CA2401534A1 - A system and a computer program for the determination of quantities relating to the circulatory system of a patient - Google Patents

A system and a computer program for the determination of quantities relating to the circulatory system of a patient Download PDF

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Publication number
CA2401534A1
CA2401534A1 CA002401534A CA2401534A CA2401534A1 CA 2401534 A1 CA2401534 A1 CA 2401534A1 CA 002401534 A CA002401534 A CA 002401534A CA 2401534 A CA2401534 A CA 2401534A CA 2401534 A1 CA2401534 A1 CA 2401534A1
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time
accordance
over time
variation over
local concentration
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CA002401534A
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CA2401534C (en
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Ulrich J. Pfeiffer
Thorsten Burger
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Pulsion Medical Systems SE
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Pulsion Medical Systems SE
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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
    • A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
    • A61B5/026—Measuring blood flow
    • A61B5/0275—Measuring blood flow using tracers, e.g. dye dilution
    • A61B5/028—Measuring blood flow using tracers, e.g. dye dilution by thermo-dilution
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
    • A61B5/026—Measuring blood flow
    • A61B5/029—Measuring or recording blood output from the heart, e.g. minute volume

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Hematology (AREA)
  • Cardiology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Surgery (AREA)
  • Biophysics (AREA)
  • Pathology (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Physiology (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Physics & Mathematics (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Measuring Pulse, Heart Rate, Blood Pressure Or Blood Flow (AREA)
  • Magnetic Resonance Imaging Apparatus (AREA)
  • Measurement Of The Respiration, Hearing Ability, Form, And Blood Characteristics Of Living Organisms (AREA)

Abstract

A system for the determination of quantities relating to the circulatory system of a patient comprises a device for the non-invasive measurement of the qualitative variation over time of the local concentration of an indicator injected into the blood circulation system at a first position, the measurement taking place at a second position of the blood circulation system. An evaluating unit is provided, in which there is implemented an evaluating algorithm which transforms the qualitative variation into a quantitative variation over time of the local concentration of the indicator injected into the blood circulation system. For the purposes of the transformation, the condition is fulfilled that the cardiac output COdye calculable from the quantitative variation over time of the local concentration in accordance with a predetermined relationship is equal to an input value of the cardiac output COe, which has been determined by thermodilution measurement.

Claims (52)

