US 20060129054 A1
Methods for non-invasively determining the cardiac output or pulmonary capillary blood flow of a subject include monitoring the subject's respiration during two ventilatory states. Such a method may include determining parameters of at least one of the ventilatory states based on one or more characteristics of the subject. Data obtained from monitoring the subject's respiration, such as an amount of gas present in exhaled gases and respiratiory flow, may be used to estimate respiratory or blood gas parameters, such as an amount of gas exchanged between blood and gases in the subject's lungs or an indicator of a content of the gas in the subject's blood.
1. A method for estimating the cardiac output of an individual, comprising:
determining a carbon dioxide elimination (VCO
calculating a carbon dioxide elimination difference between the carbon dioxide elimination of the before phase and the carbon dioxide elimination of the during phase;
estimating a partial pressure of carbon dioxide in alveoli (PACO2) of the individual for the before phase and for the during phase based on partial pressure of end tidal carbon dioxide (PetCO2) measurements of the individual from the before phase and the during phase, respectively;
converting each estimation of the partial pressure of carbon dioxide in alveoli to a carbon dioxide content (CCO
calculating a carbon dioxide content difference between the carbon dioxide content of the before phase and the carbon dioxide content of the during phase; and
dividing the carbon dioxide elimination difference by the carbon dioxide content difference to estimate cardiac output.
2. The method of
3. The method of
4. The method of
5. The method of
6. The method of
7. The method of
8. The method of
9. The method of
P CO2 PDS(n)=[FRC/(FRC+V t)]·P CO2 PDS(n−1)+(P bar·(([Vi CO2+deadspace·(PetCO2(n−1)/P bar)]/V t) [V t/(V t +FRC)])),
where (n) represents one breath, (n−1) represents a prior breath, FRC is the functional residual capacity, Vt is the tidal volume, ViCO2 is the volume of inspired carbon dioxide, PCO
10. The method of
11. The method of
12. A rebreathing method, comprising:
monitoring a subject's respiration during a non-rebreathing phase;
determining a selected amount of carbon dioxide to be collected based on at least one characteristic of the subject;
collecting the selected amount of carbon dioxide from gases exhaled by the subject;
introducing the selected amount of carbon dioxide into gases inhaled by the subject during a rebreathing phase; and
monitoring the subject's respiration during the rebreathing phase.
13. The method of
14. The method of
estimating an amount of the gas exchanged between the subject's blood and gases in at least one lung of the subject; and
estimating an indicator of a content of the gas in the subject's blood.
15. The method of
16. The method of
estimating the amount of the gas exchanged includes estimating carbon dioxide elimination; and
estimating the indicator of the content of the gas includes estimating carbon dioxide content of the subject's blood.
17. The method of
dividing a difference between carbon dioxide elimination from the non-rebreathing and rebreathing phases by a difference between carbon dioxide content from the non-rebreathing and rebreathing phases to estimate pulmonary capillary blood flow or cardiac output.
18. The method of
defining a volume within which the act of collecting is to be effected.
19. A method for estimating a pulmonary capillary blood flow or cardiac output of a subject, comprising:
monitoring a subject's respiration during a first ventilatory phase;
determining a selected amount of at least one gas to be administered to the subject based on at least one characteristic of the subject;
administering the selected amount of the at least one gas to the subject during a second ventilatory phase; and
monitoring the subject's respiration during the rebreathing phase.
20. The method of
This application is a continuation of application Ser. No. 10/657,577, filed Sep. 8, 2003, pending, which is a divisional of application Ser. No. 09/777,629, filed Feb. 6, 2001, now U.S. Pat. No. 6,648,832, issued Nov. 18, 2003, which is a continuation of application Ser. No. 09/262,510, filed Mar. 2, 1999, now U.S. Pat. No. 6,227,196, issued May 8, 2001, which is a continuation-in-part of application Ser. No. 08/770,138, filed Dec. 19, 1996, now U.S. Pat. No. 6,306,098, issued Oct. 23, 2001.
1. Field of the Invention
This invention relates to non-invasive means of determining cardiac output or pulmonary capillary blood flow in patients and, more specifically, to partial re-breathing systems and methods for determining cardiac output or pulmonary capillary blood flow in patients.
