Surgery – Respiratory method or device – Means for indicating improper condition of apparatus
Reexamination Certificate
2000-03-03
2003-12-30
Lewis, Aaron J. (Department: 3761)
Surgery
Respiratory method or device
Means for indicating improper condition of apparatus
C128S204210, C128S204230, C128S205230
Reexamination Certificate
active
06668824
ABSTRACT:
BACKGROUND OF THE INVENTION
1. Field of the Invention
This invention relates generally to breathing ventilators, and more particularly relates to a pneumatically driven, electronically controlled ventilator system for providing breathing gas to a patient, and a method and system for detection of disconnection and occlusion in an airway of the ventilator system.
2. Description of Related Art
A patient receiving breath pressure support from a ventilator system typically receives breathing gas through a patient circuit of the ventilator. The patient circuit generally consists of two flexible conduits connected to a fitting called a patient wye. The free ends of the conduits are attached to the ventilator so that one conduit receives breathing gas from the ventilator's pneumatic system, and the other conduit returns gas exhaled by the patient to the ventilator. The volume of the exhaled gas may then be measured in a spirometer before it finally exits through an exhalation valve. The wye fitting is typically connected to the patient's breathing attachment or enclosure, which conducts breathing gas into the lungs, and exhaled gas from the lungs to the exhalation branch of the patient circuit. The pneumatic system at the inspiratory end of the patient circuit is typically closed before a breath, and the exhalation valve at the exhalation end of the patient circuit is typically preceded by a one-way valve, to prevent gas from flowing retrograde in the exhalation branch of the patient circuit.
Occurrences of low pressures in the exhalation limb of the patient's breathing gas circuit during the exhalation phase of the pressure supported breath can be a cause of concern for the patient unless they are carefully controlled. Pressures in the patient lung that fall below PEEP (Positive End Expiratory Pressure, a baseline pressure value) can impair a patient's lung function, and it can be important to maintain PEEP in a patient's lung to prevent collapse of the lung.
Disconnections of a patient breathing circuit can occur at the inspiratory limb, the expiratory limb, the patient circuit wye, or between the endotracheal tube and the patient wye. Patient breathing circuit disconnections result in the patient receiving either no breathing gas or very little gas from the ventilator, and can interfere severely with maintenance of PEEP. During ventilation, it is also desirable to be able to assess the state of the tubing system so that conditions such as kinked tubes and high resistance filters that can occlude the flow of breathing gas and interfere with maintenance of PEEP are detected, to prevent injury to the patient attached to the ventilator, and so that increases in the work of breathing are minimized. It is also important to detect an occlusion condition in which the exhalation valve is stuck closed. Therefore, it is important to be able to detect disconnections and occlusions and to alert the respiratory therapist to these conditions. The present invention meets these needs.
SUMMARY OF THE INVENTION
Briefly, and in general terms, the present invention provides for a system and method for detecting disconnection and occlusion of a tubing system in the patient circuit of a patient ventilator. Once a patient tubing disconnection has been determined, the ventilator can then open the exhalation valve, deliver an idle flow with 100% oxygen to the tubing system, disable breath triggering, and generate an alarm indicating disconnection. The system and method of the invention can also detect a reconnection of the tubing system, and initiate resumption of pressure supported inspiration. For occlusion detection, the pressure drop in the tubing system is determined by pressure sensors in the inspiratory and expiratory airways of the tubing system. The two pressure drop values are compared and a severe alarm will sound if the actual pressure drop exceeds the severe level. Once occlusion is detected, the ventilator can respond to protect the patient from over distension, and can monitor the tubing system for abatement of the occlusion in a pressure based occlusion status cycling mode. The ventilator can revert back to normal ventilation when either circuit occlusion or exhaust port occlusion are not detected.
In one currently preferred embodiment, the invention accordingly provides for a method for detecting disconnection or occlusion of a patient tubing system of a pneumatically driven, electronically controlled ventilator system for providing breathing gas to a patient during the exhalation phase of a breath cycle, the exhalation phase having a plurality of control intervals, with each of the control intervals having a predetermined duration. A method of the invention comprises the steps of delivering a flow of breathing gas to a patient during an inspiratory phase of a breath cycle, determining an onset of an exhalation phase of the breath cycle, suspending gas flow delivery to the patient tubing system during the exhalation phase of the breath cycle, and monitoring exhalation flow and pressure in the patient tubing system during a plurality of control intervals of the exhalation phase of the breath cycle to determine whether a condition indicating disconnection of the patient tubing system has occurred. The exhalation pressure in the patient tubing system is monitored during a plurality of control intervals of the exhalation phase of the breath cycle to determine whether a condition indicating occlusion of the patient tubing system has occurred; and a disconnection signal indicating disconnection of the patient tubing system is generated responsive to the exhalation flow and the pressure in the patient tubing system if the condition indicating occlusion of the patient tubing system has not occurred, and if the condition indicating disconnection of the patient tubing system has occurred.
In another currently preferred embodiment, the invention provides for a system for detecting disconnection or occlusion of a patient tubing system of a pneumatically driven, electronically controlled ventilator system for providing breathing gas to a patient during the exhalation phase of a breath cycle, the exhalation phase having a plurality of control intervals, with each of the control intervals having a predetermined duration. The system comprises means for delivering a flow of breathing gas to a patient during an inspiratory phase of a breath cycle, means for determining an onset of an exhalation phase of the breath cycle, means for suspending gas flow delivery to the patient tubing system during the exhalation phase of the breath cycle, and means for monitoring exhalation flow and pressure in the patient tubing system during a plurality of control intervals of the exhalation phase of the breath cycle to determine whether a condition indicating disconnection of the patient tubing system has occurred. The system may include means for monitoring exhalation pressure in the patient tubing system during a plurality of control intervals of the exhalation phase of the breath cycle to determine whether a condition indicating occlusion of the patient tubing system has occurred, and means for generating a disconnection signal indicating disconnection of the patient tubing system responsive to the exhalation flow and the pressure in the patient tubing system if the condition indicating occlusion of the patient tubing system has not occurred, and if the condition indicating disconnection of the patient tubing system has occurred.
In a presently preferred embodiment, a disconnection alarm signal is generated, the exhalation valve is opened, an idle flow is delivered, and flow and pressure are monitored to determine whether a condition indicating reconnection of the patient tubing system has occurred. In another currently preferred embodiment, the resumption of flow of breathing gas to the patient tubing system is initiated during an inspiratory phase of a breath cycle if a condition indicating reconnection of the patient tubing system has occurred.
The invention also provides for a method for dete
Doyle Peter
Isaza Fernando J.
Verona Itzhak
Wong Stanley
Fulwider Patton Lee & Utecht LLP
Lewis Aaron J.
Nellcor Puritan Bennett Incorporated
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