WO2023042064A1 - Synchronisation automatique pour ventilation médicale - Google Patents

Synchronisation automatique pour ventilation médicale Download PDF

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Publication number
WO2023042064A1
WO2023042064A1 PCT/IB2022/058592 IB2022058592W WO2023042064A1 WO 2023042064 A1 WO2023042064 A1 WO 2023042064A1 IB 2022058592 W IB2022058592 W IB 2022058592W WO 2023042064 A1 WO2023042064 A1 WO 2023042064A1
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Prior art keywords
cycling
triggering
event
sensitivity
phase
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PCT/IB2022/058592
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English (en)
Inventor
Nancy F. Dong
Gabriel Sanchez
Kun Li
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Covidien Lp
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Priority claimed from US17/890,957 external-priority patent/US20230078506A1/en
Application filed by Covidien Lp filed Critical Covidien Lp
Publication of WO2023042064A1 publication Critical patent/WO2023042064A1/fr

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/021—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes operated by electrical means
    • A61M16/022—Control means therefor
    • A61M16/024—Control means therefor including calculation means, e.g. using a processor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/08—Detecting, measuring or recording devices for evaluating the respiratory organs
    • A61B5/0816—Measuring devices for examining respiratory frequency
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/08—Detecting, measuring or recording devices for evaluating the respiratory organs
    • A61B5/087—Measuring breath flow
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H20/00—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance
    • G16H20/40—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance relating to mechanical, radiation or invasive therapies, e.g. surgery, laser therapy, dialysis or acupuncture
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H50/00—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics
    • G16H50/30—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics for calculating health indices; for individual health risk assessment
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/0003—Accessories therefor, e.g. sensors, vibrators, negative pressure
    • A61M2016/0027—Accessories therefor, e.g. sensors, vibrators, negative pressure pressure meter
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/0003—Accessories therefor, e.g. sensors, vibrators, negative pressure
    • A61M2016/003—Accessories therefor, e.g. sensors, vibrators, negative pressure with a flowmeter
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2205/00—General characteristics of the apparatus
    • A61M2205/33—Controlling, regulating or measuring
    • A61M2205/332—Force measuring means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2205/00—General characteristics of the apparatus
    • A61M2205/33—Controlling, regulating or measuring
    • A61M2205/3331—Pressure; Flow
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2205/00—General characteristics of the apparatus
    • A61M2205/33—Controlling, regulating or measuring
    • A61M2205/3331—Pressure; Flow
    • A61M2205/3334—Measuring or controlling the flow rate
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2205/00—General characteristics of the apparatus
    • A61M2205/33—Controlling, regulating or measuring
    • A61M2205/3331—Pressure; Flow
    • A61M2205/3344—Measuring or controlling pressure at the body treatment site
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2205/00—General characteristics of the apparatus
    • A61M2205/50—General characteristics of the apparatus with microprocessors or computers
    • A61M2205/502—User interfaces, e.g. screens or keyboards
    • A61M2205/505—Touch-screens; Virtual keyboard or keypads; Virtual buttons; Soft keys; Mouse touches
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2205/00—General characteristics of the apparatus
    • A61M2205/50—General characteristics of the apparatus with microprocessors or computers
    • A61M2205/52—General characteristics of the apparatus with microprocessors or computers with memories providing a history of measured variating parameters of apparatus or patient
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2205/00—General characteristics of the apparatus
    • A61M2205/70—General characteristics of the apparatus with testing or calibration facilities
    • A61M2205/702—General characteristics of the apparatus with testing or calibration facilities automatically during use
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2230/00—Measuring parameters of the user
    • A61M2230/40—Respiratory characteristics
    • A61M2230/42—Rate

Definitions

  • ventilator systems have long been used to provide ventilatory and supplemental oxygen support to patients. These ventilators typically comprise a connection for pressurized gas (air, oxygen) that is delivered to the patient through a conduit or tubing. As each patient may require a different ventilation strategy, modem ventilators may 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 different scenarios, such as mandatory ventilation modes, spontaneous ventilation modes, and assist-control ventilation modes. Ventilators monitor a variety of patient parameters and are well equipped to provide reports and other information regarding a patient’s condition.
  • the breathing gases delivered to the patient may not be synchronous with the patient’s own breathing effects.
  • Patient-ventilator asynchrony occurs when the initiation and/or termination of mechanical breath is not in time agreement with the initiation and termination of neural inspiration. Such patient-ventilator asynchrony is a frequent issue in ventilated patients and it is typically uncomfortable for the patient.
  • patient-ventilator asynchrony may have an impact on patient outcomes.
  • a list of adverse effects associated with poor patient-ventilator interaction includes: a higher or wasted work of breathing; patient discomfort; alveolar overdistention and lung injury; increased need of sedation; prolonged mechanical ventilation; longer hospital stays; and possibly higher mortality.
  • aspects of the present disclosure include systems and methods for automatically improving patient-ventilator synchronization.
  • the technology relates to a method, performed by a ventilator, for automatic synchrony adjustment in medical ventilation.
  • the method includes delivering positive pressure during a first inhalation phase; cycling to a first exhalation phase at an end of the first inhalation phase according to a cycling sensitivity of the ventilator; and at an end of the first exhalation phase, triggering a second inhalation phase.
  • the method further includes during at least one of the first exhalation phase or the second inhalation phase, detecting a cycling-related asynchrony event; in response to the detecting, automatically adjusting the cycling sensitivity without additional user input; delivering positive pressure during the second inhalation phase; and cycling from the second inhalation phase to a second exhalation phase according to the adjusted cycling sensitivity.