2. Background of Related Art
It is important in many medical procedures to determine or monitor the cardiac output or the pulmonary capillary blood flow of a patient. Cardiac output is the volume of blood pumped by the heart over a given period of time. Pulmonary capillary blood flow is the volume of blood that participates in gas exchange in the lungs. Techniques are known and used in the art which employ the use of catheters inserted into blood vessels at certain points (e.g., into the femoral artery, the jugular vein, etc.) to monitor blood temperature and pressure and to thereby determine the cardiac output or pulmonary capillary blood flow of the patient. Although such techniques can produce a reasonably accurate result, the invasive nature of these procedures has a high potential for causing morbidity or mortality.
Adolph Fick's formula for calculating cardiac output, which was first proposed in 1870, has served as the standard by which other means of determining cardiac output and pulmonary capillary blood flow have since been evaluated. Fick's well-known equation, which is also referred to as the Fick Equation, written for carbon dioxide (CO2), is:
It has been shown, however, that by using the principles embodied in the Fick Equation, non-invasive means may be employed to determine cardiac output or pulmonary capillary blood flow. That is, expired CO2 levels, measured in terms of fraction of expired gases that comprise CO2 (fCO2) or in terms of partial pressure of CO2 (PCO2), can be monitored and employed to estimate the content of CO2 in the arterial blood. Thus, a varied form of the Fick Equation may be employed to estimate cardiac output or pulmonary capillary blood flow based on observed changes in fCO2 or PCO2.
An exemplary use of the Fick Equation to non-invasively determine cardiac output or pulmonary capillary blood flow includes comparing a “standard” ventilation event to a change in expired CO2 values and a change in excreted volume of CO2, which is referred to as carbon dioxide elimination or CO2 elimination (VCO2), which may be caused by a sudden change in ventilation. Conventionally, a sudden change in effective ventilation has been caused by having a patient inhale or breathe a volume of previously exhaled air. This technique is typically referred to as “re-breathing.”
Some re-breathing techniques have used the partial pressure of end-tidal CO2 (PetCO2 or etCO2) to approximate the content of CO2 in the arterial blood of a patient while the patient's lungs act as a tonometer to facilitate the measurement of the CO2 content of the venous blood of the patient.
By further modification of the Fick Equation, it may be assumed that the CO2 content of the patient's venous blood does not change within the time period of the perturbation. Thus, the need to directly calculate the CO2 content of venous blood was eliminated by employing the so-called “partial re-breathing” method. (See, Capek et al., “Noninvasive Measurement of Cardiac Output Using Partial CO2 Rebreathing,” IEEE Transactions on Biomedical Engineering, Vol. 35, No. 9, September 1988, pp. 653-661 (hereinafter “Capek”).)
The carbon dioxide elimination of the patient may be non-invasively measured as the difference per breath between the volume of carbon dioxide inhaled during inspiration and the volume of carbon dioxide exhaled during expiration, and is typically calculated as the integral of the carbon dioxide signal times the rate of flow over an entire breath. The volume of carbon dioxide inhaled and exhaled may each be corrected for any deadspace or for any intrapulmonary shunt.
The partial pressure of end tidal carbon dioxide is also measured in re-breathing processes. The partial pressure of end-tidal carbon dioxide, after correcting for any deadspace, is typically assumed to be approximately equal to the partial pressure of carbon dioxide in the alveoli (PACO2) of the patient or, if there is no intrapulmonary shunt, the partial pressure of carbon dioxide in the arterial blood of the patient (PaCO2). Conventionally employed Fick methods of determining cardiac output or pulmonary capillary blood flow typically include a direct, invasive determination of CvCO
Re-breathing processes typically include the inhalation of a gas mixture that includes carbon dioxide. During re-breathing, the carbon dioxide elimination of a patient typically decreases. In total re-breathing, carbon dioxide elimination decreases to near zero. In partial re-breathing, carbon dioxide elimination does not cease. Thus, in partial re-breathing, the decrease in carbon dioxide elimination is not as large as that of total re-breathing.
Re-breathing can be conducted with a re-breathing circuit, which causes a patient to inhale a gas mixture that includes carbon dioxide.
