ICU Monitor With Medication Data
20230041220 · 2023-02-09
Inventors
Cpc classification
G16H20/40
PHYSICS
G16H50/20
PHYSICS
A61B5/744
HUMAN NECESSITIES
G16H10/60
PHYSICS
A61B5/7425
HUMAN NECESSITIES
G16H50/70
PHYSICS
A61B5/743
HUMAN NECESSITIES
A61B5/0205
HUMAN NECESSITIES
International classification
A61B5/00
HUMAN NECESSITIES
A61B5/0205
HUMAN NECESSITIES
Abstract
Systems and methods for remotely monitoring hospital patients are provided. Medical devices may capture biometric data associated with a patient positioned in an ICU environment, and a remote display device positioned external to the ICU environment may display an indication of the health of the patient based on the captured biometric data. The indication of the health of the patient may include a graph mapping normalized health statuses associated with the patient over time. Each normalized health status may be based on normalizing a particular type of biometric data based on a medical protocol, so each data point of the graph includes an indication of a normalized health status associated with the patient at a given time. The indication of the health of the patient may include an animated three-dimensional that is dynamically updated to reflect biometric data associated with the patient captured at a time selected by a user.
Claims
1-14. (canceled)
15. A remote display device positioned external to an intensive care unit (ICU) environment and configured to display, via a user interface, an indication of the health of a patient positioned in the ICU environment based on biometric data captured by one or more medical devices positioned in the ICU environment, the indication including a graph mapping one or more normalized health statuses associated with the patient over a period of time, wherein each normalized health status is based on normalizing a particular type of the captured biometric data based on a medical protocol, such that each data point of the graph includes an indication of a normalized health status associated with the patient at a given time.
16. The remote display device of claim 15, wherein the indication of the health of the patient further includes an animated three-dimensional model associated with the body of the patient, the animated three-dimensional model being dynamically updated to reflect biometric data associated with the patient captured over the period of time.
17. The remote display device of claim 15, wherein the one or more medical devices include one or more of: ventilators, arterial catheters, external pressure cuffs, pulse oximeters, electrocardiograms, and pulmonary artery (PA) catheters.
18. The remote display device of claim 15, wherein the one or more types of biometric data include one or more of: blood pressure, oxygen saturation of blood, heart rate, respiratory rate, central venous pressure, right atrial pressure, PA pressure, and cardiac output.
19. The remote display device of claim 15, wherein each of the normalized health statuses is one of: a normal health status, one or more intermediate health statuses, or an alarm health status.
20. The remote display device of claim 15, wherein each normalized health status is associated with a color as shown in the graph.
21. The remote display device of claim 15, wherein the medical protocol is selected by a user from a number of available medical protocols.
22. The remote display device of claim 15, wherein the medical protocol is created by a user.
23. The remote display device of claim 15, wherein the medical protocol includes a range of values for each type of biometric data associated that are associated with each normalized health status.
24. The remote display device of claim 15, wherein the one or more types of biometric data upon which the normalized health statuses shown in the graph are based are selected by a user.
25. The remote display device of claim 15, wherein the period of time shown is selected by a user.
26. The remote display device of claim 15, wherein the remote display device is further configured to: receive one or more text notes associated with the patient as user input; and store indications of times at which each of the one or more text notes were recorded.
27. The remote display device of claim 26, wherein the remote display device is further configured to: receive an indication of a term to be searched within the text notes as user input; search the text notes for instances of the indicated term within the text notes; and display any instances of the indicated term within the text notes.
28. The remote display device of claim 17, the period of time is selected based on a time at which a text note including an instance of the indicated term was recorded.
29. A computer-implemented method for remotely monitoring hospital patients, the method comprising: receiving, by a processor associated with a remote display device positioned outside of an intensive care unit (ICU) environment, from one or more medical devices positioned in the ICU environment, one or more types of biometric data associated with a patient positioned in the ICU environment over time; normalizing, by the processor associated with the remote display device, the one or more types of biometric data based on a medical protocol to produce a normalized health status for each type of biometric data; generating, by the processor associated with the remote display device, an indication of the health of the patient based on the captured biometric data, the indication including a graph mapping one or more normalized health statuses associated with the patient over a period of time, such that each data point of the graph includes an indication of a normalized health status associated with the patient at a given time; and displaying, by a user interface of the remote display device, the generated indication of the health of the patient.