  • the cycling-related asynchrony event is detected during the first exhalation phase. In another example, the cycling-related asynchrony event is detected during the second inhalation phase. In a further example, the cycling-related asynchrony event is one of a premature-cycling event or a double-triggering event, and adjusting the cycling sensitivity decreases the cycling sensitivity. In yet another example, the cycling- related asynchrony event is a delayed-cycling event, and adjusting the cycling sensitivity increases the cycling sensitivity. In still another example, the cycling-related asynchrony event is detected based on a slope of a net flow crossing zero during the first exhalation phase.
  • the cycling-related asynchrony event is detected based on at least one of a slope of a net flow exceeding a slope threshold during the first exhalation phase, or a second slope of a net flow exceeding a slope threshold during the first exhalation phase.
  • the method further includes receiving a user input to activate an automated synchronization mode.
  • the technology relates to a ventilator for providing automatic synchrony adjustment in medical ventilation.
  • the ventilator includes a pressure generating system; a processor; and memory storing instructions that, when executed by the processor, cause the ventilator to perform a set of operations.
  • the operations include delivering positive pressure during a first inhalation phase; cycling to a first exhalation phase at an end of the first inhalation phase according to a cycling sensitivity of the ventilator; at an end of the first exhalation phase, triggering a second inhalation phase; during at least one of the first exhalation phase or the second inhalation phase, detecting a cycling-related asynchrony event; in response to the detecting, during the first exhalation phase, automatically adjusting the cycling sensitivity without additional user input; delivering positive pressure during the second inhalation phase; and cycling from the second inhalation phase to a second exhalation phase according to the adjusted cycling sensitivity.
  • the cycling-related asynchrony event is one of a premature-cycling event or a double-triggering event, and adjusting the cycling sensitivity decreases the cycling sensitivity.
  • the cycling-related asynchrony event is a delayed- cy cling event, and adjusting the cycling sensitivity increases the cycling sensitivity.
  • the cycling-related asynchrony event is detected based on a slope of a net flow crossing zero during the first exhalation phase.
  • the cycling- related asynchrony event is detected based on a second slope of a net flow exceeding a slope threshold during the first exhalation phase.
  • the technology relates to a method, performed by a ventilator, for automatic synchrony adjustment in medical ventilation.
  • the method includes triggering a first inhalation phase according to a triggering sensitivity of the ventilator; delivering positive pressure during a first inhalation phase; cycling to a first exhalation phase at an end of the first inhalation phase; during the first exhalation phase, detecting a first triggering- related asynchrony event; in response to detecting the first triggering-related asynchrony event, during the first exhalation phase automatically adjusting the triggering sensitivity without additional user input; at an end of the first exhalation phase, triggering a second inhalation phase according to the adjusted triggering sensitivity; and delivering positive pressure during the second inhalation phase.
  • the first triggering-related asynchrony event is a missed-triggering event, and adjusting the triggering sensitivity increases the triggering sensitivity.
  • the first triggering-related asynchrony event is an auto-triggering event, and adjusting the triggering sensitivity decreases the triggering sensitivity.
  • the first triggering-related asynchrony event is detected based on a local minimum and a local maximum of a slope of net flow signal.
  • the first triggering-related asynchrony event is detected based on a local minimum and a local maximum of a slope of a derivative of an intrapleural pressure signal.
  • adjusting the triggering sensitivity adjusts the triggering sensitivity by a first amount
  • the method further includes: cycling from the second inhalation phase to a second exhalation phase; during the second exhalation phase, detecting a second triggering- related asynchrony event; and based on detecting the second triggering-related asynchrony event, re-adjusting the adjusted triggering sensitivity by a second amount that is different than the first amount.
  • the first triggering-related asynchrony event is an auto-triggering event
  • the second triggering-related asynchrony event is a missed-triggering event
  • the first amount is less than the second amount.
  • FIG. 1 is a diagram illustrating an example of a medical ventilator connected to a human patient.
  • FIG. 2 depicts an example method for ventilator auto-synchronization.
  • FIG. 3 depicts example plots for an example of an ineffective effort (i.e., missed triggering (MT)) asynchrony event.
  • FIGS. 4A-4B depict example plots for an example of an auto-triggering asynchrony event.
  • FIGS. 5A-5B depict example plots for an example of a double-trigger asynchrony event.
  • FIGS. 6A-6B depict example plots for an example of a premature cycling asynchrony event.
  • FIGS. 7A-7B depict example plots for an example of a delayed cycling asynchrony event.
  • FIG. 8 depicts an example method for automatic synchrony adjustment in medical ventilation.
  • FIG. 9 depicts another example method for automatic synchrony adjustment in medical ventilation.
  • ventilators are used to provide breathing gases to patients who are otherwise unable to breathe sufficiently.
  • pressurized air and oxygen sources are often available from wall outlets, tanks, or other sources of pressurized gases.
  • 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 gases having a desired concentration are supplied to the patient at desired pressures and flow rates.
  • modern ventilators may be customized for the particular needs of an individual patient.
  • patient-ventilator asynchrony is a frequent problem that results in patient discomfort and may have negative impacts on patient outcomes.
  • the various types of major patient-ventilator asynchrony include (1) ineffective effort (i.e., missed triggering (MT); (2) auto triggering (AT); (3) double triggering (DT); (4) premature cycling (PC); and (5) delayed cycling (DC).
  • Each of the patient asynchrony types results from the ventilator triggering and/or cycling at an improper time that is out of synchronization with the patient’s own breathing efforts.
  • Some current triggering and cycling methods include a flow method, a pressure method, and an IE Sync method or signal distortion method. All these triggering and cycling methods include triggering and cycling sensitivity settings that at least partially control when triggering and cycling occurs.
  • a clinician uses default triggering and cycling settings then fine-tunes them based on the patient’s initial conditions and other ventilator settings.
  • patient-ventilator asynchrony can result due to variability of patient conditions and breathing patterns with the fixed tri ggering/cy cling sensitivity settings.
