Methods and systems that monitor and respond to changes in physiological status based on measurements of respiration characteristics and pulmonary arterial pressure obtained from implantable sensors

1. A method for use by a system at least a portion of which is implanted within a patient and used to deliver cardiac pacing therapy, the method comprising:

using a first implantable sensor to determine a baseline measure of pulmonary arterial pressure (PAP) for the patient at rest;

using a second implantable sensor to determine a baseline measure of respiration for the patient at rest;

determining an acceptable range of PAP measures for the patient at rest based on the baseline measure of PAP that is determined for the patient at rest;

determining an acceptable range of respiration measures for the patient at rest based on the baseline measure of respiration that is determined for the patient at rest;

using the first implantable sensor to detect whenever the patient's PAP at rest is outside the acceptable range of PAP measures for the patient at rest;

using the second implantable sensor to detect whenever the patient's respiration at rest is outside the acceptable range of respiration measures for the patient at rest;

triggering a first action in response to detecting that the patient's PAP at rest is outside the acceptable range of PAP measures for the patient at rest, while contemporaneously the patient's respiration at rest is within the acceptable range of respiration measures for the patient at rest;

triggering a second action in response to detecting that the patient's respiration at rest is outside the acceptable range of respiration measures for the patient at rest, while contemporaneously the patient's PAP at rest is within the acceptable range of PAP measures for the patient at rest; and

triggering a third action in response to detecting that the patient's PAP at rest is outside the acceptable range of PAP measures for the patient at rest, while contemporaneously the patient's respiration at rest is outside the acceptable range of respiration measures for the patient at rest, the third action comprising adjusting a pacing parameter that is used for the cardiac pacing therapy and is selected from a group consisting of a pacing rate, an atrio-ventricular (AV) delay, an interatrial conduction (AA) delay, an interventricular conduction (VV) delay, an intraventricular (LV 1 -LV 2 ) delay, and an LV pacing site;

wherein the first, second, and third actions differ from one another.

2. The method of claim 1 , wherein:

the first action that is triggered comprises a first alert that informs at least one of the patient or a medical personnel that the patient's PAP is abnormal for the patient;

the second action that is triggered comprises a second alert that informs at least one of the patient or a medical personnel that the patient's respiration is abnormal for the patient; and

the third action that is triggered also comprises a third alert that informs at least one of the patient or a medical personnel that both the patient's PAP is abnormal for the patient and the patient's respiration is abnormal for the patient.

3. The method of claim 1 , wherein:

the second action that is triggered also comprises adjusting a pacing parameter that is used for cardiac pacing therapy and is selected from the group consisting of a pacing rate, an atrio-ventricular (AV) delay, an interatrial conduction (AA) delay, an interventricular conduction (VV) delay, an intraventricular (LV 1 -LV 2 ) delay, and an LV pacing site; and

the pacing parameter that is adjusted and corresponds to the second action differs from the pacing parameter that is adjusted and corresponds to the third action.

4. The method of claim 1 , wherein the baseline measure of respiration for the patient at rest is selected from the group consisting of:

a baseline measure indicative of respiration rate for the patient at rest;

a baseline measure indicative of tidal volume for the patient at rest;

a baseline measure indicative of inspiratory time for the patient at rest;

a baseline measure indicative of expiratory time for the patient at rest;

a baseline measure indicative of minute ventilation for the patient at rest; and

a baseline measure indicative of morphology of a signal waveform indicative of respiration for the patient at rest.

5. The method of claim 1 , wherein:

the second implantable sensor is used to determine a separate baseline measure of respiration for the patient at rest for each of a plurality of different types of measures of respiration;

an acceptable range of respiration measures for the patient at rest is determined for each of the plurality of different types of measures of respiration based on the respective baseline measure of respiration that is determined for the patient at rest; and

the patient's respiration at rest is determined to be outside the acceptable range of respiration measures for the patient at rest whenever N out of M of the different types of measures of respiration is/are outside their respective baseline measure of respiration for the patient at rest, where M is a number specifying the different types of measures of respiration for which a respective acceptable range of respiration measures is determined for the patient at rest, and N is a predefined number that is equal to or less than M.

6. The method of claim 5 , wherein a said acceptable range of respiration measures for the patient at rest is determined for at least two of the following different types of measures of respiration:

respiration rate for the patient at rest;

tidal volume for the patient at rest;

inspiratory time for the patient at rest;

expiratory time for the patient at rest;

minute ventilation for the patient at rest; or

morphology of a signal waveform indicative of respiration for the patient at rest.

