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Work of breathing display for a ventilation system

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20120277616 patent thumbnailZoom

Work of breathing display for a ventilation system


A breathing support system is provided. The system may include a breathing support device configured to deliver gas to a patient and a display device associated with the breathing support device. The display device may he configured to display a work of breathing graphic indicating one or more work of breathing measures regarding the patient's breathing.

Browse recent Nellcor Puritan Bennett Incorporated patents - Pleasanton, CA, US
Inventors: Warren G. Sanborn, Peter R. Doyle
USPTO Applicaton #: #20120277616 - Class: 600538 (USPTO) - 11/01/12 - Class 600 
Surgery > Diagnostic Testing >Respiratory >Measuring Breath Flow Or Lung Capacity

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The Patent Description & Claims data below is from USPTO Patent Application 20120277616, Work of breathing display for a ventilation system.

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TECHNICAL FIELD

The present disclosure relates generally to the field of respiratory support, and more particularly to a graphical display indicating work of breathing measures.

BACKGROUND

One indication of a patient\'s condition during respiration support is the status of the patient\'s work of breathing (WOB). Work of breathing may be defined as the work associated with inflating the patient\'s lungs during a breathing cycle. During respiration support, a ventilator provides at least a portion of the total work of breathing for the patient. The total work of breathing (WOBTOTAL) may generally be defined as the sum of the work of breathing provided by the patient (WOBPATIENT) and the work of breathing support provided by the ventilator (WOBVENTILATOR).

The work of breathing provided by the patient (WOBPATIENT) may be approximated as the sum of two components: an elastic WOB component (WOBPATIENT-ELASTIC) and a resistive WOB component (WOBPATIENT-RESISTIVE). The elastic WOB component is generally defined as the work required to overcome the elastance of the patient\'s respiratory system, while the resistive component is generally defined as the work required to overcome the airway resistance of the patient\'s respiratory system.

Elastance may generally be defined in terms of the elastic properties of the lung and chest, or the forces associated with expanding the lung. In particular, the degree of stiffness of the lung-chest region may be referred to as the elastance of the respiratory system. The elastance of the respiratory system may also be discussed in terms of compliance, which may be defined as the inverse of elastance. Generally, the easier it is to stretch the lung-chest region.

Resistance forces, or the non-elastic forces at work in the breathing cycle, are the forces associated with moving air through a patient\'s airways. Lung resistance may be at least partially defined by a patient\'s physiological conditions. For example, patients suffering from asthma typically experience muscular constriction of the bronchi. Such patients may also experience swelling of the bronchial mucosa. The work required to achieve a particular amount of air flow through the breathing passageways generally increases in proportion to the severity of constriction. In some ventilation systems, flow and pressure sensors are used to compute estimates of the patient\'s resistance and compliance.

One or more WOB values, e.g., the total WOB, the patient\'s WOB (WOBPATIENT), the ventilator\'s WOB (WOBVENTILATOR), the elastic WOB component (WOBPATIENT-ELASTIC), and/or the resistive WOB component (WOBPATIENT-RESISTIVE) may be determined and/or monitored in various manners. For example, a patient\'s WOB may be determined from either measured or estimated values relating to the patient\'s respiratory physiology by applying direct or indirect approaches and following established algorithms. Measured values may be obtained more directly by invasive procedures, e.g., procedures that require the installation of an esophageal balloon. Such techniques are typically invasive and require specialized skill. Thus, outside of the research setting it may be undesirable to obtain WOB measures employing such invasive means.

In a pressure assisted ventilation (PAV) system, the patient\'s work of breathing (WOBPATIENT), the elastic WOB component (WOBPATIENT-ELASTIC), and/or the resistive WOB component (WOBPATIENT-RESISTIVE) may be estimated by inputting measurements from various sensors into the breathing algorithms. In PAV ventilation, the patient is supplied with continuous pressure assistance throughout an inspiratory effort and in direct proportion to the moment-to-moment inspiratory effort. Typically, none of the instantaneous inspiratory pressure, the instantaneous flow, or the resulting volume are set by the caregiver. Because the PAV breathing algorithm harmoniously links the ventilator to the patient, the patient effectively “drives” the ventilator. By appropriately setting the value of the proportionality (% support) control, the caregiver may effectively partition the total WOB between the patient (WOBPATIENT) and the ventilator (WOBVENTILATOR).