  • the present technology provides for, among other things, improvements to patient synchronization during ventilation by automatically adjusting ventilator triggering sensitivity and/or cycling sensitivity based on the detected types of patient-ventilator asynchronies.
  • This automated synchronization (“AutoSync”) technology includes asynchrony detection algorithms to reliably and accurately detect the patient-ventilator asynchrony and classify the type of asynchrony.
  • the asynchrony detection algorithms may be continuously performed during ventilation, and the triggering and/or cycling criteria may be automatically adjusted to maintain ventilator synchrony in substantially real time. For instance, changes to sensitivity values may be achieved on a breath-to-breath basis.
  • the present technology for improved ventilator synchronization without the need for additional hardware or accessories and further reduces the need for user settings or interactions with the ventilator.
  • FIG. 1 is a diagram illustrating an example of a medical ventilator 100 connected to a human patient 150.
  • the ventilator 100 may provide positive pressure ventilation to the 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 to the pneumatic system via an invasive (e.g., endotracheal tube, as shown) or a non-invasive (e.g., nasal mask) patient interface.
  • 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 a patient interface 180 to an inhalation limb 134 and an exhalation limb 132 of the ventilation tubing system 130.
  • Pneumatic system 102 may have a variety of configurations.
  • system 102 includes an exhalation module 108 coupled with the exhalation limb 132 and an inhalation module 104 coupled with the inhalation limb 134.
  • Compressor 106 or other source(s) of pressurized gases e.g., air, oxygen, and/or helium
  • the pneumatic system 102 may include a variety of other components, including mixing modules, valves, sensors, tubing, accumulators, filters, etc., which may be internal or external sensors to the ventilator (and may be communicatively coupled, or capable communicating, with the ventilator).
  • Controller 110 is operatively coupled with pneumatic system 102, signal measurement and acquisition systems, and an operator interface 120 that may enable an operator to interact with the ventilator 100 (e.g., change ventilation settings, select operational modes, view monitored parameters, etc.). Controller 110 may include memory 112, one or more processors 116, storage 114, and/or other components of the type found in command and control computing devices. In the depicted example, operator interface 120 includes a display 122 that may be touch-sensitive and/or voice-activated, enabling the display 122 to serve both as an input and output device.
  • the memory 112 includes non-transitory, computer-readable storage media that stores software that is executed by the processor 116 and which controls the operation of the ventilator 100.
  • the memory 112 may store instructions that, when executed by the processor 116, cause the ventilator 100 to perform operations such as the operations described herein.
  • 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.
  • modem 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 clinically appropriate ventilation for patients in various different scenarios, such as mandatory ventilation modes and assist control ventilation modes. Assist control modes (also referred to herein as “spontaneous modes”) allow a spontaneously breathing patient to trigger inspiration during ventilation. In a spontaneous or assisted mode of ventilation, the ventilator begins (triggers) inspiration upon the detection of patient demand or patient effort to inhale. The ventilator ends inspiration and begins expiration (cycles to expiration) when a threshold is met or when a patient demand or effort for exhalation is detected.
  • Assist control modes also referred to herein as “spontaneous modes” allow a spontaneously breathing patient to trigger inspiration during ventilation. In a spontaneous or assisted mode of ventilation, the ventilator begins (triggers) inspiration upon the detection of patient demand or patient effort to inhale. The ventilator ends inspiration and begins expiration (cycles to expiration) when
  • a patient’s inspiratory trigger is detected based on the magnitude of deviations (deviations generated by a patient’s inspiratory effort) of a measured parameter from a determined baseline.
  • the patient’s inspiration effort is detected when the measured patient exhalation flow value drops below a flow threshold or baseline (i.e. the base flow) by a set amount (based on the triggering sensitivity).
  • the patient’s inspiration effort is detected when the measured expiratory pressure value drops below a pressure baseline (for example, the set PEEP value) by a set amount (based on triggering sensitivity).
  • Another parameter that can be used for triggering is a derived signal, such as an estimate of the intrapleural pressure of the patient and/or the derivative of the estimate of the patient’s intrapleural pressure.
  • the term “intrapleural pressure,” as used herein, refers generally to the pressure exerted by the patient’s diaphragm on the cavity in the thorax that contains the lungs, or the pleural cavity.
  • the derivative of the intrapleural pressure value will be referred to herein as a “Psync” value that has units of pressure per time.
  • the signal distortion triggering mode may operate on the Psync signal or other signals, such as flow or pressure.
  • FIG. 2 depicts an example method 200 for ventilator auto-synchronization.
  • the ventilator monitors for an asynchrony event.
  • Monitoring for an asynchrony event may include continuously, or substantially continuously, performing asynchrony detection algorithms discussed herein (e.g., continuously evaluating the criteria discussed herein).
  • Such performance or execution of the algorithms may include analyzing various waveforms of ventilation characteristics and other values calculated or derived therefrom.
  • the first type of asynchrony event is a triggering-related asynchrony that occurs when the ventilator triggers an inspiratory phase either too early or too late.
  • the inspiratory phase may also be referred to as an inhalation phase.
  • the second type of asynchrony event is a cycling-related asynchrony event that occurs when the ventilator cycles from an inspiratory phase to an expiratory phase either too early or too late.
  • the expiratory phase may also be referred to as an exhalation phase.
  • Example triggering-related asynchrony events include an ineffective effort (i.e., missed triggering (MT)) event and an auto-triggering (AT) event.
  • Example cycling-related asynchrony events include a premature cycling event, a delayed cycling event, and a double triggering event. Additional details regarding these different types of asynchrony events and examples of how to detect such events is described further below with reference to FIGS. 3-10.
  • a triggering-asynchrony may be detected at operation 204.
  • the ventilator may automatically alter a triggering sensitivity at operation 208. Altering the ventilator’s triggering sensitivity may be accomplished by adjusting a value associated with the triggering sensitivity. The magnitude and the direction of the change of the triggering sensitivity value may be based on the type of asynchrony event that is detected. For example, where a missed triggering (MT) event is detected and where the triggering sensitivity value is a triggering threshold, the triggering threshold or sensitivity value is decreased by a first interval amount.
