and system to detect respiratory asynchrony |
JP6014597B2 (en) | 2010-11-23 | 2016-10-25 | コーニンクレッカ フィリップス エヌ ヴェKoninklijke Philips N.V. | Respiratory pace adjustment system for adjusting patient respiratory activity |
DE102010055243B4 (en) | 2010-12-20 | 2016-10-27 | Drägerwerk AG & Co. KGaA | Automatically controlled ventilator |
WO2012085748A1 (en) | 2010-12-20 | 2012-06-28 | Koninklijke Philips Electronics N.V. | Respiration-rate dependent respiratory assistance |
WO2012085787A2 (en) | 2010-12-21 | 2012-06-28 | Koninklijke Philips Electronics N.V. | System and method for inexsufflating a subject |
US10065007B2 (en) | 2011-03-18 | 2018-09-04 | Maquet Critical Care Ab | Breathing apparatus and method for support ventilation |
US9629971B2 (en) | 2011-04-29 | 2017-04-25 | Covidien Lp | Methods and systems for exhalation control and trajectory optimization |
US9987444B2 (en) | 2011-07-01 | 2018-06-05 | Koninklijke Philips N.V. | System and method for limited flow respiratory therapy |
DE102011106406A1 (en) | 2011-07-02 | 2013-01-03 | Dräger Medical GmbH | Method for controlling end-expiratory pressure in a ventilator circuit |
RU2626113C2 (en) | 2011-11-07 | 2017-07-21 | Конинклейке Филипс Н.В. | Automated adjustment of synchronising with patient for non-invasive lungs ventilation |
US9364624B2 (en) | 2011-12-07 | 2016-06-14 | Covidien Lp | Methods and systems for adaptive base flow |
US9498589B2 (en) | 2011-12-31 | 2016-11-22 | Covidien Lp | Methods and systems for adaptive base flow and leak compensation |
US8985107B2 (en) | 2012-02-28 | 2015-03-24 | General Electric Company | Method, arrangement and computer program product for respiratory gas monitoring of ventilated patients |
US10179218B2 (en) | 2012-03-02 | 2019-01-15 | Breathe Technologies, Inc. | Dual pressure sensor continuous positive airway pressure (CPAP) therapy |
US9993604B2 (en) * | 2012-04-27 | 2018-06-12 | Covidien Lp | Methods and systems for an optimized proportional assist ventilation |
JP6075972B2 (en) | 2012-05-30 | 2017-02-08 | 日本光電工業株式会社 | Respiratory state determination device |
RU2641975C2 (en) | 2012-06-08 | 2018-01-23 | Конинклейке Филипс Н.В. | Method and system for lung function monitoring |
US10362967B2 (en) | 2012-07-09 | 2019-07-30 | Covidien Lp | Systems and methods for missed breath detection and indication |
US9375542B2 (en) * | 2012-11-08 | 2016-06-28 | Covidien Lp | Systems and methods for monitoring, managing, and/or preventing fatigue during ventilation |
WO2014096996A1 (en) | 2012-12-18 | 2014-06-26 | Koninklijke Philips N.V. | Inspiratory pressure control in volume mode ventilation cross-reference to related applications |
WO2014133430A1 (en) | 2013-03-01 | 2014-09-04 | Breas Medical Ab | A system and method for synchronization of breathing in a mechanical ventilator |
US9358355B2 (en) | 2013-03-11 | 2016-06-07 | Covidien Lp | Methods and systems for managing a patient move |
US10165966B2 (en) | 2013-03-14 | 2019-01-01 | University Of Florida Research Foundation, Incorporated | Methods and systems for monitoring resistance and work of breathing for ventilator-dependent patients |
WO2014144606A2 (en) | 2013-03-15 | 2014-09-18 | Board Of Regents Of The Nevada System Of Higher Education, On Behalf Of The University Of Nevada, Reno | Methods of treating muscular dystrophy |
JP6204086B2 (en) | 2013-06-28 | 2017-09-27 | 日本光電工業株式会社 | Respiratory state determination device |
US10064583B2 (en) | 2013-08-07 | 2018-09-04 | Covidien Lp | Detection of expiratory airflow limitation in ventilated patient |
WO2015021350A1 (en) | 2013-08-09 | 2015-02-12 | Advanced Cooling Therapy, Llc | Systems and methods for providing ventilation |
WO2015038663A1 (en) | 2013-09-10 | 2015-03-19 | Ahmad Samir S | Continuous positive airway pressure therapy target pressure comfort signature |
US9675771B2 (en) | 2013-10-18 | 2017-06-13 | Covidien Lp | Methods and systems for leak estimation |
US9839760B2 (en) | 2014-04-11 | 2017-12-12 | Vyaire Medical Capital Llc | Methods for controlling mechanical lung ventilation |
US9808591B2 (en) * | 2014-08-15 | 2017-11-07 | Covidien Lp | Methods and systems for breath delivery synchronization |
US9950129B2 (en) | 2014-10-27 | 2018-04-24 | Covidien Lp | Ventilation triggering using change-point detection |
US9925346B2 (en) | 2015-01-20 | 2018-03-27 | Covidien Lp | Systems and methods for ventilation with unknown exhalation flow |
US9757270B2 (en) | 2015-02-09 | 2017-09-12 | Tencar Inc. | Ostomy appliance |
US20160228282A1 (en) | 2015-02-09 | 2016-08-11 | Georgann M. Carrubba | Ostomy appliance |
WO2016140980A1 (en) | 2015-03-02 | 2016-09-09 | Covidien Lp | Medical ventilator, method for replacing an oxygen sensor on a medical ventilator, and medical ventilator assembly |
WO2017068464A1 (en) | 2015-10-19 | 2017-04-27 | Koninklijke Philips N.V. | Anomaly detection device and method for respiratory mechanics parameter estimation |
CN108348718B (en) * | 2015-11-02 | 2021-02-02 | 皇家飞利浦有限公司 | Breath-by-breath re-assessment of patient lung parameters for improved estimation performance |
JP6960929B2 (en) * | 2016-02-18 | 2021-11-05 | コーニンクレッカ フィリップス エヌ ヴェKoninklijke Philips N.V. | Enhanced respiratory parameter estimation and out-of-tune detection algorithms through the use of central venous pressure manometry |
US10765822B2 (en) | 2016-04-18 | 2020-09-08 | Covidien Lp | Endotracheal tube extubation detection |
US10357624B2 (en) | 2016-12-06 | 2019-07-23 | Iasset Ag | Ventilator apparatus and method for operating a ventilator in said ventilator apparatus |
US10668239B2 (en) | 2017-11-14 | 2020-06-02 | Covidien Lp | Systems and methods for drive pressure spontaneous ventilation |
CA3099804A1 (en) | 2018-05-14 | 2019-11-21 | Covidien Lp | Systems and methods for respiratory effort detection utilizing signal distortion |
-
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- 2019-10-02 US US16/590,530 patent/US11752287B2/en active Active
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