Leak-compensated flow triggering and cycling in medical ventilators
This disclosure describes systems and methods for compensating for inelastic and elastic leaks in a ventilation system. The disclosure describes a model-based enhancement to conventional flow triggering and cycling methodologies that improves the timing and patient work of flow-based triggering and cycling performance. The methods and systems described herein compensate for the leak condition and minimize additional effort a patient has to exert to generate the same patient synchrony and comfort level compared to no leak condition. One method described includes calculating an elastic leakage and an inelastic leakage based on current measurements of pressure and flow in the ventilation system and then estimating a leak-compensated lung flow using the inelastic and elastic leaks and pneumatic attributes of the patient-ventilator system.
1. A method of compensating for leakage in a ventilation system during delivery of gas from a medical ventilator to a patient comprising:
monitoring an instantaneous flow at a location in the ventilation system based on one or more measurements of pressure and flow in the ventilation system;
modeling leakage as a first leakage component through a first orifice of a fixed size and a second leakage component through a second orifice of a varying size, wherein the first and second leakage components are different functions of instantaneous pressure in the ventilation system;
estimating a leak-compensated instantaneous lung flow of gas inhaled or exhaled by the patient based on the one or more measurements, the first leakage component and second leakage component; and
using the leak-compensated instantaneous lung flow and a threshold to identify patient-initiated transitions into inhalation or exhalation.
2. The method of claim 1 wherein the threshold is a leak-free cycle threshold indicative of a patient-initiated transition into exhalation and using comprises:
cycling into an exhalation phase of the medical ventilator based on the leak-free cycle threshold and the leak-compensated instantaneous lung flow.
3. The method of claim 1 wherein the threshold is a leak-free trigger threshold indicative of a patient-initiated transition into inhalation and using comprises:
triggering an inhalation phase of the medical ventilator based on the leak-free trigger threshold and the leak-compensated instantaneous lung flow.
4. The method of claim 1 wherein estimating a leak-compensated instantaneous lung flow further comprises:
generating an estimate of instantaneous lung flow at a patient interface based on one or more measurements taken at different locations in the ventilation system.
5. The method of claim 1 further comprising:
receiving the threshold from an operator.
6. The method of claim 1 further comprising:
estimating current leakage from the ventilation system during delivery of gas to the patient based on the one or more measurements and the first leakage component and second leakage component.
7. The method of claim 1 further comprising:
measuring leakage from the ventilation system during delivery of gas to the patient based on measurements of at least one of pressure and flow taken from a first breath;
generating a leakage equation based on the measurements of at least one of pressure and flow taken from a first breath, the leakage equation including the first leakage component and the second leakage component; and
estimating current leakage from the ventilation system in a second breath immediately subsequent to the first breath based on the leakage equation and measurements of at least one of pressure and flow taken from the second breath.
8. The method of claim 7 wherein the threshold is a trigger threshold indicative of patient inhalation and using comprises:
estimating the leak-compensated instantaneous lung flow of gas inhaled by the patient based on the estimated current leakage in the second breath; and
triggering an inhalation phase of the medical ventilator during the second breath based on the leak-compensated lung flow.
9. The method of claim 1 further comprising;
estimating leakage from the ventilation system during delivery of gas to the patient based on measurements of at least one of pressure and flow taken over a plurality of previous breaths.
10. The method of claim 1 further comprising;
estimating one or more tubing characteristics indicative of compliance and resistance of the ventilation system; and
generating the leak-compensated instantaneous lung flow based on the estimated tubing characteristics, the one or more measurements of pressure and flow, the first leakage component and second leakage component.
11. A method of compensating for leakage in a ventilation tubing system during delivery of gas from a medical ventilator to a patient comprising:
identifying an inelastic leakage in the ventilation system as a first function of at least one of a pressure measurement and a flow measurement in the ventilation system;
identifying an elastic leakage in the ventilation system as a second function of at least one of the pressure measurement and the flow measurement in the ventilation system;
estimating compliance and resistance of the ventilation tubing system; and
transitioning the medical ventilator between inhalation and exhalation based on the inelastic leakage, the elastic leakage, the compliance and resistance and the at least one of the pressure measurement and the flow measurement in the ventilation system.
12. The method of claim 11 transitioning the medical ventilator between inhalation and exhalation further comprises:
generating a leak-compensated lung flow based on the elastic leakage and at least one of the pressure measurement and the flow measurement in the ventilation system;
comparing the leak-compensated lung flow to a flow trigger threshold indicative of the patient's breathing effort when there is no leakage in the ventilation system; and
triggering an inhalation phase of the medical ventilator based on results of the comparing operation.
13. The method of claim 11 wherein transitioning the medical ventilator between inhalation and exhalation comprises:
generating a leak-compensated lung flow based on the elastic leakage and at least one of the pressure measurement and the flow measurement in the ventilation system;
comparing the leak-compensated lung flow to a flow cycle threshold indicative of the patient's breathing effort when there is no leakage in the ventilation system; and
cycling into an exhalation phase of the medical ventilator based on results of the comparing operation.
14. A pressure support system comprising:
a pressure generating system adapted to generate a flow of breathing gas;
a ventilation system including a patient interface device;
one or more sensors operatively coupled to the pressure generating system or the ventilation system, each sensor capable of generating an output indicative of a pressure of the breathing gas;
a processor;
an elastic leak estimation module that identifies an elastic leakage in the ventilation system; and
a compensation module that generates a leak-compensated lung flow based on the elastic leakage and at least one output indicative of a pressure of the breathing gas.
15. The system of claim 14 further comprising:
an exhalation detection module that determines when a patient has begun to exhale based on a cycle threshold, the leak-compensated lung flow and an output of at least one sensor.
16. The system of claim 14 further comprising:
an inhalation detection module that determines when a patient has begun to inhale based on a trigger threshold, the leak-compensated lung flow and an output of at least one sensor.
17. The system of claim 14 further comprising:
an inelastic leak estimation module that identifies an inelastic leakage in the ventilation system; and
wherein the compensation module further generates the leak-compensated lung flow based on the inelastic leakage.
18. The system of claim 17 further comprising:
a pressure monitoring module that monitors at least one output of the one or more sensors and provides data indicative of the pressure of the breathing gas to the elastic leak estimation module.
19. A controller for a medical ventilator comprising:
a microprocessor; and
a lung flow estimation means that adjusts a ventilator net flow threshold based on:
identifying an instantaneous elastic leakage in the ventilation system as a first function of at least one of a pressure measurement and a flow measurement in the ventilation system; and
identifying an instantaneous inelastic leakage in the ventilation system as a second function of at least one of a pressure measurement and a flow measurement in the ventilation system.
20. The controller of claim 19 wherein the lung flow estimation means comprises:
an inelastic leak estimation module that identifies the instantaneous inelastic leakage in the ventilation system; and
an elastic leak estimation module that identifies the instantaneous elastic leakage in the ventilation system.
21. The controller of claim 19 wherein the lung flow estimation means comprises:
a compensation module that generates a leak-compensated lung flow based on the instantaneous elastic leakage and at least one sensor output indicative of the pressure measurement in the ventilation system.