1. A system for the determination of quantities relating to the circulatory system of a patient, comprising a device for the non-invasive measurement of the qualitative variation over time of the local concentration of an indicator injected into the blood circulation system at a first position, said measurement taking place at a second position of the blood circulation system and an evaluating unit which comprises an input interface for reading in an input value of the cardiac output COe of the patient, and in which there is implemented an evaluating process which transforms the qualitative variation over time of the local concentration of the indicator injected into the blood circulation system into a quantitative variation over time of the local concentration of the indicator injected into the blood circulation system, wherein the condition is fulfilled that the cardiac output COdye, which is calculable from the quantitative variation over time of the local concentration according to a predetermined relationship, is equal to the input value of the cardiac output COe.
2. A system in accordance with Claim 1, wherein the cardiac output COdye according to the predetermined relationship is proportional to the reciprocal of the integral of the quantitative time variance of the local concentration over the time interval up to the maximum of the quantitative time variance of the local concentration.
3. A system in accordance with Claim 1, wherein the cardiac output COdye according to the predetermined relationship is proportional to the reciprocal of the integral of a linear approximation of the rising flank of the quantitative time variance of the local concentration over the time interval up to the maximum of the quantitative time variance of the local concentration.
4. A system in accordance with any of the Claims 1 - 3, wherein the input interface is connected to a device for the measurement of the variation over time of the local blood temperature at a third position of the blood circulation system of the patient after the injection into the blood circulation system at the first position of a bolus which contains the indicator and is cooled to below body temperature, said device being equipped to determine and provide the input value of the cardiac output COe from the variation over time of the local blood temperature in accordance with the methods commonly used for thermodilution measurements.
5. A system in accordance with any of the Claims 2 - 4, wherein the evaluating process implemented in the evaluating unit transforms the qualitative variation over time of the local concentration of the indicator injected into the blood circulation system into a corrected quantitative variation over time of the local concentration of the indicator injected into the blood circulation system, in that the time axis is transformed in such a manner that a defined range of the rising flank of the quantitatively corrected time variance of the local concentration extends over a time interval which has a predetermined relationship to a comparison value.
6. A system in accordance with Claim 5, wherein the time axis is transformed by means of a transport function g(t).
7. A system in accordance with the Claims 4, 5 and 6, wherein the transport function g(t) is approximated with the help of the equation wherein Co*(t) is the rising flank of the qualitative indicator concentration curve, ATtd is the time point of appearance of the cooled bolus, .DELTA.T(t) is the variation over time of the local blood temperature alteration, Tmax is the time point at which the local blood temperature alteration reaches its maximum value and a is an integration variable.
8. A system in accordance with Claim 5, wherein the time axis is linearly transformed.
9. A system in accordance with Claim 5, wherein the comparison value corresponds to the time period over which extends a defined range of the rising flank of the time variance of the local blood temperature corresponding to the defined range of the rising flank of the quantitatively corrected time variance.
10. A system in accordance with any of the Claims 2-4, wherein the evaluating process implemented in the evaluating unit transforms the qualitative variation over time of the local concentration of the indicator injected into the blood circulation system into a corrected quantitative variation over time of the local concentration of the indicator injected into the blood circulation system, in that the time axis is transformed in such a manner that a defined range of the rising flank of the quantitatively corrected variation over time of the local concentration has an average slope m which has a predetermined relationship to a comparison value.
11. A system in accordance with Claim 10, wherein the time axis is linearly transformed.
12. A system in accordance with Claim 10, wherein the comparison value corresponds to the average slope, over which extends a defined range of the rising flank of the time variance of the local blood temperature corresponding to the defined range of the rising flank of the quantitatively corrected time variance.
13. A system in accordance with any of the Claims 5-12, wherein the defined range extends from 20% to 80% of the maximum of the quantitatively corrected variation over time of the local concentration.
14. A system in accordance with Claim 12, wherein, in the course of the transformation, the condition is additionally fulfilled, that the quantitatively corrected variation over time of the local concentration has the same time of appearance AT as the variation over time of the local blood temperature.
15. A system in accordance with any of the preceding Claims, wherein the evaluating process determines the starting concentration of the injected indicator with reference to the circulating volume of blood TBV from the quantitative variation over time of the local concentration of the indicator injected into the blood circulation system and calculates the circulating volume of blood TBV by forming the quotient of the injected quantity of indicator and the starting concentration determined with reference to the circulating volume of blood TBV.
16. A system in accordance with Claim 15, wherein the starting concentration of the injected indicator is determined by backward extrapolation of the variation over time of the local concentration of the indicator injected into the blood circulation system up to the time point of appearance ATdye of the indicator or up to the time point of the injection of the indicator.
17. A system in accordance with Claim 15, wherein the evaluating process also calculates the intrathoracic volume of blood ITBV as the product of the cardiac output COe and the average transit time MTTdye obtained from the corrected quantitative variation over time of the local concentration of the indicator injected into the blood circulation system.