With reference to
The change in CO2 elimination and in the partial pressure of end-tidal CO2 caused by the change in ventilation in the system of
During total re-breathing, the partial pressure of end-tidal carbon dioxide (PetCO2) is typically assumed to be equal to the partial pressure of carbon dioxide in the venous blood (PvCO2) of the patient, as well as to the partial pressure of carbon dioxide in the arterial blood (PaCO2) of the patient and to the partial pressure of carbon dioxide in the alveolar blood (PACO2) of the patient. The partial pressure of carbon dioxide in blood may be converted to the content of carbon dioxide in blood by means of a carbon dioxide dissociation curve.
In partial re-breathing, measurements during normal breathing and subsequent re-breathing are substituted into the carbon dioxide Fick equation. This results in a system of two equations and two unknowns (carbon dioxide content in the mixed venous blood and cardiac output), from which cardiac output or pulmonary capillary blood flow can be determined without knowing the carbon dioxide content of the mixed venous blood (CvCO2).
Total re-breathing is a somewhat undesirable means of measuring cardiac output or pulmonary capillary blood flow because the patient is required to breathe directly into and from a closed volume of gases (e.g., a bag) in order to produce the necessary effect. Moreover, it is typically impossible or very difficult for sedated or unconscious patients to actively participate in inhaling and exhaling into a fixed volume.
Known partial re-breathing methods are also advantageous over invasive techniques of measuring cardiac output or pulmonary capillary blood flow because partial re-breathing techniques are non-invasive, use the accepted Fick principle of calculation, are easily automated, and facilitate the calculation of cardiac output or pulmonary capillary blood flow from commonly monitored clinical signals. However, known partial re-breathing methods are somewhat undesirable because they are a less accurate means of measuring the cardiac output or pulmonary capillary blood flow of non-intubated or spontaneously breathing patients, may only be conducted intermittently (usually at intervals of at least about four minutes), and result in an observed slight, but generally clinically insignificant, increase in arterial CO2 levels. Moreover, the apparatus typically employed in partial re-breathing techniques do not compensate for differences in patient size or breathing capacities. In addition, many devices employ expensive elements, such as three-way valves, which render the devices too expensive to be used as disposable units.
Thus, there is a need for adjustable deadspace re-breathing apparatus that compensate for differences in the sizes or breathing capacities of different patients, that may be employed to provide a more accurate and continuous measurement of gases exhaled or inhaled by a patient, and are less expensive than conventional re-breathing apparatus and, thereby, facilitate use of the adjustable deadspace re-breathing apparatus as a single-use, or disposable, product. There is also a need for a more accurate method of estimating the cardiac output or pulmonary capillary blood flow of a patient.
In accordance with the present invention, apparatus and methods for measuring the cardiac output or pulmonary capillary blood flow of a patient are provided. The apparatus of the present invention includes a deadspace (i.e., volume of re-breathed gases), the volume of which can be adjusted without changing airway pressure. The invention also includes methods of adjusting the volume of deadspace to obtain a more accurate cardiac output or pulmonary capillary blood flow value. A modified form of the Fick Equation may be employed with the adjustable deadspace volume to calculate the cardiac output or pulmonary capillary blood flow of the patient. The apparatus of the present invention also employs significantly less expensive elements of construction, thereby facilitating the use of the apparatus as a disposable product.
The apparatus and methods of the present invention apply a modified Fick Equation to calculate changes in partial pressure of carbon dioxide (PCO
In previous partial re-breathing methods, a deadspace, which may comprise an additional 50-250 ml capacity of air passage, was provided in the ventilation circuit to decrease the effective alveolar ventilation. In the present invention, a ventilation apparatus is provided with a deadspace having an adjustable volume to provide a change in ventilation for determining accurate changes in CO2 elimination and in partial pressure of end-tidal CO2 that is commensurate with the requirements of patients of different sizes or breathing capacities. In one embodiment of the ventilation apparatus, selectively adjustable deadspace is provided into which the patient may exhale and from which the patient may inhale. Thus, the adjustable deadspace volume of the apparatus accommodates a variety of patient sizes or breathing capacities (e.g., from a small adult to a large adult). As a result, the patient is provided with a volume of re-breathable gas commensurate with the patient's size or breathing capacity, which decreases the effective ventilation of the patient without changing the airway pressure of the patient. Because airway and intra-thoracic pressure are not affected by the re-breathing method of the present invention, cardiac output and pulmonary capillary blood flow are not significantly affected by re-breathing.
