Method and device for treating ataxic breathing

Abstract

The present invention relates to a method for re-synchronizing a breathing pattern of a patient (16) suffering from ataxic breathing, the method including the steps of monitoring the breathing pattern of the patient (16) during sleep; detecting whether the monitored breathing pattern includes an ataxic breathing episode; and if an ataxic breathing episode is detected, ventilating the patient (16) and eliminating a spontaneous breathing of the patient (16) for a predetermined first period of time (Δt.sub.1) by providing a flow of breathing gas (14) to an airway of the patient (16) with a volume of the breathing gas (14) provided per minute being above an individual-related threshold value of the patient (16).

Claims

1. Method for re-synchronizing a breathing pattern of a patient suffering from ataxic breathing, the method including the steps of: monitoring the breathing pattern of the patient during sleep; detecting that the monitored breathing pattern includes an ataxic breathing episode; and in response to detecting that the monitored breathing pattern includes the ataxic breathing episode, ventilating the patient and eliminating a spontaneous breathing of the patient for a predetermined first period of time (Δt.sub.1) by providing a flow of breathing gas to an airway of the patient with a volume of the breathing gas provided per minute being above an individual-related threshold value of the patient.

2. The method according to claim 1, wherein detecting the ataxic breathing episode includes evaluating one or more of a minute ventilation, a breathing frequency, and a breathing amplitude of the patient.

3. The method according to claim 2, wherein a part of the monitored breathing pattern of the patient is identified the ataxic breathing episode if a variation over time of the one or more of the minute ventilation, the breathing frequency, and the breathing amplitude of the patient is larger than a predetermined threshold.

4. The method according to claim 1, further comprising the steps of: discontinuing the flow of the breathing gas after the predetermined period of time for at least a second predetermined period of time(Δt.sub.2); (ii) monitoring the breathing pattern of the patient during the second predetermined period of time (Δt.sub.2); (iii) if another ataxic breathing episode is detected during the second period of time (Δt.sub.2), ventilating the patient and eliminating the spontaneous breathing of the patient again for a predetermined third period of time (Δt.sub.3); repeating steps (i)-(iii) until no ataxic breathing episode is detected any more during the second period of time (Δt.sub.2).

5. The method according to claim 4, wherein each time step (iii) is repeated, the flow of breathing gas is provided with a volume per minute that is increased compared to the flow of breathing gas provided in a previous step (iii).

6. The method according to claim 1, further comprising the step of determining the individual-related threshold value of the patient by determining a minute ventilation of the patient when no ataxic breathing episode is detected in the monitored breathing pattern.

7. The method according to claim 1, wherein the step of ventilating the patient and eliminating the spontaneous breathing of the patient for the first period of time (Δt.sub.1) includes sensing one or more breathing parameters of the patient and increasing the volume per minute of the provided flow of breathing gas until the one or more sensed breathing parameters are synchronized with the provided flow of breathing gas, and then further increasing the volume per minute of the provided flow of breathing gas at this point by a predetermined fixed or relative extra value.

8. The method according to claim 1, wherein the provided flow of breathing gas is an oscillating gas flow.

9. A device for re-synchronizing a breathing pattern of a patient suffering from ataxic breathing, comprising: a sensor for monitoring the breathing pattern of the patient during sleep, wherein the sensor generates a breathing signal; a pressure generator for generating a flow of breathing gas; a pressure circuit including a patient interface for guiding the generated flow of breathing gas to an airway of the patient; and a controller which is configured to: evaluate the breathing signal in order to detect whether the monitored breathing pattern includes an ataxic breathing episode; and if the ataxic breathing episode is detected in the breathing signal, control the pressure generator to provide for a predetermined first period of time (Δt.sub.1) the flow of breathing gas with a volume per minute being above an individual-related threshold value of the patient so as to ventilate the patient and eliminate a spontaneous breathing of the patient for said predetermined first period of time (Δt.sub.1).

10. The device according to claim 9, wherein the sensor includes at least one of a flow sensor, a pressure sensor, a camera, a radar sensor, an accelerometer, a piezoelectric sensor and an electrochemical gas sensor.

11. The device according to claim 9, wherein the controller is configured to: determine one or more of a minute ventilation, a breathing frequency, and a breathing amplitude of the patient based on the breathing signal; evaluate a variation over time of the one or more of the minute ventilation, the breathing frequency, and the breathing amplitude; and identify a part of the monitored breathing pattern of the patient as ataxic breathing episode if the variation over time of the one or more of the minute ventilation, the breathing frequency, and the breathing amplitude of the patient is larger than a predetermined threshold.

