Methods and apparatus for varying the back-up rate for a ventilator
A ventilator device delivers ventilatory support to a patient in a back up timed mode when patient respiration is not detected or a spontaneous mode when patient respiration is detected. The timing threshold governing the back-up mode is chosen to deviate from normal expected respiration time for the patient to promote patient initiated ventilation in the spontaneous mode but permit back-up ventilation in the event of apnea. Automated adjustments to the timing threshold during the timed mode are made from the less vigilant timing threshold to a more vigilant threshold at or near a timing of normal expected breathing of the patient. Such adjustments may be made from a minimum to a maximum vigilance timing settings or incrementally there between as a function of time in the timed mode which is preferably the number of delivered machine breaths.
1. An apparatus for setting back up support ventilation comprising:
a ventilation generation device,
a sensor for detecting spontaneous patient breathing, and
a controller, including at least one processor, the controller coupled with the sensor and the ventilation generation device, the controller configured to control:
a first machine initiated breath as a function of an initial timing threshold based on absence of a detection of a spontaneous breath by the controller;
adjustment of the initial timing threshold to a modified timing threshold based on a predetermined number of machine initiated breath counts; and
a second machine initiated breath as a function of the modified timing threshold.
2. The apparatus according to claim 1 , wherein the predetermined number of machine initiated breath counts comprise a breath cycle.
3. The apparatus according to claim 2 , wherein the modified timing threshold is adjusted to a value that is closer to a patient average breath rate or period if a spontaneous patient breath is absent during the breath cycle.
4. The apparatus according to claim 2 , wherein the modified timing threshold is adjusted to a value that is further away from a patient average breath rate or period if a spontaneous patient breath is detected during the breath cycle.
5. The apparatus according to claim 1 , wherein the adjustment of the initial timing threshold is based on a measure of adequacy of patient ventilation.
6. The apparatus according to claim 5 , wherein the ventilation generation device is set to deliver a target ventilation and the sensor is configured to measure actual ventilation and the adequacy of patient ventilation comprises a relationship between the target ventilation and the actual measured ventilation.
7. The apparatus according to claim 6 , wherein the relationship comprises a ratio of the actual measured ventilation and the target ventilation.
8. The apparatus according to claim 6 , wherein the sensor comprises a flow sensor or a differential pressure transducer and the actual measured ventilation is determined from a signal from the flow sensor or the differential pressure transducer.
9. The apparatus according to claim 6 , wherein the apparatus comprises a servoventilator.
10. The apparatus according to claim 9 , wherein the ventilation generation device comprises an impeller and a motor.
11. A method for adjusting back-up ventilation support in a ventilator, the ventilator having a controller and the method comprising:
initiating, with the controller, delivery of a first machine initiated breath if a spontaneous patient breath is not detected before lapsing of a first timing threshold;
adjusting, by the controller, the first timing threshold to a second timing threshold based on a predetermined number of machine initiated breath counts; and
initiating with the controller a second machine initiated breath as a function of the second timing threshold.
12. The method according to claim 11 , wherein the predetermined number of machine initiated breath counts comprise a breath cycle.
13. The method according to claim 12 , further comprising adjusting, by the controller, the first timing threshold so that the second timing threshold is closer to a patient average breath rate or period if the spontaneous patient breath is not detected before lapsing of the first timing threshold.
14. The method according to claim 12 , further comprising adjusting, by the controller, the first timing threshold so that the second timing threshold is further away from a patient average breath rate or period if the spontaneous patient breath is not detected before lapsing of the first timing threshold.
15. The method according to claim 11 , further comprising adjusting the first timing threshold to the second timing threshold based on a measure of adequacy of patient ventilation.