Ventilator-initiated prompt regarding auto-PEEP detection during pressure ventilation of patient exhibiting obstructive component
This disclosure describes systems and methods for monitoring and evaluating ventilatory parameters, analyzing ventilatory data associated with those parameters, and providing useful notifications and/or recommendations to clinicians. Modern ventilators monitor, evaluate, and graphically represent a myriad of ventilatory parameters. However, many clinicians may not easily identify or recognize data patterns and correlations indicative of certain patient conditions, changes in patient condition, and/or effectiveness of ventilatory treatment. Further, clinicians may not readily determine appropriate ventilatory adjustments that may address certain patient conditions and/or the effectiveness of ventilatory treatment. Specifically, clinicians may not readily detect or recognize the presence of Auto-PEEP during various types of pressure ventilation of a patient exhibiting an obstructive component. According to embodiments, a ventilator may be configured to monitor and evaluate diverse ventilatory parameters to detect Auto-PEEP and may issue suitable notifications and recommendations to the clinician when Auto-PEEP is implicated.
1. A ventilatory system for issuing a smart prompt when Auto-PEEP is implicated during pressure ventilation of a patient exhibiting an obstructive component, comprising:
at least one processor; and
at least one memory, communicatively coupled to the at least one processor and containing instructions that, when executed by the at least one processor, issue a smart prompt when Auto-PEEP is implicated, the ventilatory system comprising:
an Auto-PEEP detection module for detecting that Auto-PEEP is implicated for the patient upon detecting that parameter data breaches one or more predetermined thresholds;
a smart prompt module for:
determining a list of entries for mitigating Auto-PEEP, wherein the list of entries is determined based at least in part on determining that the patient exhibits an obstructive component;
issuing a smart prompt when Auto-PEEP is implicated, the smart prompt displaying:
a notification that Auto-PEEP is implicated; and
the list of entries for mitigating Auto-PEEP, the list of entries including one or more primary entries comprising one or more of:
decrease inspiratory time (T I );
adjust ventilatory settings until end-expiratory flow (EEF) approximates zero; and
investigate reasons for increased obstruction.
2. The ventilatory system of claim 1 , further comprising:
the smart prompt module for determining the notification, wherein the notification is based at least in part on the parameter data that implicated Auto-PEEP.
3. The ventilatory system of claim 2 , wherein the notification comprises information regarding the parameter data that implicated Auto-PEEP.
4. The ventilatory system of claim 1 , wherein the list of entries further includes one or more secondary entries.
5. The ventilatory system of claim 4 , wherein the patient is a triggering patient, and wherein the primary entries further comprise:
investigate reasons for an elevated patient respiratory drive.
6. The ventilatory system of claim 4 , wherein the patient is a non-triggering patient, and wherein the primary entries further comprise:
decrease respiratory rate (RR).
7. The ventilatory system of claim 4 , wherein the secondary entries comprise one or more of:
decrease inspiratory pressure in order to decrease delivered tidal volume (V T ) so that T E may be adequate to completely exhale delivered V T ; and
increase set PEEP to improve detection of patient triggering.
8. The ventilatory system of claim 1 , wherein the ventilator detects that flow is about zero during inspiration, and wherein the ventilator determines a time; t, from detection of about zero flow until set inspiratory time (T I ) ends, the primary entries comprising one or more of:
decrease T I by up to t such that expiratory time (T E ) may be increased while maintaining tidal volume (V T ); and
decrease T I by more than t such that T E may be increased, wherein when T I is decreased by more than t, the primary entries further comprise:
increase inspiratory pressure (IP) to maintain V T .
9. A graphical user interface of a ventilator for displaying one or more smart prompts corresponding to a detected condition of a patient, the ventilator configured with a computer having a user interface including the graphical user interface for accepting commands and for displaying information, the graphical user interface comprising:
at least one window; and
one or more elements within the at least one window comprising at least one smart prompt element for communicating information regarding the detected condition, wherein the detected condition is Auto-PEEP, and wherein the at least one smart prompt element further comprises:
a notification that Auto-PEEP is implicated; and
a list of entries for mitigating Auto-PEEP, the list of entries determined based at least in part on determining that a patient exhibits an obstructive component, the list of entries comprising one or more of:
decrease inspiratory time (T I );
adjust ventilatory settings until end-expiratory flow (EEF) approximates zero; and
investigate reasons for increased obstruction.
10. The graphical user interface of claim 9 , wherein the patient is a triggering patient, and wherein the list of entries further comprise one or more of:
investigate reasons for an elevated patient respiratory drive;
decrease inspiratory pressure in order to decrease delivered tidal volume (V T ) so that T E may be adequate to completely exhale delivered V T ; and
increase set PEEP to improve detection of patient triggering.
11. The graphical user interface of claim 9 , wherein the patient is a non-triggering patient, and wherein the list of entries further comprise one or more of:
decrease respiratory rate (RR); and
decrease inspiratory pressure in order to decrease delivered tidal volume (V T ) so that T E may be adequate to completely exhale delivered V T .
12. The graphical user interface of claim 9 , wherein the ventilator determines that the patient exhibits an obstructive component by:
determining a predicted expiratory time (T E );
determining an actual T E for the patient; and
determining that the actual T E is greater than the predicted T E .
13. The graphical user interface of claim 9 , wherein the ventilator determines that the patient exhibits an obstructive component by:
determining a normal pulmonary time constant;
calculating a pulmonary time constant for the patient; and
determining that the calculated pulmonary time constant is greater than the normal pulmonary time constant.
14. The graphical user interface of claim 9 , wherein the ventilator determines that Auto-PEEP is implicated by:
receiving one or more predetermined thresholds associated with end-expiratory flow (EEF);
detecting that EEF is positive when the EEF breaches the one or more predetermined thresholds; and
determining that Auto-PEEP is implicated when EEF is positive for a predetermined number of breaths.
15. The graphical user interface of claim 9 , wherein the ventilator determines that Auto-PEEP is implicated by:
calculating a time required to reach functional residual capacity (FRC);
comparing the time required to reach FRC with expiratory time (T E ); and
determining that Auto-PEEP is implicated when the time required to reach FRC is greater than T E .
16. The graphical user interface of claim 9 , wherein the ventilator detects that Auto-PEEP is implicated by:
receiving a positive end-expiratory pressure (PEEP) setting, wherein the PEEP setting is about 0 cm H 2 O or greater;
receiving one or more predetermined thresholds associated with end-expiratory pressure (EEP);
detecting that the EEP breaches the one or more predetermined thresholds when the EEP minus the PEEP setting is greater than the one or more predetermined thresholds; and
determining that Auto-PEEP is implicated when the EEP breaches the one or more predetermined thresholds.
17. The graphical user interface of claim 9 , wherein the ventilator detects that Auto-PEEP is implicated by:
comparing a pulmonary time constant to expiratory time (T E ); and
determining that Auto-PEEP is implicated when the T E is less than a predetermined number of pulmonary time constants.