12. The device according to claim 9, wherein the controller is configured to: control the pressure generator to discontinue the flow of the breathing gas after the predetermined period of time for at least a second predetermined period of time (Δt.sub.2); (ii) control the sensor to monitor the breathing pattern of the patient during the second predetermined period of time (Δt.sub.2); and (iii) control the pressure generator, if another ataxic breathing episode is detected during the second period of time (Δt.sub.2), to provide again the flow of breathing gas for a predetermined third period of time ((Δt.sub.3) with the volume per minute being above the individual-related threshold value of the patient so as to ventilate the patient and eliminate the spontaneous breathing of the patient; wherein the controller is configured to repeat control steps (i)-(iii) until no ataxic breathing episode is detected any more during the second period of time (Δt.sub.2).

13. The device according to claim 12, wherein each time control step (iii) is repeated by the controller, the controller controls the pressure generator to provide the flow of breathing gas with the volume per minute that is increased compared to the flow of breathing gas provided in a previous control step (iii).

14. The device according to claim 9, wherein the controller is configured to determine the individual-related threshold value of the patient by determining a minute ventilation of the patient based on the breathing signal when no ataxic breathing episode is detected in the monitored breathing pattern.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

(1) These and other aspects of the invention will be apparent from and elucidated with reference to the embodiments described hereinafter. In the following drawings

(2) FIG. 1 schematically illustrates a respiratory therapy device according to an embodiment of the present invention;

(3) FIG. 2 illustrates an embodiment of a respiratory therapy method according to the present invention in form of a block diagram; and

(4) FIG. 3 shows a schematic graph that illustrates an exemplary volume flow over time of a breathing pattern of a patient.

DETAILED DESCRIPTION EXEMPLARY EMBODIMENTS

(5) As used herein, the singular form of “a”, “an”, and “the” include plural references unless the context clearly dictates otherwise. As used herein, the terms “first”, “second” merely distinguish between different components, time periods or features of the same type, but shall not imply any chronological order or a certain amount.

(6) Directional phrases used herein, such as, for example and without limitation, top, bottom, left, right, upper, lower, front, back, and derivatives thereof, relate to the orientation of the elements shown in the drawings and are not limited upon the claims unless expressly recited therein.

(7) The embodiments explained in the following are to be merely understood as exemplary embodiments of the herein presented device and method. These embodiments are described for the purpose of illustration based on what is currently considered to be most practical and preferred. However, on the contrary, it is intended to cover modifications and equivalent arrangements that are within the spirit and scope of the appended claims.

(8) FIG. 1 schematically illustrates an exemplary embodiment of the respiratory therapy device according to the present invention. The device is therein in its entirety denoted by reference numeral 10.

(9) The respiratory therapy device 10 comprises a gas flow generator 12 (also denoted as pressure generator 12) which is configured to generate a flow of breathing gas. Said generated flow of breathing gas is schematically indicated by arrows 14. The breathing gas may include air, oxygen, or a mixture thereof. It is delivered from the gas flow generator 12 to an airway of a patient 16 via a pressure circuit 18.

(10) The pressure circuit 18 connects the pressure generator 12 to the airway of the patient 16. It may include a conduit or hose 20 which is connected at its a first end to the pressure generator 12 and at its second opposite end to a patient interface 22. The patient interface 22 is preferably configured to direct the generated flow of breathing gas 14 to the airway of the patient 16 in a non-invasive manner. The patient interface 22 may include a mask, such as a full face mask for covering the nose and mouth, a mouth mask for covering the mouth, a nose mask for covering the nose, or a total face mask for covering most parts of the face including the nose, the mouth and the eyes.

(11) The pressure support system shown in FIG. 1 is what is usually known as a single-limb system, meaning that the pressure circuit 18 includes only one delivery conduit 20 connecting the patient 16 to the pressure generator 12.

(12) The present invention also contemplates that the pressure support system can be a two-limb system, having a delivery conduit and an exhaust conduit connected to the patient 16. In a two-limb system, the exhaust conduit carries exhaust gas from the patient 16 and includes an exhaust valve at the end distal from the patient 16.

(13) The pressure therapy device 10 furthermore comprises a sensor 24 and a controller 26. The sensor 24 is used for monitoring the breathing pattern of the patient 16. It generates a breathing signal that is indicative of the breathing pattern of the patient 16. The sensor 24 may include one or more sensors. The sensor 24 may e.g. comprise a flow sensor, a pressure sensor or an electrochemical gas sensor, and may be arranged at or within the patient interface 22 or within the delivery conduit 20 at a position close to the patient interface 22. In an alternative embodiment, the sensor 24 may include a camera or radar sensor that is arranged remote from the patient 16, the pressure generator 12, and the pressure circuit 18. This camera may monitor the movements of the patient's chest in order to derive the breathing signal. In a still further embodiment a radar sensor may be used for monitoring the chest movements of the patient 16 and thereby deriving the breathing signal.

