St. Michael's Hospital.

Maquet Critical Care Ab

Universitéde Montreal

Unity Health Toronto

Jennifer Beck

Christer Sinderby

Norman Comtois

Fredrik Jalde

Lars Lindstrom

Joachim Sallvin

Pär Emtell

Christer Ström

Michael Kock

Jadranka Spahija

Frederik Jalde

Giacomo Grasselli

A mechanical ventilation system comprises a plurality of ventilation therapy sub-systems. Each of the ventilation therapy sub-systems is adapted to assist a respiratory function of the patient. The system also comprises a detector of the respiratory drive of the patient, an operator interface receiving one or more control parameters, and a main controller. The main controller assigns a therapeutic contribution to each of the ventilation therapy sub-systems based on the respiratory drive of the patient and on the control parameters. The controller modulates the respiratory drive of a patient by controlling each of the plurality of the ventilation therapy sub-systems according to its assigned therapeutic contribution. Distinct ventilation therapy sub-systems may apply negative pressure on the abdomen of the patient, deliver a non-pressurizing inspiratory flow to the patient, or induce a positive pressure in the airways of the patient.

Systems, devices and methods for modulating a respiratory drive of a patient

A device for providing ventilatory assist to a patient has a manifold having an inspiratory port to receive an inspiratory flow from an inspiratory supply line, an interface port connectable to an external end of an endotracheal tube inserted in a patient's trachea and an expiratory port configured to receive an expiratory flow from the endotracheal tube via the interface port. An inspiratory lumen has a distal end insertable in the endotracheal tube. A cross-section of the inspiratory lumen is smaller than that of the endotracheal tube to allow gas flowing in the endotracheal tube. The inspiratory flow is directed to the inspiratory lumen, or to the endotracheal tube, or at once to the inspiratory lumen and to the endotracheal tube.

Device, method and system for providing ventilatory assist to a patient

A device and method for controlling a level of ventilatory assist applied to a patient by a mechanical ventilator measures, during patient's assisted breath, an inspiratory volume Vproduced by both the patient and the mechanical ventilator, an inspiratory volume Vcontributed by the mechanical ventilator, and an inspiratory assist pressure Pproduced by the mechanical ventilator. A first relation between pressure Pand volume Vand a second relation between pressure Pand volume Vare calculated. Using the first and second relations, a ratio is determined between pressure Pat volume Vand pressure Pat volume V, with volume Vequal to volume V, for a plurality of volumes Vand V. Values of Pare multiplied by the corresponding calculated ratios to calculate a third relation between a predicted inspiratory pressure Pand volume V. The mechanical ventilator is responsive to the third relation to control the level of ventilatory assist.

Device and method for controlling ventilatory assist

The present disclosure relates to a method and a mechanical ventilation system for adjusting a level of ventilatory assist to a patient. A neuro-mechanical efficiency of the patient is determined. A control value is received at the mechanical ventilation system. The level of ventilatory assist to the patient is determined on the basis of the neuro-mechanical efficiency and of the control value. The mechanical ventilation system may be adjusted automatically based on the determined level of ventilatory assist to the patient. Alternatively, the determined level of ventilatory assist to the patient may be displayed for the benefit of an operator and a manual command may be received for adjusting the mechanical ventilation system.

Method and system for adjusting a level of ventilatory assist to a patient

The present disclosure relates to a method and a system for validating inspiratory muscle activity of a patient. Left and right electrical activity signals respectively representing activity of a left muscle and of a right muscle synchronized with an inspiratory effort of the patient are acquired from non-invasive sensors. A cardiac activity signal is extracted from the left and right electrical activity signals. A synchrony, a symmetry or a proportionality of the left and right electrical activity signals from which the cardiac activity signal is extracted is verified. A mechanical ventilation system incorporating the system for validating inspiratory muscle activity of the patient is also disclosed.

Method and system for validating inspiratory muscle activity of a patient, and mechanical ventilation system using the same

The present disclosure relates to a method and a system for quantifying timing discrepancies between inspiratory effort and ventilatory assist. A trigger error is determined by comparing a start time of neural inspiration with a start time of the ventilatory assist. A cycling-off error is determined by comparing an end time of the neural inspiration with an end time of the ventilatory assist. The ventilatory assist is synchronized when the trigger error is lower than a first threshold and the cycling-off error is lower than a second threshold. The ventilatory assist may also be characterized in terms of early or late trigger and of early or late cycling-off. A trigger of a ventilator may be adjusted according to the trigger error and a cycling-off of a ventilator may be adjusted according to the cycling-off error.

Method and system for quantifying timing discrepancies between inspiratory effort and ventilatory assist

A ventilatory assist system and method are disclosed. The system comprises a tube for connection to a patient's airway, inspiratory and expiratory tube lumens connected to the tube, an inspiratory air source connected to the inspiration tube lumen, and a controller of air pressure in the expiratory tube lumen. The pressure controller is responsive to a physiological breathing signal representative of patient's inspiratory effort to allow air flow through the expiratory tube lumen during a patient's expiration phase, partially restricting the air flow through the expiratory tube lumen to a so minimum air flow during a patient's inspiration phase. During both respiratory phases, a unidirectional air flow is produced through the inspiratory and expiratory tube lumens to prevent air expired by the patient from being breathed again. The physiological breathing signal allows synchronization of the ventilatory assist with breathing efforts of the patient.