In an alternative method, the volume of deadspace may be effectively lessened by selectively leaking exhaled gas from the ventilation system to atmosphere or to a closed receptacle means during inspiration. Similarly, additional carbon dioxide may be introduced into the deadspace to increase the effective deadspace volume. Changing the effective deadspace volume in such a manner has substantially the same effect as changing the actual volume of the deadspace of the ventilation apparatus.
The ventilation apparatus of the present invention includes a tubular portion, which is also referred to as a conduit, to be placed in flow communication with the airway of a patient. The conduit of the ventilation apparatus may also be placed in flow communication with or include an inhalation course and an exhalation course, each of which may include tubular members or conduits. In a common configuration, the inhalation course and exhalation course may be interconnected in flow communication between a ventilator unit (i.e., a source of deliverable gas mechanically operated to assist the patient in breathing) and the patient. Alternatively, however, a ventilator unit need not be used with the ventilation apparatus. For example, inhaled air and exhaled air may be taken from or vented to atmosphere. Other conventional equipment commonly used with ventilator units or used in ventilation of a patient, such as a breathing mask, may be used with the inventive ventilation apparatus.
A pneumotachometer for measuring gas flow and a capnometer for measuring CO2 partial pressure are provided along the flow path of the ventilation apparatus and, preferably, in proximity to the conduit, between the inhalation and exhalation portions of the ventilation apparatus and the patient's lungs. The pneumotachometer and capnometer detect changes in gas concentrations and flow and are preferably in electrical communication with a computer programmed (i.e., by software or embedded hardware) to store and evaluate, in substantially real time, the measurements taken by the detection apparatus. Other forms of detection apparatus may, alternatively or in combination with the pneumotachometer and the capnometer, be employed with the ventilation apparatus of the present invention.
Deadspace having an adjustable volume is provided in flow communication with the conduit. In particular, the deadspace is in flow communication with the exhalation portion of the ventilation apparatus (e.g., the expiratory course), and may be in flow communication with the inhalation portion (e.g., the inspiratory course) of the ventilation apparatus. In one embodiment, the volume of the deadspace may be manually adjusted. Alternatively, electromechanical means may be operatively associated with the computer and with the deadspace to provide automatic adjustment of the volume of the deadspace in response to the patient's size or breathing capacity or in response to changes in the ventilation or respiration of the patient.
In an alternative embodiment, a tracheal gas insufflation (“TGI”) apparatus is employed to provide the change in ventilation necessary to determine pulmonary CO2 changes and to determine the cardiac output or pulmonary capillary blood flow of a patient in accordance with the differential Fick Equation disclosed previously. Tracheal gas insufflation apparatus are known, and are typically used to flush the deadspace of the alveoli of the lungs and to replace the deadspace with fresh gas infused through the TGI apparatus. That is, fresh gas is introduced to the central airway of a patient to improve alveolar ventilation and/or to minimize ventilatory pressure requirements. A TGI apparatus may be interconnected, for example, by means of a catheter, with a ventilator apparatus and includes a means of introducing fresh gas into the breathing tube and into the lungs of the patient. The TGI apparatus may be used in the methods of the present invention to determine baseline measurements of CO2 elimination, partial pressure of end tidal CO2, or partial pressure of alveolar CO2 during TGI. When the TGI system is turned off, a deadspace is formed by the patient's trachea and the endo-tracheal tube of the TGI apparatus, which facilitates measurement of a change in the partial pressure of CO2 and in the amount of CO2 eliminated by the patient that may be evaluated in accordance with the method of the present invention. Further, the catheter of the TGI apparatus may be variably positioned within the trachea of the patient to further adjust the deadspace volume.