  • MT missed triggering
  • decreasing the triggering threshold or sensitivity value results in the ventilator being more sensitive for triggering purposes.
  • a smaller effort from the patient will cross the threshold and trigger an inspiratory phase.
  • Such a change that allows a smaller or weaker patient effort to trigger a breath may be referred to as raising the triggering sensitivity or making the ventilator more sensitive or responsive to triggering.
  • the ventilator is made to be more sensitive to trigger events and responds sooner to detect a trigger (e.g., by decreasing the triggering sensitivity value such as the triggering threshold).
  • the triggering threshold or sensitivity value is increased by a second interval amount (e.g., the ventilator is made less sensitive and a larger breathing effort from the patient is required to cross the threshold and trigger an inspiratory phase).
  • Increasing the triggering threshold may cause the ventilator to be less sensitive or responsive for triggering purposes. In other words, a greater patient effort is needed to trigger a breath. Such a change that that requires a greater patient effort to trigger a breath may be referred to as lowering the ventilator’s triggering sensitivity.
  • the triggering sensitivity value may be a flow sensitivity threshold value or setting.
  • the flow sensitivity threshold defines the rate of flow inspired by a patient that triggers the ventilator to deliver a mandatory or spontaneous breath. When the patient inhales and their inspiratory flow exceeds the flow sensitivity threshold, a trigger occurs and the ventilator delivers a breath.
  • a flow sensitivity threshold that is set too low may result in auto-triggering asynchronies, whereas a flow sensitivity threshold that is set too high may result in missed triggering asynchrony events.
  • the flow sensitivity threshold setting may range between 0.1 liters per minute (1pm) to 20 1pm for an adult or pediatric circuit.
  • the triggering sensitivity value may be a pressure sensitivity threshold or setting.
  • the pressure sensitivity threshold or setting sets the pressure drop below baseline (PEEP) required to begin a patient-initiated breath (either mandatory or spontaneous).
  • PEEP pressure drop below baseline
  • Lower pressure sensitivity thresholds or settings require less patient effort to initiate a breath.
  • fluctuations in system pressure can cause auto-triggering at very low thresholds or settings.
  • a high pressure sensitivity setting or threshold may result in missed-triggering asynchrony events.
  • the pressure sensitivity setting may range from 0.1 cn LO to 20.0 cn LO.
  • the triggering sensitivity value may be for an EE Sync or signal distortion triggering mode, where the triggering sensitivity values have a range of -2 to +2. Similar to other types of triggering sensitivity values, an increase of the triggering sensitivity value results in the patient having to provide a stronger effort to trigger the delivery of a breath (e.g., trigger an inspiratory phase). While different types of triggering sensitivity values or settings have been discussed above, it should be appreciated that in different examples and configurations, different types of values or changes may be used to cause the desired adjustment to the ventilator triggering sensitivity.
  • the first interval amount and the second interval amount by which the triggering sensitivity values is changed may be the same or different values.
  • a missed triggering event may be a more severe asynchrony event than an auto-triggering event.
  • the first interval amount associated with the missed triggering event may have a greater magnitude than the second interval amount associated with the auto-triggering event.
  • the first interval amount associated with the missed triggering event may be 0.2 1pm or 0.5 1pm
  • the second interval amount associated with the auto-triggering event may be 0.1 1pm or 0.3 1pm.
  • a cycling-related asynchrony event may be detected at operation 206.
  • a cycling sensitivity of the ventilator may be altered or adjusted in operation 210. Altering the ventilator’s cycling sensitivity may be accomplished by adjusting a value associated with the cycling sensitivity. The magnitude and the direction of the change of the cycling sensitivity value may be based on the type of asynchrony event that is detected. For example, for a premature cycling event or double triggering event, the cycling sensitivity threshold value is decreased to make the ventilator less sensitive to cycling (e.g., cycling occurs later and/or the inspiratory phase duration is longer).
  • Such a change that causes cycling to occur later may be referred to as lowering the cycling sensitivity of the ventilator to make the ventilator respond less quickly to detect a cycling event.
  • the cycling sensitivity threshold value is increased to make the ventilator more sensitive to cycling (e.g., cycling occurs earlier or the inspiratory phase duration is shorter).
  • Such a change that causes cycling to occur earlier may be referred to as raising the cycling sensitivity of the ventilator to make the ventilator respond more quickly to detect a cycling event.
  • the cycling sensitivity threshold or value may be represented as a percentage of peak flow.
  • the cycling sensitivity value may define the percentage of the measured peak inspiratory flow at which the ventilator cycles from inspiration to exhalation in spontaneous breath types. In some examples, the range for such percentages may be between 1% and 80%.
  • the cycling sensitivity value When inspiratory flow falls to the level defined by the cycling sensitivity value, cycling occurs and exhalation begins. In such an example, a higher cycling sensitivity value results in a shorter the inspiratory time (e.g., a higher ventilator cycling sensitivity).
  • the cycling sensitivity value may also be presented as a flow value of liters per minute or as a unitless range of -2 to +2 (or some other similar range).
  • an increase and/or decrease to the value may cause an increase and/or decrease to the ventilator cycling sensitivity.
  • the amount that the cycling sensitivity changes may also be dependent on the type of asynchrony event detected. For example, for a delayed-cycling event, the cycling sensitivity may be increased by 5%, whereas for a premature cycling or double-triggering event, the cycling sensitivity may be decreased by 10%.
  • Method 200 flows back to operation 202 where monitoring for additional asynchrony events continues. Method 200 may continue to loop for as long as the patient is being mechanically ventilated.