30. The method of claim 29, further comprising: generating, by the processor associated with the remote display device, an animated three-dimensional model associated with the body of the patient, wherein one or more features of the animated three-dimensional model associated with the body of the patient are based on the one or more types of biometric data captured by the one or more medical devices positioned in the ICU environment over the period of time; and wherein displaying the generated indication of the health of the patient further includes displaying the animated three-dimensional model.
31. The method of claim 30, further comprising: receiving, by the user interface of the remote display device, an indication of a period of time selected by a user; dynamically updating, by the processor associated with the remote display device, the animated three-dimensional model associated with the body of the patient to reflect biometric data associated with the patient captured by the one or more medical devices over the period of time selected by a user.
32. The method of claim 29, wherein the one or more medical devices include one or more of: ventilators, arterial catheters, external pressure cuffs, pulse oximeters, electrocardiograms, and pulmonary artery (PA) catheters.
33. The method of claim 29, wherein the one or more types of biometric data include one or more of: blood pressure, oxygen saturation of blood, heart rate, respiratory rate, central venous pressure, right atrial pressure, PA pressure, and cardiac output.
34. The method of claim 29, wherein each normalized health status is one of: a normal health status, one or more intermediate health statuses, or an alarm health status.
35-59. (canceled)
Description
BRIEF DESCRIPTION OF THE DRAWINGS
[0023]
[0024]
[0025]
[0026]
[0027]
DETAILED DESCRIPTION
[0028] The present disclosure provides a software and hardware platform that allows healthcare providers to easily observe biometrics from multiple medical devices attached to a patient in the intensive care unit (ICU). The platform aggregates readings and settings across a wide array of equipment such as ventilators, pulse oximeters, and other bedside monitors, and displays them on a single screen in real time through an application. These screens can be implemented via remote display devices, including tablets or other mobile computing devices that can be mounted outside of each patient’s room in the ICU or at other appropriately secure locations (such as a nurses’ station), or almost anywhere, subject to security protocols - or personal computers or smart phones. In short, this platform provides a window into the ICU from a safe distance outside - thus minimizing the need for health care personnel to physically enter the ICU for monitoring and recording data from the bedside monitors and ventilators.
[0029] Using this platform, healthcare professionals can see the biometrics of all patients in their care, whether the healthcare professional is onsite or offsite - in meeting rooms, at homes in hotels and so on. In addition, this platform allows providers to send customized instructions to ICU teams for display on the aforementioned tablets via a secure messaging channel. The mobile access feature is compatible with PCs, tablets and all smart devices.
[0030] There are many generations of bedside monitors and ventilators currently in use, ranging from those that are not integrated with Electronic Medical Record (EMR) systems and require manual charting, and those that stream all settings to the EMR. In some examples, this platform may be implemented via these existing bedside monitors and ventilators that have either been integrated with EMR systems or have published APIs which allow for real-time data capture, storage and display. Moreover, in some examples, this platform may be integrated into older generations of bedside monitors and ventilators, i.e., makes and models that do not readily support real-time data transmission. The data from such machines will be captured through a combination of methods including screen capture and available interfaces such as Recommended Standard 232 (RS-232). These devices will also need to be connectivity enabled, e.g., via an Ethernet cable or via Wi-Fi.
[0031] Generally speaking, all data capture, transmission, storage and display will be compliant with HIPAA regulations. In some examples, a multi-factor authentication (MFA), either using patient-specific fobs or other software mechanisms such as VIP Access/RSA, may be implemented in order to ensure the highest levels of cybersecurity.
[0032] Furthermore, the present disclosure provides a ventilator weaning platform that aids in clinical decision support through remote monitoring of ventilator settings and real time analysis of patient data with a focus on weaning from ventilation. The key thrust is reducing ventilator associated events (VAE) by weaning patients from mechanical ventilation in the most efficient and optimized manner. Generally speaking, a ventilator weaning platform accomplishes remote monitoring of ventilator settings via a screen that displays real time ventilator settings outside of each patient’s room. To achieve this, data is streamed from a ventilator patient’s electronic medical record (EMR) to, e.g., a cloud-based server, and then presented on the aforementioned screen.