During re-breathing, the deadspace provided by the apparatus of the present invention facilitates a rapid drop in CO2 elimination, which thereafter increases slightly and slowly as the functional residual lung gas capacity, which is also referred to as functional residual capacity or “FRC,” equilibrates with the increase in the partial pressure of CO2 in the alveoli. Partial pressure of end tidal CO2 increases at a slower rate than CO2 elimination following the addition of deadspace, depending on alveolar deadspace and the cardiac output or pulmonary capillary blood flow of the patient, but then stabilizes to a new level. A “standard,” or baseline, breathing episode is conducted for a selected period of time immediately preceding the introduction of a deadspace into the breathing circuit (i.e., immediately preceding re-breathing) and CO2 elimination and partial pressure of end tidal CO2 values are determined based on measurements made during the “standard” breathing event. These values are substituted as the values VCO
Cardiac output or pulmonary capillary blood flow may be determined in accordance with the method of the present invention by estimating the partial pressure of CO2 in the alveoli or the content of the blood in capillaries that surround the alveoli of the lungs of a patient (Cc′CO
In addition, the accuracy of the cardiac output or pulmonary capillary blood flow measurement may be increased by correcting CO2 elimination values to account for flow of CO2 into the functional residual capacity of the lungs, which is the volume of gas that remains in the lungs at the end of expiration. The cardiac output or pulmonary capillary blood flow of the patient may then be determined by accounting for the functional residual capacity and by employing the values obtained in accordance with the method of the present invention, as well as other determined values, known values, estimated values, or any other values based on experiential data, such as by a computer processor in accordance with the programming thereof. Alternatively, cardiac output or pulmonary capillary blood flow may be estimated without accounting for functional residual capacity.
The ventilation apparatus of the present invention may also employ inexpensive yet accurate monitoring systems as compared to the systems currently used in the art. The methods of the invention may include the automatic adjustment of the deadspace volume of the apparatus to accommodate patients of different sizes or breathing capacities or changes in the ventilation or respiration of a patient, and provides consistent monitoring with modest recovery time. Further, the present apparatus and methods can be used with non-responsive, intubated patients and with non-intubated, responsive patients.
Other features and advantages of the present invention will become apparent through a consideration of the ensuing description, the accompanying drawings, and the appended claims.
Ventilation Apparatus and Methods
An additional length of conduit or hose 60, which provides a deadspace volume for receiving exhaled gas from the patient, is preferably in flow communication with the tubular airway 52. Both ends of the additional length of hose 60 are preferably in flow communication with tubular airway 52. The additional length of hose 60 is configured to be selectively expandable to readily enable the volume of deadspace to be adjusted commensurate with the size or breathing capacity of the patient, or commensurate with changes in the ventilation or respiration of the patient, such as an increased or decreased tidal volume or modified respiration rate. As suggested by
A three-way valve 68 may be disposed along the flow path of tubular airway 52 between the two ends of additional length of hose 60 and selectively positioned to direct inspiratory gas into a deadspace 70 comprised of the additional length of hose 60 upon inhalation, to selectively prevent exhaled gas from entering the deadspace 70 during normal breathing, or to direct exhaled gas into deadspace 70 during re-breathing so that the patient will re-breathe previously exhaled gases or a gas including CO2 from the deadspace 70.
A flow meter 72, such as a pneumotachometer, and a carbon dioxide sensor 74, which is typically referred to as a capnometer, may be exposed to the flow path of the ventilation apparatus, preferably between the tubular airway 52 and the additional length of hose 60. Thus, the flow meter 72 and carbon dioxide sensor 74 are exposed to any air or gas that flows through ventilation apparatus 50. The flow meter 72 detects gas flow through the ventilation apparatus 50.
A flow meter 72 of a known type, such as the differential-pressure type respiratory flow sensors manufactured by Novametrix Medical Systems Inc. (“Novametrix”) of Wallingford, Conn. (e.g., the Pediatric/Adult Flow Sensor (Catalog No. 6717) or the Neonatal Flow Sensor (Catalog No. 6718)), which may be operatively attached to a ventilation apparatus (not shown), as well as respiratory flow sensors based on other operating principles and manufactured or marketed by others, may be employed to measure the flow rates of the breathing of the patient.