  • FIG. 3 depicts example plots for an example of an ineffective effort (i.e., missed triggering (MT)) asynchrony event. More specifically, FIG. 3 includes an upper plot 302 and a lower plot 303.
  • the upper plot 302 includes an IZE phase signal 304, a Psync signal 306, a net flow (Qnet) signal 308, and an airway pressure signal (Paw) 310.
  • the lower plot 303 includes the IZE phase signal 304, a slope of the Psync signal (slopePsync) 312, and a slope of the net flow signal (slopeQnet) 314.
  • the lower plot 303 also includes a missed trigger (MT) signal 316.
  • the IZE phase signal 304 is a binary signal that is either high or low.
  • the ventilator is in an inspiratory phase and is delivering a breath to the patient.
  • the ventilator is an expiratory phase and allowing the patient to exhale.
  • the Psync signal represents the derivative of a calculated intrapleural pressure value and has units of pressure per time, as discussed above and in the ’916 Application.
  • the airway pressure signal 310 represents the pressure of the airway and has units of pressure.
  • the airway pressure signal 310 may be the mean airway pressure and may be measured at the wye or at other locations within the breathing circuit and/or ventilator.
  • the net flow (Qnet) signal 308 represents the net flow, which may be determined based on an inspiratory flow (Qinsp) measurement and an exhalation flow (Qexh) measurement.
  • the missed trigger (MT) signal 316 is a binary signal that goes high/true when a missed trigger (MT) asynchrony event has been detected.
  • the slope of the Psync signal (slopePsync) 312 represents a change in the Psync signal over time, and the slopePsync signal 312 may have units of pressure per time squared (e.g., cmEEO/s 2 ).
  • the slopePsync signal may be determined or calculated by subtracting a current Psync value from a prior Psync value.
  • k is a discrete time index and may represent a current measurement cycle or control cycle.
  • the constant a represents a number of prior measurement cycles (or other time index as appropriate). As an example, measurements may be made or calculated by the ventilator, at discrete measurement cycles or control cycles, such as 2 milliseconds (ms), 5 ms, 8 ms, 10 ms, 20 ms, etc.
  • the constant a is an integer and thus represents a number of control cycles and is effectively equal to a time (e.g., a multiplied by the control cycle duration equals a time duration).
  • the constant a may be between 2-20, depending on the length of the control cycle.
  • the ultimate duration prior to current control cycle may be between 20 ms and 100 ms.
  • the slope of slope of the net flow signal (slopeQnet) 314 represents a change in the net flow (Qnet) signal over time, and the slopeQnet signal 314 may have units of flow per time (e.g., Liter/min 2 ).
  • the slopeQnet signal may be determined or calculated by subtracting a current Qnet value from a prior Qnet value.
  • Equation 2 k represents a current measurement cycle or control cycle and a is a constant that represents a number of prior measurement cycles.
  • Ineffective efforts that cause missed triggers include a patient’ s efforts that fail to trigger the ventilator, which are the most common form of patient ventilator asynchrony. Events of ineffective efforts are identified in 38% of patients with prolonged mechanical ventilation and were associated with increased mortality. During mechanical exhalation (e.g., an expiratory phase), if a patient’s respiratory effort occurs, the effort pulls both Qnet and Psync down (e.g., lower or more negative) until the mechanical inspiration is triggered.
  • the following criteria may be used to determine whether a missed-trigger asynchrony event has occurred. Specifically, if the following four criteria are met, a missed-trigger asynchrony event is declared and the missed trigger (MT) signal 316 goes to high/true:
  • the set duration in Criterion 2 may be between 0-500 ms, such as 50 ms, 100 ms, 200 ms, 250 ms, etc.
  • the constants pi and P2 in Criterion 4 are threshold may be used to distinguish the missed trigger event due to an ineffective effort from other types of cardiogenic events.
  • the constants pi and P2 may within the range of 0.2- 1.0, such as 0.2, 0.4, 0.5, 0.6, 0.8, etc. where slopeQnet may have units of Liter/min 2 and slopePsync may have units of cmEEO/s 2 .
  • the above criteria may be evaluated during the same exhalation phase for which the asynchrony event occurs.
  • the triggering sensitivity may be altered prior to the next triggering event (e.g., prior to the next breath).
  • the triggering sensitivity is altered prior to a second inspiratory phase after the occurrence of the event being detected.
  • the detection and adjustment of the triggering sensitivity may all be performed without additional input or interaction from the clinician or other user.
  • FIGS. 4A-4B depict example plots for an example of an auto-triggering asynchrony event. More specifically, FIGS. 4A-4B include an upper plot 402, a lower plot 403, and an enlarged portion 405 of the lower plot 403.
  • the upper plot 402 includes the IZE phase signal 404, the net flow (Qnet) signal 408, and the airway pressure signal (Paw) 410.
  • the lower plot 403 (and the enlarged portion 405) include the IZE phase signal 404, a calculated Pmus signal 420, and an auto-triggering (AT) signal 416.
  • the auto-triggering (AT) signal 416 is a binary signal that goes high/true when an auto-triggering (AT) asynchrony event has been detected.
  • the calculated Pmus signal represents the pressure generating capability of the inspiratory muscles over time. Rather than a directly measured Pmus value, the Pmus may be calculated using the equation of motion. For example, the calculated Pmus value may be calculated according to the following Equation 3:
  • an occurrence of an auto-triggering asynchrony event is highlighted by the circle 418.
  • Auto-triggering occurs when the ventilator is triggered and delivers a new breath in the absence of patient’s inspiratory effort, which is a common phenomenon during assisted ventilation. These additional breaths may lead to hyperinflation, respiratory alkalosis, hyperventilation, and diaphragmatic dysfunction.
  • the Pmus signal may be analyzed. In a properly triggered breath, the Pmus signal drops substantially below zero, indicating a large patient effect. In an auto-triggered breath, the Pmus value may be less negative (e.g., more shallow) as compared to the Pmus of prior breaths.