The values of the patient\'s lung-chest compliance and lung resistance may be continuously estimated and inserted into the PAV breathing algorithm in order for the algorithm to function properly. These estimates may be made automatically by the ventilator and fed back to the breathing algorithm as perhaps better fits the needs of the patient in intensive care, whereas manual techniques may be used to estimate the values for more stable patients, e.g., in a home setting.

SUMMARY

In accordance with the present disclosure, systems and methods for monitoring and/or displaying one or more work of breathing measures are provided.

According to one embodiment, a breathing support system is provided. The system may include a breathing support device configured to deliver gas to a patient and a display device associated with the breathing support device. The display device may be configured to display a work of breathing graphic indicating one or more work of breathing measures regarding the patient\'s breathing.

According to another embodiment, a device for displaying work of breathing information associated with a breathing support system is provided. The device may include a work of breathing calculation module configured to determine one or more work of breathing measures regarding a patient\'s breathing, and a display configured to present a work of breathing graphic indicating the one or more determined work of breathing measures.

According to yet another embodiment, a method for displaying a work of breathing graphic associated with a breathing support system is provided. The method may include calculating one or more work of breathing measures regarding a patient\'s breathing, and displaying a work of breathing graphic indicating the one or more calculated work of breathing measures.

According to yet another embodiment, a ventilation system for assisting with a patient\'s breathing is provided. The system may include gas delivery means for delivering gas to a patient, and display means for displaying a work of breathing graphic that indicates one or more work of breathing measures regarding the patient\'s breathing.

According to yet another embodiment, a computer-readable medium including computer-executable instructions for providing a work of breathing graphic associated with breathing support for a patient is provided. The computer-executable instructions may include instructions for calculating one or more work of breathing measures regarding a patient\'s breathing, and instructions for displaying a work of breathing graphic indicating the one or more calculated work of breathing measures.

BRIEF DESCRIPTION OF THE DRAWINGS

Some embodiments of the disclosure may be understood by referring, in part, to the following description and the accompanying drawings, in which like reference numbers refer to the same or like parts, and wherein:

FIG. 1 illustrates a ventilation system for providing ventilation support to a patient, including a ventilator configured to display a work of breathing graphic, according to one embodiment of the disclosure;

FIG. 2 illustrates a ventilation system for providing ventilation support to a patient, including a ventilator and a separate module for displaying a work of breathing graphic, according to one embodiment of the disclosure;

FIG. 3 is a block diagram illustrating an example system for determining and displaying work of breathing measures, according to some embodiments;

FIG. 4 illustrates a first example graphic work of breathing graphic, according to one embodiment of the disclosure;

FIG. 5 illustrates a second example graphic work of breathing graphic, according to one embodiment of the disclosure;

FIG. 6 illustrates a third example graphic work of breathing graphic, according to another embodiment of the disclosure;

FIG. 7 illustrates a fourth example graphic work of breathing graphic, according to another embodiment of the disclosure;

FIG. 8 illustrates a fifth example graphic work of breathing graphic, according to another embodiment of the disclosure; and

FIG. 9 illustrates a sixth example graphic work of breathing graphic, according to another embodiment of the disclosure.

DETAILED DESCRIPTION

Selected embodiments of the disclosure may be understood by reference, in part, to FIGS. 1-9, wherein like numbers refer to same and like parts.

In general, the present disclosure describes generating and/or displaying a work of breathing graphic (WOB graphic) for use with a ventilator or other breath delivery or breathing support system that may provide caregivers with various information concerning work of breathing through an easily understood graphical display. The WOB graphic may be used, e.g., for monitoring and/or adjusting the amount of work of breathing contributed by the patient and/or the amount contributed by the ventilator. For example, the display may allow a caregiver to monitor a patient\'s work of breathing in real time or substantially in real time. A caregiver may use such information for various purposes, such as, for example, to ensure that the patient\'s work of breathing is within a safe or desirable range and/or to determine whether and/or how to adjust one or more ventilator settings (e.g., to increase or decrease respiratory support to the patient).

In some embodiments, the WOB graphic may depict (graphically, numerically, or otherwise) the effect that changes in one or more ventilator settings have on the work of breathing being contributed by a patient, e.g., in order to determine whether or not such adjustments are causing a patient to work at a level above, within, or below an acceptable or desired range of work. The WOB graphic may be user-friendly such that caregivers of various degrees of technical sophistication may understand or interpret the display and/or be able to utilize the display for implementing or managing a respiration support strategy. Additionally, the WOB graphic may be used in conjunction with traditional ventilation systems and applications, e.g., pressure assisted ventilation (PAV) applications.