The carbon dioxide sensor 74 detects CO2 levels and, therefore, facilitates a determination of changes in CO2 levels that result from changes in the ventilation or respiration of the patient. The carbon dioxide sensor 74 and its associated airway adapter may be an “on airway” sensor, a sampling sensor of the type which withdraws a side stream sample of gas for testing, or any other suitable type of carbon dioxide sensor. Exemplary carbon dioxide sensors and complementary airway adapter include, without limitation, the Pediatric/Adult Single Patient Use Airway Adapter (Catalog No. 6063), the Pediatric/Adult Reusable Airway Adapter (Catalog No. 7007), or the Neonatal/Pediatric Reusable Airway Adapter (Catalog No. 7053), which are manufactured by Novametrix. Alternatively, combined flow and carbon dioxide sensors, as known in the art, may be employed.
The data obtained by the flow meter 72 and by the carbon dioxide sensor 74 are preferably used to determine the cardiac output or pulmonary capillary blood flow of the patient. Accordingly, the flow meter 72 and carbon dioxide sensor 74 may be operatively associated with a computer 76 (e.g., by direct cable connection, wireless connection, etc.) programmed to store or analyze data from the flow meter 72 and the carbon dioxide sensor 74 and programmed to determine the cardiac output or pulmonary capillary blood flow of the patient from the stored or analyzed data.
As previously described herein, the differential Fick Equation requires a change in the partial pressure of carbon dioxide and a change in carbon dioxide elimination to be induced in the patient in order to estimate the cardiac output or pulmonary capillary blood flow of the patient. As the patient re-breathes previously exhaled gas, the amount of CO2 inhaled by the patient increases, thereby facilitating the evaluation of increased CO2 levels during a change in effective ventilation, as compared to the CO2 levels of the patient's breathing during normal ventilation. The re-breathing ventilation apparatus 50 of the present invention provides the ability to selectively adjust the volume of deadspace from which air is re-breathed in accordance with the size or breathing capacity of the patient, or in response to changes in the ventilation or respiration of the patient. For example, if the detected change in partial pressure of end tidal CO2 is less than a threshold pressure (e.g., 1 mm Hg), or the change in CO2 elimination is less than a threshold percentage or fraction (e.g., 20% or 0.2) of a baseline CO2 elimination, then the deadspace volume may be increased by an appropriate amount (e.g., 20%). Similarly, if the detected change in partial pressure of end tidal CO2 is greater than a threshold pressure (e.g., 12 mm Hg), or the change in CO2 elimination is greater than a threshold percentage or fraction (e.g., 80% or 0.8) of the baseline CO2 elimination, then the deadspace volume may be decreased by an appropriate amount (e.g., 20%).
In an alternative embodiment of the re-breathing ventilation apparatus 50′ of the invention, as shown in
In another alternative embodiment of the ventilation apparatus 50″ of the present invention, as shown in
The deadspace 70″ in the embodiment shown in
In yet another embodiment of the ventilation apparatus 50′″ of the present invention, as shown in
In the several embodiments of the invention previously illustrated and described, the amount or volume of the deadspace has been selectively adjustable by providing means for adjusting the volume of the deadspace, such as by providing length-expanding means. It may be equally appropriate, however, to provide a change in ventilation, as required by the differential Fick Equation, by leaking some of the exhaled gas out of the system during the inspiration phase of a breath or by increasing the level of CO2 in the deadspace, both of which provide an effective change in the volume of deadspace. Thus, as illustrated by
The volume of exhaled gas that should be leaked from the ventilation apparatus 50 or introduced therein during a re-breathing event, as well as the timing and duration of such leakage or introduction, may be determined by the computer 76 (see
With reference to
An adaptor fitting 134 may be used to connect a ventilation apparatus 136, such as the type previously described in reference to FIGS. 1-8(B), to the TGI apparatus 120. That is, the ventilation apparatus 136 may include a Y-piece 58 from which an inspiratory course 54 and an expiratory course 56 extend. The ventilation apparatus 136 may also include a flow meter 72 and a carbon dioxide sensor 74 disposed in flow communication therewith to collect data during normal breathing and during a re-breathing event. In the illustrated TGI apparatus 120, the endotracheal tube 122 provides a volume of deadspace that may be required for re-breathing in addition to any deadspace volume provided by the ventilation apparatus 136. In order to act as a deadspace, however, the TGI apparatus (i.e., the gas source 128 and flow meter 132) is preferably turned off, the amount of insufflation reduced, or the TGI apparatus otherwise disabled. Exhaled air is thereby allowed to flow into the endotracheal tube 122 and, preferably, through the Y-piece 58. The endotracheal tube 122 and ventilation apparatus 136 or portions thereof may then serve as deadspace. The volume of deadspace provided by the TGI apparatus 120 may be further increased or decreased, as necessary, by varying the depth to which the catheter 126 is positioned in the patient's trachea.