7. The method of claim 1 , further comprising:

using an implantable sensor, which may or may not be the same as one of the first and second implantable sensors, to determine when the patient is at rest.

8. The method of claim 7 , wherein:

the implantable sensor that is used to determine when the patient is at rest comprises an accelerometer, which is different than the first and second implantable sensors.

9. The method of claim 1 , wherein:

the first implantable sensor is configured to sense PAP; and

the second implantable sensor is configured to sense thoracic impedance.

10. The method of claim 9 , wherein:

the second implantable sensor is configured to produce a thoracic impedance signal from which one or more types of respiration measures can be determined.

11. The method of claim 1 , wherein:

each of the first, second, and third actions comprise adjusting a same pacing parameter that is used for the cardiac pacing therapy and is selected from the group consisting of a pacing rate, an atrio-ventricular (AV) delay, an interatrial conduction (AA) delay, an interventricular conduction (VV) delay, an intraventricular (LV 1 -LV 2 ) delay, and an LV pacing site; and

adjustments that are made to the same pacing parameter and correspond to the first, second, and third actions differ from one another.

12. A system at least a portion of which is implantable within a patient, the system comprising:

a first implantable sensor configured to sense pulmonary arterial pressure (PAP);

a second implantable sensor configured to sense thoracic impedance;

one or more processors configured to:

determine a baseline measure of PAP for the patient at rest based on one or more measures obtained using the first implantable sensor;

determine a baseline measure of respiration for the patient at rest based on one or more measures obtained using the second implantable sensor;

determine an acceptable range of PAP measures for the patient at rest based on the baseline measure of PAP that is determined for the patient at rest;

determine an acceptable range of respiration measures for the patient at rest based on the baseline measure of respiration that is determined for the patient at rest;

detect whenever the patient's PAP at rest is outside the acceptable range of PAP measures for the patient at rest based on one or more measures obtained using the first implantable sensor;

detect whenever the patient's respiration at rest is outside the acceptable range of respiration measures for the patient at rest based on one or more measures obtained using the second implantable sensor;

trigger a first action in response to a detection that the patient's PAP at rest is outside the acceptable range of PAP measures for the patient at rest, while contemporaneously the patient's respiration at rest is within the acceptable range of respiration measures for the patient at rest;

trigger a second action in response to a detection that the patient's respiration at rest is outside the acceptable range of respiration measures for the patient at rest, while contemporaneously the patient's PAP at rest is within the acceptable range of PAP measures for the patient at rest; and

trigger a third action in response to a detection that the patient's PAP at rest is outside the acceptable range of PAP measures for the patient at rest, while contemporaneously the patient's respiration at rest is outside the acceptable range of respiration measures for the patient at rest, the third action comprising adjusting a pacing parameter that is used for the cardiac pacing therapy and is selected from a group consisting of a pacing rate, an atrio-ventricular (AV) delay, an interatrial conduction (AA) delay, an interventricular conduction (VV) delay, an intraventricular (LV 1 -LV 2 ) delay, and an LV pacing site;

wherein the first, second, and third actions differ from one another.

13. The system of claim 12 , wherein:

the first action that is triggered comprises a first alert that informs at least one of the patient or a medical personnel that the patient's PAP is abnormal for the patient;

the second action that is triggered comprises a second alert that informs at least one of the patient or a medical personnel that the patient's respiration is abnormal for the patient; and

the third action that is triggered also comprises a third alert that informs at least one of the patient or a medical personnel that both the patient's PAP is abnormal for the patient and the patient's respiration is abnormal for the patient.

14. The system of claim 12 , wherein:

the second action that is triggered also comprises adjusting a pacing parameter that is used for cardiac pacing therapy and is selected from the group consisting of a pacing rate, an atrio-ventricular (AV) delay, an interatrial conduction (AA) delay, an interventricular conduction (VV) delay, an intraventricular (LV 1 -LV 2 ) delay, and an LV pacing site; and

the pacing parameter that is adjusted and corresponds to the second action differs from the pacing parameter that is adjusted and corresponds to the third action.