(14) The controller 26 is configured to control the pressure generator 12 based on a predefined operating algorithm and based on the breathing signal provided by the sensor 24. The controller 26 may include one or more of a digital processor, an analog processor, a digital circuit designed to process information, an analog circuit designed to process information, a state machine and/or other mechanisms for electronically processing information. Preferably, the controller 26 includes a CPU having software stored thereon for carrying out the mechanisms as explained below and for controlling the pressure generator 12 in the way explained below. Although controller 26 is shown in FIG. 1 as a single entity, this is for illustrative purposes only. In some implementations, controller 26 may include a plurality of processing units. These processing units may be physically located within the same device, or controller 26 may represent processing functionality of a plurality of devices operating in coordination.

(15) The controller 26 may be configured to execute one or more computer program modules which are hardware and/or software implemented. The one or more computer program modules may include an evaluation module 28 and a pressure generator control module 30.

(16) The evaluation module 28 is preferably configured to evaluate the breathing signal provided by the sensor 24 in order to detect whether the monitored breathing pattern of the patient 16 includes an ataxic breathing episode.

(17) The pressure generator control module 30 is preferably configured to control the pressure generator 12 based on the evaluation of the breathing signal provided by the evaluation module 28. According to a preferred embodiment, the pressure generator control module 30 is configured to turn on the pressure generator 12 for providing the pressurized flow of breathing gas 14 only if the evaluation module 28 detects an ataxic breathing episode in the breathing signal provided by the sensor 24. In this case the pressure generator control module 30 preferably controls the pressure generator to provide the flow of breathing gas 14 for a predetermined period of time (herein denoted as first time period) with a volume per minute which is above an individual-related threshold value of the patient 16, wherein said individual-related threshold value corresponds or equals the minute ventilation of the patient 16 during regular breathing when no ataxic breathing occurs.

(18) The pressure generator 12 is in other words controlled to provide a pressurized flow of breathing gas 14 that exceeds the “regular” minute ventilation of the patient 16. The provision of a pressurized flow of breathable gas 14 that exceeds the “normal” minute ventilation of the patient 16 results in an elimination of the spontaneous breathing of the patient 16 such that the patient 16 is completely mechanically ventilated by means of the pressure generator 12.

(19) The elimination of the spontaneous breathing of the patient 16 overrides the person's irregular breathing pattern that occurs during ataxic breathing. This shall help to restore the balance between O.sub.2 and CO.sub.2, which balance is usually disordered during ataxic breathing, back to normal values again. The breathing pattern is thereby re-synchronized in similar way as a hearth rhythm is synchronized by an ICD.

(20) FIG. 1 shows a block diagram which schematically illustrates an embodiment of a method for re-synchronizing the breathing pattern of the patient 16. In a first step S10, the breathing pattern of the patient 16 is monitored, e.g. based on the breathing signal provided by the sensor 24. As long as no ataxic breathing episode occurs, the pressurized flow of breathable gas 14 may either be completely turned off or kept at a comparatively low level that allows the patient 16 to breathe spontaneously. This situation may, for example, be the case during time period 32 that is schematically illustrated in the volume flow-over-time graph shown in FIG. 3.

(21) The breathing signal provided by sensor 24 may e.g. be sampled in regular intervals in order to detect whether the monitored breathing pattern includes an ataxic breathing episode (see step S12). As long as no ataxic breathing episode is detected in the monitored breathing pattern the method remains in a closed loop between step S10 and step S12.

(22) If, on the other hand, an ataxic breathing episode is detected in the breathing signal, the afore-mentioned flow of breathing gas 14 is provided for a predetermined first time period Δt.sub.1 to overdrive the spontaneous breathing of the patient 16 (see step S14).

(23) A typical volume flow during ataxic breathing is depicted in FIG. 3 in time period 34. It may be seen that during this ataxic breathing time period 34 the amplitude, the frequency, and/or the minute ventilation vary rather strongly compared to regular breathing. It is therefore preferred to identify a part of the monitored breathing pattern of the patient 16 as ataxic breathing episode if a variation over time of one or more of the minute ventilation, the breathing frequency, and the breathing amplitude of the patient 16 is larger than a predetermined threshold. The minute ventilation, the breathing frequency, and/or the breathing amplitude are preferably derived from the breathing signal generated by the sensor 24.

(24) The provision of the gas flow 14 for overdriving spontaneous breathing of the patient 16 during the first time period Δt.sub.1 is schematically illustrated in time span 36 in FIG. 3. It can be seen that during this time period the volume per minute of the provided breathing gas flow 14 is above the minute ventilation during regular breathing (compare to time period 32 in FIG. 3).