  • the following criteria may be used to determine whether an autotriggering asynchrony event has occurred. Specifically, if the following three criteria are met, an auto-triggering asynchrony event is declared and the auto-triggering asynchrony signal 416 goes to high/true:
  • a local minimum of calculated Pmus in the prior inspiratory phase is greater than a threshold (y) (e.g., is not more negative than the threshold (y));
  • the threshold (y) is in Criterion 2 a constant that may be within a range of values.
  • the threshold (y) may be between -0.25 crnFFO and -5 cmEEO, such as -1.0 cmEEO, -2.0 cmEEO, -3.0 cmEEO, etc.
  • the threshold (y) is used to distinguish patient efforts that are indicative of a breath (e.g., large efforts represented by negative Pmus values with high magnitudes) from those effects that are not indicative of a breath (e.g., small efforts represented by negative Pmus values with small magnitudes).
  • Criterion 3 is utilized to confirm that the auto-triggering event occurred based on the patient’s own breathing pattern for a number of prior breaths.
  • 3 is a constant between 0.2 and 0.8, such as 0.3, 0.4, 0.5, 0.6, 0.7, etc.
  • the variable Pmusmean-min represents an average local minimum of Pmus over a number of prior breaths during the inspiratory phase. For example, number of prior breaths may be between 2-10 breaths among other possible numbers of prior breaths.
  • the above criteria may be evaluated during the exhalation phase following the asynchrony event.
  • the triggering sensitivity may be altered prior to the next triggering event (e.g., prior to the next breath).
  • the triggering sensitivity is altered prior to a second inspiratory phase after the occurrence of the event being detected.
  • the detection and adjustment of the triggering sensitivity may all be performed without additional input or interaction from the clinician or other user.
  • FIGS. 5A-5B depict example plots for an example of a double-trigger asynchrony event. More specifically, FIGS. 5A-5B include an upper plot 502, a lower plot 503, and an enlarged portion 505 of the lower plot 503.
  • the upper plot 502 includes the IZE phase signal 504, a Psync signal 506, a net flow signal (Qnetl) 508, and an airway pressure signal (Paw) 510.
  • the lower plot 503 and the enlarged portion 505 include a the IZE phase signal 504, the Psync signal 506, a 10% inspired volume signal 522, a 10% exhaled volume signal 524, and a double-triggering (DT) signal 516.
  • DT double-triggering
  • the double-triggering (DT) signal is a binary signal that goes high/true when an auto-triggering asynchrony event has been detected.
  • Double triggering refers to the occurrence of two consecutive inspirations with one inspiratory effort. Double-triggering generally occurs when respiratory drive is high, ventilator support is insufficient, or neural inspiratory time is longer than ventilator delivered inspiratory time. Double-triggering may provoke high tidal volume (up to twice of the set value) putting the patient at risk of ventilator-induced lung injury and ventilator-induced diaphragmatic dysfunction.
  • the patient’s respiratory effort continues even during the exhalation phase and the flow is pulled to the lungs, which is reflected in a negative value of Psync.
  • the exhalation phase is generally short and the expired volume is much smaller compared to the inspired volume since the patient’s respiratory effort continues.
  • the following criteria may be used to determine whether a double-triggering asynchrony event has occurred. Specifically, if the following four criteria are met, an auto-triggering asynchrony event is declared and the double-triggering signal 516 goes to high/true:
  • the expired volume is less than a * inspired volume (e.g., - Vexh ⁇ s *Vinsp) and
  • Criterion 3 The constant a in Criterion 3 is a fraction less than 1. Thus, Criterion 3 ensures that the expired volume is substantially less than the inspired volume, which is indicative of a double-trigger event. In some examples, the constant a is between 0.05-0.5, such as 0.1, 0.2, 0.3, 0.4, etc. Criterion 4 confirms that the prior exhalation phase was short, e.g., less than the duration threshold (Q. In some examples, the duration threshold (Q may be between 200-800 ms, such as 300 ms, 400 ms, 500 ms, etc.
  • the above criteria may be evaluated during the second inspiratory phase of the double triggering asynchrony event.
  • the cycling sensitivity may be altered prior to the next cycling event (e.g., prior to the next breath).
  • the cycling sensitivity is altered prior to a second exhalation phase after the occurrence of the asynchrony event being detected.
  • the detection and adjustment of the cycling sensitivity may all be performed without additional input or interaction from the clinician or other user.
  • FIGS. 6A-6B depict example plots for an example of a premature cycling asynchrony event. More specifically, FIGS. 6A-6B include an upper plot 602, a lower plot 603, and an enlarged portion 605 of the lower plot 603.
  • the upper plot 602 includes in the IZE phase signal 604, the net flow signal (Qnetl) 608, and the airway pressure signal (Paw) 610.
  • the lower plot 603 includes the IZE phase signal 604, a slope of the net flow signal (slopeQnetl) 626, and a premature-cycling signal 616.
  • the premature-cycling signal is a binary signal that goes high when a premature-cycling asynchrony event has been detected.
  • the slope of the net flow signal (slopeQnetl) 626 represents a change in the net flow signal (Qnetl) over time.
  • the slopeQnetl signal may be determined or calculated by subtracting a current Qnetl value from a prior Qnetl value.
  • the following criteria may be used to determine whether a premature-cycling asynchrony event has occurred. Specifically, if the following three criteria are met, premature-cycling asynchrony event is declared and the premature-cycling signal 616 goes to high/true:
  • the slopeQnetl is less than (e.g., more negative) than a slope threshold (9).
  • the constant r] in Criterion 1 is a time duration that indicates a short term at the beginning of the expiration phase.
  • the constant r may be between 200 ms and 800 ms, such as 300 ms, 400 ms, 500 ms, 600 ms, 700 ms, etc.
  • the slope threshold (9) is a value to help confirm that exhalation has occurred.