18. A system in accordance with any of the Claims 4 - 17, wherein the evaluating process also calculates the intrathoracic thermovolume ITTV as the product of the cardiac output COe and the average transit time MTTtd obtained from the variation over time of the local blood temperature.
19. A system in accordance with Claim 18, wherein the evaluating process calculates the extravascular thermovolume E TV by forming the difference between the intrathoracic volume of blood ITBV and the intrathoracic thermovolume IT TV.
20. A system in accordance with any of the Claims 14 - 19, wherein the evaluating process calculates the peripheral perfusion by forming the difference between the average transit time MTTdye obtained from the corrected quantitative variation over time of the local concentration of the indicator injected into the blood circulation system and the average transit time MTTdye,o obtained from the qualitative variation over time of the local concentration of the indicator injected into the blood circulation system.
21. A system in accordance with any of the Claims 14 - 19, wherein the evaluating process calculates the peripheral perfusion by forming the difference between the time of appearance ATdye obtained from the corrected quantitative variation over time of the local concentration of the indicator injected into the blood circulation system and the time of appearance ATdye,o obtained from the qualitative variation over time of the local concentration of the indicator injected into the blood circulation system.
22. A system in accordance with any of the preceding Claims, wherein the evaluating process also calculates the rate of degradation of the indicator PDR from the exponential fall over time of the quantitative time variance of the local concentration of the indicator injected into the blood circulation system after it is assumed that the mixing process is complete.
23. A system in accordance with any of the preceding Claims, wherein the evaluating process also determines the proportion of the indicator remaining in the blood after a predefined time span.
24. A system in accordance with any of the preceding Claims, wherein the indicator is indocyanin-green and the device for the non-invasive measurement of the qualitative variation over time of the local concentration comprises means for the transmission of near infrared electromagnetic waves and a sensor which is sensitive in the near infrared range.
25. A system in accordance with Claim 24, wherein the non-invasive measurement of the qualitative variation over time of the local concentration is a transmission measurement that is to be effected on a forger, a toe, the nose or an ear of the patient.
26. A system in accordance with any of the Claims 24 - 25, wherein the means for the transmission of near infrared electromagnetic waves are equipped for the production of at least two different wavelengths, and the system is equipped in such a manner that the intensities of the different wavelengths can be selectively detected by means of the sensor.
27. A system in accordance with Claim 26, wherein one of the different wavelengths amounts to approximately 805 nm.
28. A system in accordance with any of the Claims 4 - 27, wherein means for determining the input value of the cardiac output COe from the variation over time of the local blood temperature employing the methods that are commonly used for a thermodilution measurement process are integrated in the evaluating unit, and wherein the input interface for reading in the input value of the cardiac output COe is a virtual or physically implemented internal interface of the evaluating unit.
29. A system in accordance with any of the preceding Claims, wherein the system also comprises means for the measurement of the variation over time of the central venous blood pressure and also the variation over time of the arterial blood pressure, and wherein a further evaluating process for carrying out a pulse contour analysis using the measured variation over time of the central venous blood pressure and the arterial blood pressure is implemented in the evaluating unit.
30. A computer program for determining quantities relating to the circulation system of a patient, comprising an evaluating process which is executable by a computer and which processes input data in the form of the qualitative variation over time of the local concentration of an indicator injected into the blood circulation system at a first position wherein said variation is determined by a non-invasive measurement at a second position of the blood circulation system, in that the evaluating process transforms the qualitative variation over time of the local concentration of the indicator injected into the blood circulation system into a quantitative variation over time of the local concentration of the indicator injected into the blood circulation system, wherein the condition is fulfilled that the cardiac output COdye, which is calculable from the quantitative variation over time of the local concentration in accordance with a predetermined relationship, is equal to an input value of the cardiac output COe which is determined in some other manner.
31. A computer program in accordance with Claim 30, wherein the cardiac output COdye in accordance with the predetermined relationship is proportional to the reciprocal of the integral of the quantitative time variance of the local concentration over the time interval up to the maximum of the quantitative time variance of the local concentration.
32. A computer program in accordance with Claim 30, wherein the cardiac output COdye in accordance with the predetermined relationship is proportional to the reciprocal of the integral of a linear approximation of the rising flank of the quantitative time variance of the local concentration over the time interval up to the maximum of the quantitative time variance of the local concentration.
33. A computer program in accordance with any of the Claims 30 - 32, wherein the evaluating process processes as further input data the variation over time of the local blood temperature measured at a third position of the blood circulation system of the patient after the injection of a bolus into the blood circulation system at the first position where said bolus is cooled below body temperature and contains the indicator, and wherein the input value of the cardiac output COe is determined by the methods commonly used for thermodilution measurements.
34. A computer program in accordance with any of the Claims 30 - 33, wherein the evaluating process transforms the qualitative variation over time of the local concentration of the indicator injected into the blood circulation system into a corrected quantitative variation over time of the local concentration of the indicator injected into the blood circulation system, in that the time axis is transformed in such a manner that a defined range of the rising flank of the quantitatively corrected time variance of the local concentration extends over a time interval which has a predetermined relationship to a comparison value.