(25) The value for the minute ventilation that is to be set during the first time period Δt.sub.1 may be determined in several ways:

(26) One possibility is to determine the minute ventilation of the patient 16 when no ataxic breathing episode is detected in the monitored breathing pattern, e.g. during time period 32, and then to set the volume per minute of the provided gas flow 14 to a value above the determined “normal” minute ventilation (e.g. 10%, 20% or 50% above).

(27) The second possibility is to use the breathing signal of the sensor 24 while the pressurized flow of breathing gas 14 is slowly ramped up. As long as the patient 16 is breathing spontaneously, the gas flow sensed by a flow sensor 24 will be influenced by the breathing effort of the patient 16. The flow of breathing gas 14 provided by the pressure generator 12 may thus be slowly ramped up until the sensed breathing parameters (e.g. the sensed inhaled and exhaled breathing flow of the patient 16) is synchronized with the flow of breathing gas 14 provided by the pressure generator 12. At this point mechanical ventilation of the patient 16 begins and spontaneous breathing is eliminated. If this point is detected, the controller 26 may control the pressure generator 12 to further increase the volume per minute of the provided flow of breathing gas 14 by an additional predetermined fixed or relative extra value.

(28) It shall be noted that independent of the way how the volume per minute of the gas flow 14 is determined and set, spontaneous breathing is overdriven only for the predetermined first period of time Δt.sub.1. This first time period Δt.sub.1 may be equal to or less than one minute, equal to or less than two minutes, or equal to or less than five minutes. After that time period Δt.sub.1 the flow of gas 14 is preferably turned off or reduced to a level below the regular minute ventilation of the patient 16. Time period 38 schematically illustrated in FIG. 3 shows a corresponding situation. This situation corresponds to method step S16 during which the provision of the gas flow 14 is discontinued/interrupted for at least a second period of time Δt.sub.2. The breathing pattern of the patient 16 is monitored again by the sensor 24 during the second time period Δt.sub.2 (see step S18).

(29) If no ataxic breathing episode occurs during time period Δt.sub.2, the method may return to step S10 (see method step S20).

(30) If, however, an ataxic breathing episode is detected again during time period Δt.sub.2, the pressure generator 12 may be controlled to again provide the breathing gas flow 14 to overdrive spontaneous breathing of the patient 16 (see step S22). The method may afterwards return to step S16 so as to repeat method steps S16-S22 until no ataxic breathing episodes are detected anymore (see FIG. 2).

(31) In the example shown in FIG. 3 the breathing pattern of the patient 16 at first sight returns to a normal state after the first provision of the gas flow 14 during time period 36 (see beginning of time period 38 in FIG. 3). However, then ataxic breathing begins again. This could be e.g. the case if the re-synchronization provided during time period 36 has not been enough to completely eliminate ataxic breathing. The gas flow 14 is therefore provided again during time period 40 in the example shown in FIG. 3. The controller 26 of the device 10 may be configured to control the pressure generator 12 to provide the flow of breathing gas this time for a third time period Δt.sub.3 which is longer than the first time period Δt.sub.1. This shall increase the likelihood of eliminating the occurrence of an ataxic breathing episode. Alternatively, the same effect may be achieved if the third time period Δt.sub.3 equals the first time period Δt.sub.1 and the flow rate during the third time period Δt.sub.3 is increased compared to the flow rate applied during the first time period Δt.sub.1. According to an another embodiment, the third time period Δt.sub.3 may even be or shorter than the first time period Δt.sub.1.

(32) It may be also seen in the example schematically illustrated in FIG. 3 that the breathing of the patient 16 returns to a normal state without any occurrence of an ataxic breathing episode in time period 42 after the second re-synchronization of the breathing pattern (during time period 40).

(33) Lastly, it shall be noted that the provided flow of breathing gas 14 is preferably designed to be an oscillating gas flow. This may include a sinusoidal behavior of the volume flow but may also include indiscrete changes between phases of high level pressure (during inhalation) and phases of low level pressure (during exhalation).

(34) While the invention has been illustrated and described in detail in the drawings and foregoing description, such illustration and description are to be considered illustrative or exemplary and not restrictive; the invention is not limited to the disclosed embodiments. Other variations to the disclosed embodiments can be understood and effected by those skilled in the art in practicing the claimed invention, from a study of the drawings, the disclosure, and the appended claims.

(35) In the claims, the word “comprising” does not exclude other elements or steps, and the indefinite article “a” or “an” does not exclude a plurality. A single element or other unit may fulfill the functions of several items recited in the claims. The mere fact that certain measures are recited in mutually different dependent claims does not indicate that a combination of these measures cannot be used to advantage.

(36) A computer program may be stored/distributed on a suitable medium, such as an optical storage medium or a solid-state medium supplied together with or as part of other hardware, but may also be distributed in other forms, such as via the Internet or other wired or wireless telecommunication systems.

(37) Any reference signs in the claims should not be construed as limiting the scope.