  • the slope threshold may be between -2 liter/min 2 and -10 liter/min 2 , such as -4, -5, -6, -7 liter/min 2 etc.
  • the cycling sensitivity may be altered prior to the next cycling event (e.g., prior to the next breath). In other examples, the cycling sensitivity is altered prior to a second exhalation phase after the occurrence of the asynchrony event being detected.
  • the detection and adjustment of the cycling sensitivity may all be performed without additional input or interaction from the clinician or other user.
  • FIGS. 7A-7B depict example plots for an example of a delayed cycling asynchrony event. More specifically, FIGS. 7A-7B include an upper plot 702, a lower plot 703, and an enlarged portion 705 of the lower plot 703.
  • the upper plot 702 includes the IZE phase signal 704, the net flow signal (Qnetl) 708, and the airway pressure signal (Paw) 710.
  • the lower plot 703 and the enlarged portion 705 include the IZE phase signal 704, the airway pressure signal (Paw) 710, the slope of the net flow signal (slopeQnetl) 726, a second slope of the net flow signal (2ndSlopeQnetl) 728, and a delayed-cycling signal 716.
  • the second slope of the net flow signal (2ndSlopeQnetl) 728 represents a change in the slope of the net flow signal (slopeQnetl).
  • the second slope of the net flow signal (2ndSlopeQnetl) 728 may be considered to be similar to the acceleration of the net flow signal (Qnetl).
  • the second slope of the net flow signal (2ndSlopeQnetl) 728 may be determined or calculated by subtracting a current slopeQnetl value from a prior slopeQnetl value. For example, the 2ndSlopeQnetl signal 728 may be calculated using the following Equation 5:
  • Equation 5 k represents a current measurement cycle or control cycle and p is a constant that represents a number of prior measurement cycles.
  • the constant p may be the same as the constant a.
  • the constant p may be less than the constant a.
  • the constant p may be between 1-15, and the resultant time duration may be between 10 ms and 80 ms.
  • an occurrence of a delayed-cycling asynchrony event is highlighted by the circle 718. Delayed-cycling occurs when the exhalation valve opens too late causing mechanical inspiration to extend into the neural expiration.
  • the following criteria may be used to determine whether a delayed-cycling asynchrony event has occurred. Specifically, if the following three criteria are met, a delayed-triggering asynchrony event is declared and the delayed-cycling signal 716 goes to high/true:
  • breath phase is inspiration phase
  • the duration threshold (tp) in Criterion 2 is time threshold.
  • the duration threshold (tp) may be between 50 ms and 500 ms, such as 100 ms, 150 ms, 200 ms, 250 ms, etc.
  • the second slope threshold (y) may be between -1.0 and -6.0 Liter/min 3 .
  • FIG. 8 depicts an example method 800 for automatic synchronization in medical ventilation.
  • the operations of method 800 may be performed by a ventilator and/or a component thereof.
  • a user input is received to activate an automated synchronization mode.
  • the input may be received via a touch screen of the ventilator or via some other input mechanism of the ventilator. In some examples, this step may be omitted and the ventilator, or a particular mode of the ventilator, may automatically utilize automated synchronization operations.
  • positive pressure is delivered during a first inhalation phase.
  • the positive pressure may be delivered according to a ventilation type or ventilation strategy set on the ventilator, which may be selected by the user.
  • the ventilator cycles to a first exhalation phase at the end of the first inhalation phase.
  • the cycling to the first exhalation phase is performed according to a cycling sensitivity of the ventilator.
  • the cycling sensitivity may be represented or controlled by a cycling sensitivity value or setting, as discussed above.
  • the cycling sensitivity value may be a default value used by the ventilator. In other examples, the cycling sensitivity value may be an initial value that is set based on user input.
  • a second inhalation phase is triggered at the end of the first exhalation phase.
  • a cycling-related asynchrony event is detected.
  • the cycling- related asynchrony event may be detected during at least one of the first exhalation phase or the second inhalation phase.
  • different types of cycling-related asynchrony events may be detected in different phases, as discussed above.
  • the detection of the cycling-related asynchrony event may be based on the types of factors and criteria discussed above.
  • the cycling-related asynchrony maybe detected based on measured flow signals, a Psync signal, or other types of signals, as discussed above.
  • the cycling-related asynchrony event may be detected based on a slope of a net flow crossing zero during the first exhalation phase.
  • the cycling-related asynchrony event may be detected based on a slope of a net flow crossing zero during the first exhalation phase. Further, the cycling-related asynchrony event may be detected based on a slope of a net flow exceeding a slope threshold during the first exhalation phase. While the term “exceeding” is used herein, such a term also applies to a negative crossing of a negative threshold (e.g., a signal moving further negative passing a negative threshold). As another option, the cycling-related asynchrony event may be detected based on a second slope of a net flow exceeding a slope threshold during the first exhalation phase.
  • the cycling-related asynchrony event may be detected based on a Psync signal being negative during an exhalation phase. Other factors and criteria discussed above, along with the combinations thereof, may also be used in detecting the cycling-related asynchrony events.
  • the cycling sensitivity of the ventilatoris adjusted in operation 812. Adjusting the cycling sensitivity of the ventilator may include adjusting a cycling sensitivity value or setting. Adjusting the cycling sensitivity value may be based on the type of the asynchrony event that is detected. For example, for some cycling-related asynchrony events (e.g., a delayed- cycling event), the cycling sensitivity may be increased.
  • the cycling sensitivity may be decreased.
  • the amount of the adjustment to the cycling sensitivity may also be based on the type of cycling-related asynchrony event that is detected.
  • the adjustment to the cycling sensitivity may also be performed automatically by the ventilator without any additional user interaction or input.
  • Method 800 may continue to monitor for additional or subsequent asynchrony events and continue to adjust the cycling sensitivity while the patient is being ventilated. Accordingly, the ventilator is able to automatically adjust as the patient’s condition changes.