[0033] In the course of accumulating patient data in the ICU, new ways of handling different disease conditions, new therapies, devices, treatments and technologies may be discovered. Identifying targets will bring about collaborations with pharmaceutical companies therapeutic indications may be recommended for a given population profile: usage, dosage, administration and comparator profiles. The healthcare team may control ventilators remotely or the ventilator weaning platform itself may control ventilators with or without human intervention. This will involve non-ICU applications, including but not limited to using the ventilator weaning platform in a sustaining mode for patients with ventilators at home, in skilled nursing facilities and long-term care facilities.
[0034] Automatic data collection can eliminate delays, improve charting efficiency, and reduce errors caused by incorrect data. In particular, electronic medical record (EMR) and ventilator data analysis with may improve patient outcomes by monitoring key factors such as: Fraction of Inspired Oxygen (FIO2), Positive End Respiratory Pressure (PEEP), Tidal Volume, Respiratory Rate, Peak Inspiratory Flow, Pressure Support, Peak Inspiratory Flor Rate, Low Minute Ventilation Alarm Limit, High Pressure Alarm Limit, High Respiratory Rate Alarm Limit, and Low Tidal Volume Alarm Limit. Analysis of this data can be used to update and customize automated ventilator protocols and thereby reduce the duration of mechanical ventilation. Gathering data from many thousands of patients and ventilators, examining successful and unsuccessful weaning outcomes, and comparing this information against reason for admission, demographics, co-morbidities, level of sedation, etc. has yielded a quantitative/predictive model that can be applied to a specific patient, thus allowing a ventilator weaning platform to be custom adjusted for each patient to optimize successful weaning and extubation.
[0035] For example, patient data (physical, medications, radiology, underlying disease conditions, etc.) along with ventilator settings may stream to the cloud, analysis may be performed, and data may streamed back to the displays outside of each patient’s room and/or made available remotely to the clinical team. The power of this analysis is that the ventilator weaning platform will have access to data from many patients and will compare similar patients in its database to the exact patient in each room. Generally speaking, the ventilator platform aggregates data, performs a unique analysis/prediction and places that information in the hands of the care team, who will then make actual decisions regarding the ventilator (e.g., changing ventilator settings, initiating a spontaneous breathing trial, extubating, etc.). For example, a monitor outside of each patient room may display ventilator settings as well as a visual system (red/yellow/green background) highlighting each patient’s trajectory on the ventilator as they progress in the ventilator weaning process.
[0036] Furthermore, in some examples, the ventilator weaning platform may include a clinical guidance tool rooted in this analysis and driven by protocol. The remote display device may also recommend/remind the treating healthcare professional (or team of healthcare professionals) of the need (when appropriate) for a spontaneous breathing trial (SBT).
[0037] Advantageously, the ventilator weaning platform makes ventilator information (including, e.g., ventilator settings information, recommendations, etc.) displayed on the screens of remote display device easily available to the clinical team on their phones and computers at any time and in any location. Beneficially, using this ventilator weaning platform, senior intensivists will minimize their chances of contracting COVID-19, efficiently guiding junior physicians and other members of the clinical team through ventilator management. Perhaps more importantly, one skilled intensivist will be able to monitor many ventilated patients simultaneously.
[0038] In particular, with a 22% shortage of intensivists in 2020 in the United States, there are multiple benefits associated with remote monitoring in the current crisis. Primarily, the ventilator weaning platform aims to keep critical specialists from becoming infected with COVID-19 (or other infectious diseases). When critical care physicians and nurses become infected, clinical teams from other areas of the hospital fill-in to treat their ICU patients. Many of these physicians and nurses have little ICU experience, particularly in managing ventilated patients. This ventilator weaning platform will be very helpful to an untrained or less trained workforce as more and more hospital staff are enlisted to help in ICUs. The remote display device will act not only as a guidance tool for mechanical ventilation, but will serve as an easy to interpret communications tool for patient status (e.g., preparing to wean, weaning, ready to extubate). Advantageously, with remote monitoring, senior critical care physicians are not required to enter each patient’s room to evaluate ventilator settings as they can simply walk through the ICU hallways and view settings outside of each patient’s room. Additionally, the use of PPE is minimized as each member of the clinical team is not required to don protective equipment to perform ventilator setting checks.