Method and system for patient-synchronized ventilatory assist with endotracheal through-flow

In a method for positioning linear array of electrodes (LAE) mounted on distal end section of elongated flexible member in patient's respiratory airways (PRA) at level of diaphragm, a length of the member pre-determined to position LEA at the level of the diaphragm is inserted through PRA. Signals representative of an electrical activity of the diaphragm (EAdi) are detected through LAE, presence/absence of ECG signal components is detected in EAdi signals, and position of LAE in PRA is detected in response to presence/absence of ECG signal components in EAdi signals. Lower esophageal sphincter activity may be detected in EAdi signals, and position of LAE in PRA determined in response to the detected lower esophageal sphincter. End-expiratory occlusion of PRA may be performed to verify that the electrical activity of the diaphragm coincides with a negative deflection of PRA pressure again in view of determining adequate positioning of LAE.

Method and device positioning a linear array of electrodes in a patient's respiratory airways

A method and device for determining dynamic hyperinflation during mechanical ventilation of a spontaneously breathing patient, wherein mechanical ventilation is removed during one breath of the patient, inspiratory and expiratory volumes of the patient are measured during the one breath, and a difference between the inspiratory and expiratory volumes measured during the one breath is calculated. Dynamic hyperinflation of the patient's lungs is indicated in relation to the calculated difference.

Detection of dynamic hyperinflation in spontaneously breathing mechanically ventilated patients

A method and system for measuring changes in inspiratory load of a patient's respiratory system during mechanical ventilation. The method and system calculate a first relation between a measured inspiratory airway pressure and a measured electrical activity of respiratory muscle, and a second relation between a measured inspiratory volume and the measured electrical activity. A load index is calculated from the first and second relations. Changes in inspiratory load are determined based on the load index.

Method for measuring changes in inspiratory load

A method and device determine a level of mechanical ventilatory assist to be delivered to a patient. A patient's neural respiratory drive is measured and multiplied by an existing amplification factor to obtain an existing predicted ventilatory pressure. A mechanical ventilator is controlled accordingly. An existing resulting pressure is measured. The patient's neural respiratory drive is multiplied by a modified amplification factor to obtain a new predicted pressure. The existing and new predicted pressures are compared to determine an anticipated change in pressure. The mechanical ventilator is now controlled according to the new predicted pressure. A new resulting pressure is measured. The existing and new resulting pressures are compared to determine an actual change in pressure. The anticipated and actual changes in pressure are compared. The amplification factor is increased, maintained or decreased in response to the comparison between the anticipated and actual changes in pressure.

Method and device for determining a level of ventilatory assist to a patient

In a method and device for positioning a linear array of electrodes mounted on a distal end section of an elongated flexible member in a patient's respiratory airways at the level of the patient's diaphragm, a length of the elongated flexible member pre-determined to position the linear array of electrodes at the level of the patient's diaphragm is inserted through the patient's respiratory airways. Signals representative of an electrical activity of the patient's diaphragm (EAdi) are detected through the electrodes of the linear array, a presence or absence of ECG signal components is detected in the EAdi signals, and the position of the linear array of electrodes in the patient's respiratory airways is detected in response to the presence or absence of the ECG signal components in the EAdi signals. Also, lower esophageal sphincter activity may be detected in the EAdi signals, and the position of the linear array of electrodes in the patient's respiratory airways determined in response to the detected lower esophageal sphincter. Finally, an end-expiratory occlusion of the patient's respiratory airways may be performed to verify that the electrical activity of the diaphragm coincides with a negative deflection of the patient's respiratory airways pressure again in view of determining adequate positioning of the linear array of electrodes.

Electrode positioning

The present invention relates to a method and device for determining a level of ventilatory assist to a ventilator-dependent patient, in which a critical threshold of a respiration-related feature is calculated. Fatigue of a respiratory muscle of the ventilator-dependent patient develops when the critical threshold is reached by the respiration-related feature. The level of ventilatory assist to the ventilator-dependent patient is controlled in relation to the critical threshold of the respiration-related feature so as to prevent fatigue of the patient's respiratory muscle.

Method and device using myoelectrical activity for optimizing a patient's ventilatory assist

The present invention relates to a method of delivering combined positive and negative pressure assist ventilation to a patient, wherein a positive pressure is applied to the patient's airways to inflate the patient's lungs, a negative pressure is applied around the patient's ribcage and/or abdomen in order to reduce a load imposed by the ribcage and/or abdomen on the patient's lungs, and application of the positive and negative pressures is synchronized. The present invention also relates to a system for delivering combined positive and negative pressure assist ventilation to a patient, comprising a positive pressure ventilator connected to the patient's airways for applying a positive pressure to the patient's airways to inflate the patient's lungs, a negative pressure ventilator installed on the patient's ribcage and/or abdomen for applying a negative pressure around the patient's ribcage and/or abdomen in order to reduce a load imposed by the ribcage and/or abdomen on the patient's lungs, and a controller for synchronizing operation of the positive and negative pressure ventilators.

Combined positive and negative pressure assist ventilation

A closed loop system uses (a) the intensity of the diaphragm electromyogram (EMG) for a given inspiratory volume; (b) the inspiratory volume for a given EMG intensity; or (c) a combination of (a) and (b); in view of controlling the level of gas flow, gas volume or gas pressure delivered by a mechanical (lung) ventilator. The closed loop ventilator system enables for automatic or manual adjustment of the level of inspiratory support in proportion to changes in the neuro-ventilatory efficiency such that the neural drive remains stable at a desired target level. An alarm can also be used to detect changes in neuroventilatory efficiency in view of performing manual adjustments.

Growing community of inventors

Toronto, Canada

Jennifer Beck