JP2012005882A - 無効吸気努力を検出し患者と人工呼吸器の相互作用を改善する方法および装置 - Google Patents
無効吸気努力を検出し患者と人工呼吸器の相互作用を改善する方法および装置 Download PDFInfo
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- 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
- A61B5/0871—Peak expiratory flowmeters
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/42—Detecting, measuring or recording for evaluating the gastrointestinal, the endocrine or the exocrine systems
- A61B5/4205—Evaluating swallowing
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
- A61M16/0051—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes with alarm devices
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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
- A61M16/026—Control means therefor including calculation means, e.g. using a processor specially adapted for predicting, e.g. for determining an information representative of a flow limitation during a ventilation cycle by using a root square technique or a regression analysis
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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
- A61M16/0003—Accessories therefor, e.g. sensors, vibrators, negative pressure
- A61M2016/003—Accessories therefor, e.g. sensors, vibrators, negative pressure with a flowmeter
- A61M2016/0033—Accessories therefor, e.g. sensors, vibrators, negative pressure with a flowmeter electrical
- A61M2016/0036—Accessories therefor, e.g. sensors, vibrators, negative pressure with a flowmeter electrical in the breathing tube and used in both inspiratory and expiratory phase
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Abstract
【解決手段】(i)人工呼吸器がサイクル動作した後の患者の呼吸気流を監視し、(ii)前記気流を示す信号を作成し、(iii)前記信号からアーチファクトを除去し、(iv)前記信号の摂動を監視し、(v)前記摂動が顕著なとき、無効努力が生じたと判断することを含む、人工呼吸器によって機械的に換気されている患者の無効努力を検出する方法およびシステムであり、前記信号からアーチファクトを除去する前記工程が、心原性振動を表す信号を除去する工程を含み、前記信号からアーチファクトを除去する前記工程が、咳が生じたかを判断する工程を含み、前記信号からアーチファクトを除去する前記工程が、分泌を示す信号を除去する工程を含むことを特徴とする方法。
【選択図】図7
Description
本出願は、その全体が参考により本明細書に組み込まれる、2004年10月20日出願の米国仮出願第60/619957号の利益を主張する。
1)例えば一連の無効トリガ後の計量値の統計的参照値を使用し、人工呼吸器を介した外因性PEEPの供給をサーボ調整して、適用されるPEEPを漸増的に押し上げて指数を最小限に抑える。
2)例えば一連の無効トリガ後の計量値の統計的参照値を使用し、人工呼吸器を介した一回呼吸量の供給をサーボ調整して、一回呼吸量の供給を漸減的に減少させて指数を最小限に抑える。
3)例えば一連の無効トリガ後の計量値の統計的参照値を使用し、人工呼吸器を介した圧支持の供給をサーボ調整して、圧支持を漸減的に低減して指数を最小限に抑える。
4)フロートリガ式の人工呼吸器の場合、例えば一連の無効トリガ後に、IPAPを直接トリガするアルゴリズムを、フロー極性に対するその中立性に基づいて使用し、トリガを再度高感度化して指数を最小限に抑える。
これらの摂動は、
・人工呼吸器がサイクル動作した後、かつ次にトリガする前、すなわち成功した吸気補助がない状態で呼気の間に生じ、
・必ずしも正方向のフローによってではなく、むしろ遅延された負のフローによって特徴付けられ、
・ノイズ、または、分泌もしくは心原性振動などの他の低振幅現象と区別できる点で「顕著」であり、
・嚥下または咳などの他の生理現象によって引き起こされる顕著な摂動と区別できる点で「固有」である。
1)人工呼吸器自体であってよい、データ取得システムおよびメモリを含むロギング装置を使用して、換気された患者から2つの信号が記録される。これらの信号は、気流(Q)および口腔における気道内圧(P)である。
2)フローおよび気道内圧の信号は、ノイズを最小限に抑えるため、平滑/ノイズフィルタに通される。そのような1つの例は、低次で位相遅れを最小限にし、遮断周波数が1Hzであるバターワース低域フィルタである。
3)米国特許第6,152,129号(Berthon-Jones)に記載されているような、意図的でない漏れを補償するアルゴリズムをフロー信号に適用する。