[0039] As an additional advantage, the ventilator weaning platform may be agnostic to the EMR system (e.g., Epic, Cerner) as well as the equipment being used in the ICU. Accordingly, all hospital systems may benefit from the analysis provided by the ventilator weaning platform, not just hospitals contracted to a particular vendor. For instance, eICU software that is only able to communicate with other certain vendors can underserve both patients and critical care teams. Moreover, the ventilator weaning platform will reinforce best practices/outcomes in one ICU and share with others; conversely, practices with less favorable outcomes will be highlighted for physician review.
[0040] Generally speaking, as discussed above, the analysis performed by the ventilator weaning platform involves accessing protected health information (PHI) from patients’ EMR. To this end, the ventilator weaning platform employs best-in-class methods to ensure that that patient information, privacy, integrity and confidentiality data remain secure at all times. In particular, accessing PHI must incorporate the following security policies and procedures: authorization, authentication, availability, confidentiality, data integrity, and nonrepudiation (transaction records). Additionally, physical safeguards may include: use of encrypted storage or devices, restricting access to authorized personnel only, reserving copies and conducting data backups, maintaining emergency contingency protocols, and disposing outdated devices and data sources properly. For example, each remote display device may require an authentication process that links it with a given patient in a given room. In one example, disposable smart card that is unique to each patient may be inserted in each remote display device. The smart card may be programmed by hospital IT for each unique patient and, after insertion in each remote display device, the ventilator weaning platform will automatically authenticate the card with the patient’s EMR and synchronize with the cloud.
[0041] Moreover, decisions that physicians make relative to each patent, their associated EMR data, and ventilator settings may be observed and recorded. In particular, this data may be collected, aggregated, and analyzed to identify parameters that lead to successful extubation. As the ventilator weaning platform aggregates more patient data, a seamless and virtuous feedback loop may be created, in which the ventilator weaning platform gains prediction accuracy and develops patient and disease specific guidance. Where there are no ventilator management protocols for certain diseases (e.g., new diseases such as COVID-19), the platform can analyze all patients and recommend standard treatment guidelines that can be evaluated by physicians. Additionally, although a ventilator weaning platform is discussed herein, similar platforms may be used to identify other correlations in critical care medicine beyond respiratory support.
[0042]
[0043] The system 100 may further include one or more remote display devices 104 configured to graphically display indications of the health of the patients based on data associated with the patients captured by the medical devices 102. Finally, the example system 100 may include a computing device 106. The medical devices 102 and/or the remote display devices 104 may communicate with the computing device 106 via a network 108. Additionally, the medical devices 102, remote display devices 104, and/or the computing device 106 may further communicate with one or more healthcare computing devices 110 via the network 108.
[0044] Each of the remote display devices 104 may include a user interface 111 configured to present information to users and/or receive various inputs from users. In some examples, the remote display devices 104 may be configured to receive input from users, including healthcare providers, which may include, for instance, input indicating which medications (or food or water or other nutrients) are administered to patients, a manner in which the medications are administered to patients (e.g., via a pill, IV drip, ampoule, etc.) and dates and times at which these medications (or food or water or other nutrients) are administered. This data may be stored in the database 123. Furthermore, each remote display device 104 may be configured to graphically display indications of the health of the patients based on the biometric data associated with the patients captured by the medical devices 102 via a respective user interface 111. In some examples, displaying the indications of the health of patients via the respective user interfaces 111 may include displaying indications of dates and times at which various medications (or food or water or other nutrients) were administered to patients, and indications of a manner in which the medications are administered to patients (e.g., via a pill, IV drip, ampoule, etc.), e.g., alongside or overlaid upon displayed indications of biometric data associated with patients captured by the medical devices 102.