A computer 76 (see
Methods of Determining Cardiac Output or Pulmonary Capillary Blood Flow
The determination of cardiac output or pulmonary capillary blood flow for a given patient may be based on data obtained with the flow monitor and the carbon dioxide sensor that are associated with the ventilation apparatus of the present invention. Raw flow and CO2 signals from the flow monitor and the carbon dioxide sensor may be filtered to remove any artifacts, and the flow signals and CO2 signals (e.g., data regarding partial pressure of CO2) may be stored by the computer 76.
Each breath, or breathing cycle, of the patient may be delineated, as known in the art, such as by continually monitoring the flow rate of the breathing of the patient.
For each breathing cycle, the partial pressure of end-tidal CO2, carbon dioxide elimination (VCO
The values of VCO
Preferably, when calculating VCO
Lungs 150 typically include alveoli 160 that are in contact with blood flow and which can facilitate oxygenation of the blood, which are referred to as “perfused” alveoli, as well as unperfused alveoli 162. Both perfused alveoli 160 and unperfused alveoli 162 may be ventilated. The volume of unperfused alveoli is the alveolar deadspace.
Perfused alveoli 160 are surrounded by and in contact with pulmonary capillaries 164. As deoxygenated blood 166 enters pulmonary capillaries 164, oxygen binds to the hemoglobin molecules of the red blood cells of the blood, and CO2 is released from the hemoglobin. Blood that exits pulmonary capillaries 164 in the direction of arrow 171 is referred to as oxygenated blood 168. In alveoli 160 and 162, a volume of gas known as the functional residual capacity (FRC) 170 remains following exhalation. The alveolar CO2 is expired from a portion 172 of each of the alveoli 160 that is evacuated, or ventilated, during exhalation.
The ventilated portion 178 of each of the unperfused alveoli 162 may also include CO2. The CO2 of ventilated portion 178 of each of the unperfused alveoli 162, however, is not the result of O2 and CO2 exchange in that alveolus. Since the ventilated portion 178 of each of the unperfused alveoli 162 is ventilated in parallel with the perfused alveoli, ventilated portion 178 is typically referred to as “parallel” deadspace (PDS). Unperfused alveoli 162 also include a FRC 176, which includes a volume of gas that is not evacuated during a breath.
In calculating the partial pressure of CO2 in the alveoli (PACO
The partial pressure of CO2 in the parallel deadspace (CO2 PDS) may be calculated from the mixed inspired CO2 (ViCO
The partial pressure of end-tidal CO2, which is assumed to be substantially equal to a weighted average of the partial pressure of CO2 in all of the perfused and unperfused alveoli of a patient, may be calculated as follows:
By rearranging the preceding PetCO
The alveolar CO2 partial pressure may then be converted to alveolar blood CO2 content (CACO
In calculating VCO
The content of CO2 in the alveolar blood during the re-breathing process may then be calculated by employing a regression line, which facilitates prediction of the stable, or unchanging, content of alveolar CO2. Preferably, PACO
Pulmonary capillary blood flow may then be calculated as follows:
The operation logic of an exemplary computer program that directs the execution of the method of the present invention is briefly illustrated in the flow diagram of
The computer 76, in accordance with the program, then calculates the estimated partial pressure of CO2 (PCO
Upon proper adjustment of the adjustable deadspace and the recalculation of baseline PetCO
Although the foregoing description contains many specifics, these should not be construed as limiting the scope of the present invention, but merely as providing illustrations of some of the presently preferred embodiments. Similarly, other embodiments of the invention may be devised which do not depart from the spirit or scope of the present invention. The scope of the invention is, therefore, indicated and limited only by the appended claims and their legal equivalents, rather than by the foregoing description. All additions, deletions and modifications to the invention as disclosed herein which fall within the meaning and scope of the claims are to be embraced thereby within their scope.