4)フロー信号の一次導関数(Q')が計算される。
5)フロー信号の二次導関数(Q'')が計算される。
1)人工呼吸器自体であってよい、データ取得システムおよびメモリを含むロギング装置を使用して、換気された患者から2つの信号が記録される。これらの信号は、気流(Q)および口腔における気道内圧(P)である。
2)フローおよび気道内圧の信号は、ノイズを最小限に抑えるため、平滑/ノイズフィルタに通される。そのような1つの例は、低次で位相遅れを最小限にし、遮断周波数が1Hzであるバターワース低域フィルタである。
3)米国特許第6,152,129号(Berthon-Jones)に記載されているような、意図的でない漏れを補償するアルゴリズムをフロー信号に適用する。
4)フロー信号の一次導関数(Q')が計算される。
5)フロー信号の二次導関数(Q'')が計算される。
1. max_detected - 局所極大が生じたかを示す
2. TIE - 最も最近の局所極大の発現、すなわち患者努力の減衰の発現からの経過時間
3. potential_swallow - 患者が嚥下している可能性があるかを示す
4. TSA - 潜在的な嚥下の発現からの経過時間
5. dec_detected - 顕著な下り勾配がすでに検出されたかを示す
(Qi > Qi-1)のとき、PEF = Qi
式中、iはサンプルシーケンスを示す。PEFが約200L/min-1の閾値を超える場合、咳が生じたと考えられ、PEFはヌル値を割り当てられる。
Q'i < 0およびQ'i-1 > 0、またはQ'i = 0
Q'i > 0およびQ'i-l < 0
|Declivity| = Qa - Qb
3 最大呼気流量を決定する
10 局所極小、すなわちQ´=0は増加?
12 フロー値Qbを格納する
13 最大呼気流量
Claims (1)
- (i)人工呼吸器がサイクル動作した後および人工呼吸器がトリガした前の患者の呼吸気流を監視する手段と、
(ii)前記気流を示す信号を作成する手段と、
(iii)患者の最大呼気流量(PEF)を決定する手段と、
(iv)前記信号の摂動を監視する手段と、
(v)非無効努力から無効努力を区別するために摂動を分類する手段とを備え、
摂動を分類する前記手段は、気流の二次導関数が負の閾値よりも大きい時に発生したと判断される顕著な下り勾配を検出する手段を備えることを特徴とする、人工呼吸器によって機械的に換気されている患者の無効努力を検出するシステム。
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US61995704P | 2004-10-20 | 2004-10-20 | |
US60/619,957 | 2004-10-20 |
Related Parent Applications (1)
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JP2007537070A Division JP4960246B2 (ja) | 2004-10-20 | 2005-10-20 | 患者と人工呼吸器の相互作用における無効呼気努力を検出するシステム |
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JP2012005882A true JP2012005882A (ja) | 2012-01-12 |
JP2012005882A5 JP2012005882A5 (ja) | 2012-02-23 |
JP5662289B2 JP5662289B2 (ja) | 2015-01-28 |
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JP2007537070A Active JP4960246B2 (ja) | 2004-10-20 | 2005-10-20 | 患者と人工呼吸器の相互作用における無効呼気努力を検出するシステム |
JP2011212389A Expired - Fee Related JP5662289B2 (ja) | 2004-10-20 | 2011-09-28 | 無効吸気努力を検出し患者と人工呼吸器の相互作用を改善する方法および装置 |
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JP2007537070A Active JP4960246B2 (ja) | 2004-10-20 | 2005-10-20 | 患者と人工呼吸器の相互作用における無効呼気努力を検出するシステム |
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US (2) | US8603006B2 (ja) |
EP (1) | EP1807139B1 (ja) |
JP (2) | JP4960246B2 (ja) |
CN (2) | CN102512736B (ja) |
WO (1) | WO2006079152A1 (ja) |
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EP1807139A4 (en) | 2010-06-23 |
US9597013B2 (en) | 2017-03-21 |
CN102512736B (zh) | 2015-09-02 |
CN101043913B (zh) | 2012-02-08 |
JP5662289B2 (ja) | 2015-01-28 |
JP4960246B2 (ja) | 2012-06-27 |
WO2006079152A1 (en) | 2006-08-03 |
EP1807139A1 (en) | 2007-07-18 |
CN102512736A (zh) | 2012-06-27 |
US20140066725A1 (en) | 2014-03-06 |
CN101043913A (zh) | 2007-09-26 |
JP2008516702A (ja) | 2008-05-22 |
US8603006B2 (en) | 2013-12-10 |
US20080110461A1 (en) | 2008-05-15 |
EP1807139B1 (en) | 2019-11-27 |
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