35. A computer program in accordance with Claim 34, wherein the time axis is transformed by means of a transport function g(t).
36. A computer program in accordance with the Claims 33 - 35, wherein the transport function g(t) is approximated with the help of the equation wherein Co*(t) is the rising flank of the qualitative indicator concentration curve, ATtd is the time of appearance of the cooled bolus, .DELTA.T(t) is the variation over time of the local blood temperature alteration, Tmax is the time point at which the local blood temperature alteration reaches its maximum value, and a is an integration variable.
37. A computer program in accordance with Claim 34, wherein the time axis is linearly transformed.
38. A computer program in accordance with Claim 34, wherein the comparison value corresponds to the period of time over which extends a defined range of the rising flank of the time variance of the local blood temperature corresponding to the defined range of the rising flank of the quantitatively corrected time variance.
39. A computer program in accordance with any of the Claims 30 - 33, wherein the evaluating process transforms the qualitative variation over time of the local concentration of the indicator injected into the blood circulation system into a corrected quantitative variation over time of the local concentration of the indicator injected into the blood circulation system, in that the time axis is transformed in such a manner that a defined range of the rising flank of the quantitatively corrected time variance of the local concentration has an average slope which has a predetermined relationship to a comparison value.
40. A computer program in accordance with Claim 39, wherein the time axis is linearly transformed.
41. A computer program in accordance with Claim 39, wherein the comparison value corresponds to the average slope over which extends a defined range of the rising flank of the time variance of the local blood temperature corresponding to the defined range of the rising flank of the quantitatively corrected time variance.
42. A computer program in accordance with any of the Claims 34 - 41, wherein the defined range extends from 20% to 80% of the maximum of the quantitatively corrected variation over time of the local concentration.
43. A computer program in accordance with Claim 39, wherein, in the course of the transformation, the condition is additionally fulfilled that the quantitatively corrected variation over time of the local concentration has the same time of appearance AT as the variation over time of the local blood temperature.
44. A computer program in accordance with any of the Claims 30 - 43, wherein the evaluating process determines the starting concentration of the injected indicator taken with reference to the circulating volume of blood TBV from the quantitative variation over time of the local concentration of the indicator injected into the blood circulation system, and calculates the circulating volume of blood TBV by forming the quotient of the injected quantity of indicator and the determined starting concentration taken with reference to the circulating volume of blood TBV.
45. A computer program in accordance with Claim 44, wherein the starting concentration of the injected indicator is determined by backward extrapolation of the variation over time of the local concentration of the indicator injected into the blood circulation system up to the time point of appearance ATdye of the indicator or up to the time point of the injection of the indicator.
46. A computer program in accordance with Claim 44, wherein the evaluating process also calculates the intrathoracic volume of blood ITBV as the product of the cardiac output COe and the average transit time MTTdye obtained from the corrected quantitative variation over time of the local concentration of the indicator injected into the blood circulation system.
47. A computer program in accordance with any of the Claims 33 - 46, wherein the evaluating process also calculates the intrathoracic thermovolume ITTV as the product of the cardiac output COe and the average transit time MTTtd obtained from the variation over time of the local blood temperature.
48. A computer program in accordance with Claim 47, wherein the evaluating process calculates the extravascular thermovolume ETV by forming the difference between the intrathoracic volume of blood ITBV and the intrathoracic thermovolume ITTV.
49. A computer program in accordance with any of the Claims 30 - 48, wherein the evaluating process calculates the peripheral perfusion by forming the difference between the average transit time MTTdye obtained from the corrected quantitative variation over time of the local concentration of the indicator injected into the blood circulation system and the average transit time MTTdye,o obtained from the qualitative variation over time of the local concentration of the indicator injected into the blood circulation system.
50. A computer program in accordance with any of the Claims 30 - 48, wherein the evaluating process calculates the peripheral perfusion by forming the difference between the time of appearance ATdye obtained from the corrected quantitative variation over time of the local concentration of the indicator injected into the blood circulation system and the time of appearance ATdye,o obtained from the qualitative variation over time of the local concentration of the indicator injected into the blood circulation system.
51. A computer program in accordance with any of the Claims 30-50, wherein the evaluating process also calculates the rate of degradation of the indicator PDR from the exponential fall over time of the quantitative or qualitative time variance of the local concentration of the indicator injected into the blood circulation system after it is assumed that mixing is complete.
52. A storage medium upon which a computer program in accordance with any of the Claims 30-51 is physically stored.
CA2401534A 2001-09-07 2002-09-06 A system and a computer program for the determination of quantities relating to the circulatory system of a patient Expired - Fee Related CA2401534C (en)

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DE10143995A DE10143995A1 (en) 2001-09-07 2001-09-07 System and computer program for determining a patient's circulatory parameters
DE10143995.4 2001-09-07

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DE10143995A1 (en) 2003-04-03
EP1290976A3 (en) 2003-07-30
EP1290976A2 (en) 2003-03-12
CA2401534C (en) 2011-03-29
US20030060722A1 (en) 2003-03-27
US7209780B2 (en) 2007-04-24

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