The WOB graphic may be displayed via any of a variety of media. For example, in some embodiments, the WOB graphic may be displayed by a ventilator or a ventilator control system. In other embodiments, the WOB graphic may be displayed on a separate display device (e.g., separate from a ventilator). In particular embodiments, the WOB graphic may be displayed in association with a ventilation control system for administering a respiration support strategy. In such embodiments, a ventilator may be connected to a graphic user interface having a digital processor, a display screen, and/or one or more user inputs, or the ventilator may itself include a graphic user interface. These components may cooperate to assist a caregiver in setting up and/or adjusting the work of breathing being provided by a patient and/or the work of breathing being provided the ventilator.

In some embodiments, the WOB graphic may indicate the total work of breathing (WOBTOTAL), the patient\'s work of breathing (WOBPATIENT) (neither or which, one or which, or both of which advance or retreat along a scale) and/or the components of the patient\'s WOB—an elastic WOB component (WOBPATIENT-ELASTIC) and a resistive WOB component (WOBPATIENT-RESISTIVE). For example, the WOB graphic may include a WOBTOTAL graphic or indicator that that indicates the total work of breathing, a WOBPATIENT graphic or indicator that that indicates the patient\'s work of breathing, and an elastic-resistive WOB graphic that indicates a measure of the elastic WOB component (WOBPATIENT-ELASTIC) relative to a measure of the resistive WOB component (WOBPATIENT-RESISTIVE). As another example, the WOB graphic may include a WOBTOTAL graphic or indicator that that indicates the total work of breathing, a WOBPATIENT-ELASTIC) graphic or indicator that that indicates the patient\'s work of breathing, an elastic WOB graphic that indicates a measure of the elastic WOB component (WOBPATIENT-ELASTIC) and a resistive WOB graphic that indicates a measure of the resistive WOB component (WOBPATIENT-RESISTIVE). In other embodiments, one or more additional and/or other components of a total work of breathing measure may be displayed, e.g., the ventilator work of breathing (WOBVENTILATOR).

In some embodiments, the WOB graphic may include a scale having any suitable shape and configuration (e.g., a linear scale, a circular or semicircular scale, or an elliptical scale) and one or more indicators that move relative to the scale to indicate one or more work of breathing parameters. For example, the WOB graphic may include a first indicator that moves relative to the scale to represent a measure of WOBTOTAL, and a second indicator that moves relative to the scale to represent a measure of WOBPATIENT. The scale may be divided into sectors that generally correspond to different work of breathing levels. The sectors may be visibly discernable from each other (or at least from immediately adjacent sectors). For example, the sectors may be color-coded or distinctively shaded.

An elastic-resistive WOB graphic may be divided into a first portion and a second portion, the first portion indicating the elastic WOB component (WOBPATIENT-ELASTIC) and the second portion indicating the resistive WOB component (WOBPATIENT-RESISTIVE). The relative sizes of the first and second portions of the elastic-resistive WOB graphic may dynamically adjust to indicate the measure of the elastic WOB component relative to the measure of the resistive WOB component. In certain embodiments, the overall size of the elastic-resistive WOB graphic remains constant as the relative sizes of the first and second portions dynamically adjust.

FIGS. 1 and 2 illustrate two example embodiments of a ventilation system including a displayed WOB graphic. More particularly, FIG. 1 illustrates an example ventilation system including a ventilator configured to display a work of breathing graphic, while FIG. 2 illustrates an example ventilation system including a ventilator and a separate module for displaying a work of breathing graphic.

Referring to FIG. 1, a ventilation system 10a for providing breathing assistance to a patient 12 may include a ventilator 14 configured to display a WOB graphic 16 and one or more devices for connecting ventilator 14 to patient 12. As used throughout this document, the term “ventilator” may refer to any device, apparatus, or system for delivering breathing gas to a patient, e.g., a ventilator, a respirator, a CPAP device, or a BiPAP device. The term “patient” may refer to any person who is receiving breathing support from a ventilation system, regardless of the medical status, official patient status, physical location, or any other characteristic of the person. Thus, for example, patients may include persons under official medical care (e.g., hospital patients), persons not under official medical care, persons receiving care at a medical care facility, persons receiving home care, etc.