  • FIG. 9 depicts another example method 900 for automatic synchronization in medical ventilation.
  • Method 900 is similar to method 800 with the primary exception that method 900 is related to triggering-related asynchronies rather than cycling-related asynchronies. Similar to method 800, at operation 902 method 900 receives a user input for activating automated synchronization.
  • a first inhalation phase is triggered according to a triggering sensitivity of the ventilator.
  • the triggering sensitivity may be represented or controlled by a triggering sensitivity value or setting, as discussed above.
  • the triggering sensitivity value may be a default value and/or a user-set value when initializing the automated synchronization mode.
  • positive pressure is delivered during the first inhalation phase.
  • the ventilator cycles to a first exhalation phase at the end of the first inhalation phase.
  • a triggering-related asynchrony event is detected.
  • Detecting the triggering-related asynchrony event may be based on the factors and/or criteria discussed above.
  • the triggering-related asynchrony event may be detected based on a local minimum and a local maximum of a slope of net flow signal.
  • the first triggering-related asynchrony event is detected based on a local minimum and a local maximum of a slope of a derivative of an intrapleural pressure signal (e.g., slopePsync).
  • Other criteria discussed above may also be used detecting a triggering-related asynchrony event.
  • the triggering sensitivity is adjusted.
  • the ventilator may automatically adjust the triggering sensitivity without any additional user input or interaction. Adjusting the triggering sensitivity of the ventilator may be accomplished by adjusting a triggering sensitivity value or setting of the ventilator. Adjusting the triggering sensitivity may also be based on the type of the asynchrony event that is detected. For example, for some triggering-related asynchrony events (e.g., an auto-triggering event), the cycling sensitivity is decreased, which causes the ventilator to be less sensitive to triggering (e.g., a greater patient effort is required to trigger a breath).
  • triggering-related asynchrony events e.g., an auto-triggering event
  • decreasing the triggering sensitivity may include increasing the triggering sensitivity value or threshold.
  • the cycling sensitivity is increased, which causes the ventilator to more sensitive to triggering (e.g., a weaker patient effort will trigger a breath).
  • increasing the triggering sensitivity may include decreasing the triggering sensitivity value or threshold. The amount of the adjustment to the cycling sensitivity may also be based on the type of triggering-related asynchrony event that is detected.
  • a second inhalation phase is triggered according to the adjusted triggering sensitivity that resulted from the adjustment made in operation 912.
  • positive pressure is delivered during the second inhalation phase.
  • Method 900 may continue to monitor for additional or subsequent asynchrony events and continue to adjust the triggering sensitivity while the patient is being ventilated.
  • method 900 may further include cycling from the second inhalation phase to a second exhalation phase, and then, during the second exhalation phase, detecting a second triggering-related asynchrony event. Based on detecting the second triggering-related asynchrony event, the ventilator may then re-adjust (e.g., a second adjustment) the adjusted triggering sensitivity. The amount of the first adjustment may differ from the amount of the second adjustment.
  • the first triggering-related asynchrony event may be an auto-triggering event
  • the second triggering-related asynchrony event is a missed- triggering event.
  • the amount of the first adjustment may be less than the amount of the second adjustment.
  • the method 900 may be combined with (or executed concurrently with) method 800 to allow for changes to both the triggering sensitivity values and the cycling sensitivity values. Accordingly, the ventilator is able to automatically adjust as the patient’s condition changes.
  • the phrase “at least one of element A, element B, or element C” is intended to convey any of: element A, element B, element C, elements A and B, elements A and C, elements B and C, and elements A, B, and C.

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Abstract

Des systèmes et des procédés d'amélioration automatiquement d'une synchronisation patient-ventilateur, comprenant un procédé, exécuté par un ventilateur, pour l'ajustement synchrone automatique dans une ventilation médicale. Le procédé peut comprendre l'administration d'une pression positive durant une première phase d'inspiration ; un établissement de cycle jusqu'à une première phase d'expiration à une extrémité de la première phase d'inspiration en fonction d'une sensibilité à la périodicité ; et à une fin de la première phase d'expiration, le déclenchement d'une seconde phase d'inspiration. Le procédé peut également comprendre durant au moins l'une de la première phase d'expiration ou de la seconde phase d'inspiration, la détection d'un évènement d'absence de synchronicité lié à la périodicité ; en réponse à la détection, l'ajustement automatiquement de la sensibilité à la périodicité sans entrée utilisateur additionnelle ; l'administration d'une pression positive durant la seconde phase d'inspiration ; et l'établissement de cycle depuis la seconde phase d'inspiration vers une seconde phase d'expiration en fonction de la sensibilité ajustée à la périodicité.
PCT/IB2022/058592 2021-09-16 2022-09-12 Synchronisation automatique pour ventilation médicale WO2023042064A1 (fr)

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US20200108215A1 (en) * 2018-10-03 2020-04-09 Covidien Lp Systems and methods for automatic cycling or cycling detection
WO2021011748A1 (fr) * 2019-07-17 2021-01-21 Convergent Engineering, Inc. Système d'aide à la décision clinique relatif à la pression œsophagienne

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20140034054A1 (en) * 2012-07-31 2014-02-06 Nellcor Puritan Bennett Llc Ventilator-initiated prompt or setting regarding detection of asynchrony during ventilation
US20190344034A1 (en) * 2018-05-14 2019-11-14 Covidien Lp Systems and methods for respiratory effort detection utilizing signal distortion
US20200108215A1 (en) * 2018-10-03 2020-04-09 Covidien Lp Systems and methods for automatic cycling or cycling detection
WO2021011748A1 (fr) * 2019-07-17 2021-01-21 Convergent Engineering, Inc. Système d'aide à la décision clinique relatif à la pression œsophagienne

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