15. The system of claim 12 , wherein the one or more processors is/are configured to:

determine a separate baseline measure of respiration for the patient at rest for each of a plurality of different types of measures of respiration;

determine an acceptable range of respiration measures for the patient at rest for each of the plurality of different types of measures of respiration based on the respective baseline measure of respiration that is determined for the patient at rest; and

determine that the patient's respiration at rest is outside the acceptable range of respiration measures for the patient at rest whenever N out of M of the different types of measures of respiration is/are outside their respective baseline measure of respiration for the patient at rest;

where M is a number specifying the different types of measures of respiration for which a respective acceptable range of respiration measures is determined for the patient at rest, and N is a predefined number that is equal to or less than M.

16. The system of claim 12 , wherein the one or more processors is/are configured to use an implantable sensor, which may or may not be the same as one of the first or second implantable sensors, to determine when the patient is at rest.

17. The system of claim 16 , wherein the implantable sensor that is used to determine when the patient is at rest comprises an accelerometer, which is different than the first and second implantable sensors.

18. The system of claim 12 , wherein:

the second implantable sensor is configured to produce a thoracic impedance signal from which one or more types of respiration measures can be determined.

19. The method of claim 1 , wherein:

each of the first, second, and third actions comprises adjusting a pacing parameter that is used for the cardiac pacing therapy and is selected from the group consisting of a pacing rate, an atrio-ventricular (AV) delay, an interatrial conduction (AA) delay, an interventricular conduction (VV) delay, an intraventricular (LV 1 -LV 2 ) delay, and an LV pacing site; and

the pacing parameters that are adjusted and correspond to the first, second, and third actions differ from one another.

20. The system of claim 12 , wherein:

each of the first, second, and third actions comprises adjusting a pacing parameter that is used for the cardiac pacing therapy and is selected from the group consisting of a pacing rate, an atrio-ventricular (AV) delay, an interatrial conduction (AA) delay, an interventricular conduction (VV) delay, an intraventricular (LV 1 -LV 2 ) delay, and an LV pacing site; and

the pacing parameters that are adjusted and correspond to the first, second, and third actions differ from one another.

21. The system of claim 12 , wherein:

each of the first, second, and third actions comprise adjusting a same pacing parameter that is used for the cardiac pacing therapy and is selected from the group consisting of a pacing rate, an atrio-ventricular (AV) delay, an interatrial conduction (AA) delay, an interventricular conduction (VV) delay, an intraventricular (LV 1 -LV 2 ) delay, and an LV pacing site; and

adjustments that are made to the same pacing parameter and correspond to the first, second, and third actions differ from one another.

22. A method for use by a system at least a portion of which is implanted within a patient, the method comprising:

sensing pulmonary arterial pressure (PAP) and thoracic impedance of a patient;

detecting, based on the sensed PAP, whenever the patient's PAP is outside an acceptable range of PAP measures for the patient;

detecting, based on the sensed thoracic impedance, whenever the patient's respiration is outside an acceptable range of respiration measures for the patient;

triggering a first action in response to detecting that the patient's PAP is outside the acceptable range of PAP measures for the patient, while contemporaneously the patient's respiration is within the acceptable range of respiration measures for the patient;

triggering a second action in response to detecting that the patient's respiration is outside the acceptable range of respiration measures for the patient, while contemporaneously the patient's PAP is within the acceptable range of PAP measures for the patient; and

triggering a third action in response to detecting that the patient's PAP is outside the acceptable range of PAP measures for the patient, while contemporaneously the patient's respiration is outside the acceptable range of respiration measures for the patient;

wherein each of the first, second, and third actions comprises adjusting a pacing parameter that is used for the cardiac pacing therapy and is selected from a group consisting of a pacing rate, an atrio-ventricular (AV) delay, an interatrial conduction (AA) delay, an interventricular conduction (VV) delay, an intraventricular (LV 1 -LV 2 ) delay, and an LV pacing site; and

wherein the pacing parameters that are adjusted and correspond to the first, second, and third actions differ from one another.

23. The method of claim 22 , wherein:

the first action that is triggered comprises a first alert that informs at least one of the patient or a medical personnel that the patient's PAP is abnormal for the patient;

the second action that is triggered comprises a second alert that informs at least one of the patient or a medical personnel that the patient's respiration is abnormal for the patient; and

the third action that is triggered comprises adjusting at least one pacing parameter that is used to deliver cardiac pacing therapy using a portion of the system that is implanted.