[0045] In some examples, each remote display device 104 may be configured to graphically display indications of the health of a particular patient (i.e., based on data captured by a particular medical device 102 or particular set of medical devices 102, and/or based on data from the database 123 provided by a particular healthcare professional associated with the particular patient, e.g., including indications of which medications (or food or water or other nutrients) were administered to the patient, a manner in which the medications were administered to the patient (e.g., via a pill, IV drip, ampoule, etc.), and dates and/or times at which medications (or food or water or other nutrients) were administered to the patient, while in other examples, each remote display device 104 may be configured to graphically display indications of the health of multiple patients, based on data captured by multiple medical devices 102 associated with various patients and/or based on data from the database 123 provided by healthcare professionals associated with the various patients, e.g., including indications of medications (or food or water or other nutrients) administered to each patient, a manner in which the medications were administered to patients (e.g., via a pill, IV drip, ampoule, etc.), and dates and/or times at which medications (or food or water or other nutrients) were administered to each patient. In some examples, one or more remote display devices 104 may be positioned directly outside of rooms associated with particular patients, and each remote display device may be configured to display data associated with each respective patient. Additionally, in some examples, the remote display devices 104 may be positioned together in a room designed for patient monitoring by healthcare professionals. Moreover, in some examples, the remote display devices 104 may include mobile devices, such as laptops, smart watches, smart phones, tablets, etc., i.e., so that healthcare professionals may monitor patients from any location. In any case, each remote display device 104 may be positioned outside of the ICU environment 103 so that healthcare professionals can monitor patients without being exposed to diseases that may be present in the ICU environment 103. In some examples, the remote display devices 104 may be password protected, or may be authenticated by registered users using a security card 112. For instance, a remote display device 104 for a particular patient may be configured to remain in a locked mode unless a security card 112 associated with a healthcare professional for the patient is used to access the remote display device 104.
[0046] The computing device 106 may include a processor 114, such as one or more microprocessors, controllers, and/or any other suitable type of processor, and a memory 116 (e.g., volatile memory or non-volatile memory) accessible by the one or more processors 114 (e.g., via a memory controller). The one or more processors 114 may interact with the memory 116 to obtain, for example, computer-readable instructions stored in the memory 114 for executing a graphical display application 117, a control application 118, a ventilator weaning predictive model 120 and/or a ventilator weaning predictive model training application 122. In particular, the computer-readable instructions stored on the memory 114 may include instructions for carrying out any of the steps of the method 300 described in greater detail below with respect to
[0047] The graphical display application 117 and the control application 118 may receive various data, including patient biometric data, indications of medicine or other nutrients provided to the patient, which data may be provided from an administration device automatically or manually by healthcare professionals, e.g., including via notes related to various patient conditions, and/or manually entered indications of medications (or food or water or other nutrients) administered to the patient and dates and/or times at which medications were administered to the patient, other patient data (e.g., EMR data) and medical device settings data, including ventilator settings data, directly from the medical devices 102 or from the database 123 storing current and/or historical data captured by the medical devices 102 and/or current and/or historical data provided by healthcare professionals associated with the various patients, remote display devices 104, and/or healthcare computing device 110, and may analyze this data to generate graphics and/or information to be displayed via the remote display devices 104, i.e., via the user interfaces 111 of the remote display devices 104.
[0048] For example,
[0049] In some examples, the graphical display application 117 may generate display items (e.g., graphs, three-dimensional animations, scalars, etc.) to be displayed by the user interfaces 111 of the remote display devices 104 that are color coded, generally on a two-sided spectrum - meaning that the “good” range will be in the middle as shown by green, and as the values go either above or below the normal range, the displays will move from green to yellow to orange to red. The graphical display application 117 may color code the display items according to a pre-defined protocol. In some examples, the graphical display application 117 may be configured to operate using various pre-defined protocols, and may receive a selection of one of the pre-defined protocols from a particular hospital or healthcare professional. Additionally, in some examples, the graphical display application 117 may define a new protocol based on selections from a user.
[0050] In particular, the graphical display application 117 may normalize the biometric data such that each data point for each type of biometric data is sorted into one of several health status categories (e.g., a “normal” or “good” health status, several intermediate health statuses, a “bad” or “alarm” health status, etc.) based on a medical protocol. For instance, biometric heart rate data within a certain range of heart rates may be associated with a normal or good health status, while biometric heart rate data outside of that range may associated with an intermediate health status, and biometric heart rate data above or below certain threshold values may be associated with a bad or alarm health status. Accordingly, the graphical display application 117 may generate a single graph to display the various different types of normalized biometric data over time. For instance, the graphical display application 117 may generate a graph that includes a time axis and another axis that utilizes “lanes” for various health statuses (e.g., normal or good health status in a center lane, intermediate health statuses in bordering lanes above and below the center lane, and bad or alarm health statuses in highest and lowest lanes). Moreover, the graphical display application 117 may color-code the graphs based on the health status associated with each data point (e.g., with normal or good health status data points being shown in green, intermediate health status data points being shown in yellow or orange, bad or alarm health status data points being shown in red, etc.).