Ventilator 14 may include a ventilation control system 18, a display device 20, and a WOB calculation module 22. Ventilation control system 18 may be operable to control the ventilation support provided by ventilator 14 based on various inputs, such as inputs received from an operator and/or data received from various sensors, as discussed below. Display device 20 may be fully or partially integrated with ventilator 14 and may comprise, e.g., a touch screen display or other visual display. Display device 20 may be configured to display various information regarding the ventilation of patient 12, including WOB graphic 16 and/or other information regarding the ventilation of patient 12 (e.g., tidal volume, minute ventilation, and respiration rate). WOB graphic 16 may display one or more work of breathing measures in any suitable manner, e.g., graphically, numerically, or otherwise. WOB graphic 16 may be a full screen display or may occupy a portion of a display screen. For example, WOB graphic 16 may be located in a window or a portion of a display that includes other information regarding the ventilation of patient 12.

Display device 20 may be part of or otherwise associated with, a graphic user interface 26. In this embodiment, graphic user interface 26 may be configured to display WOB graphic 16 and/or other information via display device 20 and/or provide an interface for accepting input from human operators via display device 20 and/or other input devices (e.g., to set or modify ventilation settings, to access data, and/or to change or configure the display).

Patient 12 may be connected to ventilator 14 by a breathing circuit 30 that may include an inspiration conduit 32, an exhalation conduit 34, and/or a patient connection apparatus 36. Patient connection apparatus 36 may include any device or devices configured to connect breathing circuit 30 to one or more breathing passageways of patient 12. For example, patient connection apparatus 36 may include a patient connection tube directly connected to the patient\'s trachea, an artificial airway (e.g., an endotracheal tube or other device) inserted in the patient\'s trachea, and/or a mask or nasal pillows positioned over the patient\'s nose and/or mouth. In embodiments including a patient connection tube, the patient connection tube may include a Wye (or “Y”) connector.

Ventilation system 10a may include one or more sensors 40 for sensing, detecting, and/or monitoring one or more parameters related to the ventilation of patient 12, e.g., parameters regarding the ventilation provided by ventilator 14 and/or physiological parameters regarding patient 12. For example, sensors 40 may include one or more devices for measuring various parameters of gas flowing into or out of patient 12 or ventilator 14, e.g., the pressure, flow rate, flow volume, temperature, gas content, and/or humidity of such gas flow. Thus, sensors 40 may include, e.g., one or more pressure sensors, flow meters, transducers, and/or oxygen sensors. Sensors 40 may be located at one or more various locations in ventilation system 10a for monitoring the pressure and or flow of gasses flowing into and/or out of patient 12 and/or ventilator 14. For example, one or more sensors 40 may be located in or proximate ventilator 14, breathing circuit 30, and/or patient connection apparatus 36. For example, depending on the particular embodiment, one or more sensors 40 may be located within or proximate to ventilator 14, inspiration conduit 32 and/or exhalation conduit 34 or breathing circuit 30, an artificial airway, and/or a Wye connector.

As discussed above, ventilation control system 18 may be operable to control the ventilation support provided by ventilator 14 based on various input received from an operator (e.g., via graphic user interface 26 and/or other user interfaces on ventilator 14) and/or data received from one or more sensors 40. For example, ventilation control system 18 may regulate the pressure and/or flow of gas delivered to a patient based at least on data received from sensors 40.

WOB calculation module 22 may be operable to calculate or otherwise determine one or more work of breathing measures based on various input data, including data collected by sensors 40, as described in greater detail below with reference to FIG. 3. Such work of breathing measures determined by WOB calculation module 22 may then be communicated to graphic user interface 26 for display via display device 20.

According to the embodiment shown in FIG. 2, a ventilation system 10b for providing breathing assistance to a patient 12 may include a ventilator 14, one or more devices for connecting ventilator 14 to patient 12, and a separate WOB module 50. Ventilator 14 may include a ventilation control system 18 and a display screen 20, such as discussed above regarding the embodiment shown in FIG. 1. Ventilation control system 18 may be operable to control the ventilation support provided by ventilator 14 based on various inputs, such as inputs received from an operator and/or data received from various sensors, as discussed below. Display device 20 may be fully or partially integrated with ventilator 14 and may comprise, e.g., a touch screen display or other visual display. Display device 20 may be configured to display various information regarding the ventilation of patient 12. Display device 20 may be part of or otherwise associated with, a graphic user interface 26. In this embodiment, graphic user interface 26 may be configured to display various information via display device 20 and/or provide an interface for accepting input from human operators via display device 20 and/or other input devices (e.g., to set or modify ventilation settings, to access data, and/or to change or configure the display).

WOB module 50 may include a display device 52, a WOB calculation module 22, and any other suitable hardware or software for determining and/or displaying one or more WOB measures. For example, WOB module 50 may be configured to display a WOB graphic 16 via display device 52, e.g., a touch screen display or other visual display. As discussed above, WOB graphic 16 may be a full screen display or may occupy a portion of a display screen. In some embodiments, WOB module 50 may include a graphic user interface 54, which may be operable to display WOB graphic 16 and/or other information via display device 52 and, in some embodiments, provide an interface for accepting input from human operators via display device 52 and/or other user input devices (e.g., to set or modify various settings, access data, and/or change or configure the display).

WOB calculation module 22 may be operable to calculate or otherwise determine one or more work of breathing measures based on various input data, including data collected by sensors 40. WOB calculation module 22 may receive such input data from any suitable component of ventilation system 10b. For example, WOB module 50 may be communicatively coupled to one or more sensors 40 (e.g., sensors 40 located at or proximate to an artificial airway (e.g., an endotracheal tube or other device), a Wye connector, or breathing circuit 30) such that WOB module 50 may receive data directly from such sensors 40, e.g., as indicated by dashed line 56. Alternatively, WOB module 50 may be communicatively coupled to ventilator 14 such that WOB module 50 may receive data from ventilator 14 (e.g., as indicated by dashed line 58), which may include data received from various sensors 40 (which data may or may not be first processed or otherwise acted on by ventilator 14 and then communicated to WOB module 50). WOB calculation module 22 may receive data from sensors 40 directly or indirectly in any other suitable manner. WOB calculation module 22 may then calculate or otherwise determine one or more work of breathing measures based on such data from sensors 40, and communicate the determined work of breathing measures for display via display device 52.

It should be understood that components of ventilation systems 10a and 10b may include any hardware, software, firmware or other components suitable for providing ventilation assistance to patient 12 and/or determining and displaying one or more work of breathing measures. For example, ventilator 14 may include various processors, memory devices, user inputs, status indicators, audio devices, and/or software or other logic for providing various ventilator functions.

FIG. 3 is a block diagram illustrating an example system for determining and displaying work of breathing measures, according to some embodiments. As discussed above, WOB calculation module 22 may be operable to calculate or otherwise determine one or more work of breathing measures based on various input data. Such input data may include data received from sensors 40 and/or data or settings input by an operator, indicated in FIG. 3 as operator input 60. Such WOB measures may then be represented in a WOB graphic 16 displayed on any suitable display device 100, e.g., display devices 20 or 52 discussed above with reference to FIGS. 1 and 2. For example, WOB calculation module 22 may calculate measures for WOBTOTAL, WOBPATIENT, WOBVENTILATOR, WOBPATIENT-ELASTIC, and/or WOBPATIENT-RESISTIVE. One, some, or all of these measures may then be displayed in a WOB graphic 16 in any suitable manner, e.g., using graphic and/or numeric representations.

WOB calculation module 22 may include a processor 62, memory 64, and any other suitable hardware or software. Memory 64 may store one or more WOB algorithms 66 and/or any other suitable software or logic that may be executable by processor 60 for calculating one or more work of breathing measures, e.g., as discussed below.

WOB calculation module 22 may use data collected by sensors 40 to calculate or otherwise determine work of breathing measures in any of a variety of manners. For example, in some embodiments in which a balloon is inserted in the patient\'s esophagus, sensors 40 may be used to monitor pressure and volume (flow*time) at the airway opening (e.g., at or proximate to a Wye connector). Such data may be communicated to WOB calculation module 22, which may determine or calculate one or more WOB measures based on such received data.

Alternatively, WOB calculation module 22 may calculate estimated WOB measures based on data monitored entirely external to the patient, e.g., using WOB 66 algorithms that use data from sensors 40 as inputs. For example, in a pressure assisted ventilation (PAV) environment, WOB calculation module 22 may receive data from sensors 40 positioned in or proximate to ventilator 14 and calculate estimated WOB measures using such data as inputs for one or more suitable PAV algorithms. Example techniques for providing or generating PAV, which may lead to WOB calculations, are disclosed in U.S. Pat. No. 5,107,830, which is hereby incorporated by reference in its entirety. In addition, example techniques for determining or approximating resistance and/or elastance in a PAV environment, which may be used in calculating WOB values, are disclosed in U.S. Pat. Nos. 5,884,622 and 6,837,242, which are hereby incorporated by reference in their entirety.



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stats Patent Info
Application #
US 20120277616 A1
Publish Date
11/01/2012
Document #
13543574
File Date
07/06/2012
USPTO Class
600538
Other USPTO Classes
12820423
International Class
/
Drawings
6



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