[0051] As shown in
[0052] In some examples, as shown in
[0053] For example, when a user inputs a particular search term (e.g., “sepsis”) via the user interface 111, the graphical display application 117 may locate instances in which the term appears within the text notes, along with times associated with each instance, and may cause the user interface 111 to display the instances and associated times. For instance, the user interface 111 may display the text notes in which the term appears and may highlight the term within notes in which it appears, e.g., as shown at
[0054] Moreover, in some examples, as shown in
[0055] Furthermore, in some examples, as shown in
[0056] Additionally, in some examples, as shown in
[0057] In some examples, as shown at
[0058] In particular, the graphical display application 117 may cause the user interface 111 to display the icon 201 (or set of icons 201) indicating the method of delivery and/or generalized type of medication at a location in a graph that indicates the date or time at which the medication was administered. For medications delivered or administered instantaneously, the icon 201 may be depicted in a single instance at the time of delivery or administration, while for medications delivered or administered over a period of time, such as IV drips, the graphical display application 117 may generate two icons 201 (i.e., an icon 201 associated with the start time for the medication and an icon 201 associated with the end time for the medication) connected, e.g., by a line. For instance, the graphical display application 117 may cause the user interface 111 to display the icon 201 (or set of icons 201) indicating the method of delivery of a medication overlaid upon a graph displaying biometric data associated with the patient, i.e., such that it is possible for users to easily see biometric data associated with the patient at the time that the medication is administered, and how the biometric data associated with the patient changes over time after the medication is administered.
[0059] In some examples, as shown at
[0060] In some examples, the graphical display application 117 may access, from the database 123, data indicating one or more of the following: a date and/or time at which the medication was ordered for the patient, a date and/or time at which the medication was administered (i.e., as indicated by the administering healthcare professional), and a date and/or time at which the data was entered (i.e., by the administering healthcare professional), and display indications of this data with the detailed information via the user interface 111. That is, the date and/or time at which the medication was administered and the date and/or time at which the data was entered will generally be different unless the administration is via a machine that communicates with the database 123. Consequently, other users who view the detailed information displayed via the user interface 111 may compare the date and/or time of administration to the date and/or time of data entry to determine how quickly administration data is being entered, i.e., in order to determine the likelihood of errors, as there could be more errors if the date/time of administering the medication is long before the date/time of logging the data.
[0061] Similarly, in some examples, the graphical display application 117 may access, from the database 123, data indicating one or more of the following: a type of medication, method of administration of medication, and/or dosage of medication as ordered for the patient, and the actual type of medication, method of administration of medication and/or dosage of medication as administered by the healthcare professional (i.e., as indicated by the administering healthcare professional), and display indications of this data with the detailed information via the user interface 111. Consequently, other users who view the detailed information may compare the medication as ordered to the medication as administered to determine whether there are discrepancies in medications as ordered compared to medications as administered to the patient.
[0062] Additionally, in some examples, e.g., as shown at
[0063] Moreover, as discussed above with respect to
[0064] For example, when a user inputs a particular search term for a particular medication (e.g., “Vanco“ short for “Vancomycin”, as shown at
[0065] For instance, as shown in
[0066] Additionally, in some examples, as shown at
[0067] In some examples, the control application 118 may receive indications of search criteria from a user, e.g., via a user interface 111, and may provide data from the database 123, including biometric data from the medical devices 102 and data provided by healthcare professionals, including indications of which medications (or food or water or other nutrients) were administered to the patient, methods of delivery of the medications, dosages of the medications, and dates and/or times at which medications were administered to the patient, etc., in response to the search criteria. For instance, a user may search by any criteria, such as a particular medication, particular doses of a given medication, combinations of medications, combinations of medications and certain ranges of biometric data, etc., and the control application 118 may provide this data to the user to perform further analysis, in a manner consistent with privacy regulations in countries where patients are located. In some examples, this data searching can span across multiple patients to provide enough data for the control application 118 (or for the user, independently of the control application 118) to perform statistical analysis of the data, again, in a manner consistent with privacy regulations in countries where patients are located. For example, the control application 118 may access data from multiple patients in a manner consistent with privacy regulations in countries where patients are located and analyze the data in order to determine, e.g., the effectiveness of various medications, the effects various medications have on various biometric data, side effects associated with various medications, etc., for a large pool of patients.
[0068] Furthermore, in some examples, the control application 118 may generate the graphics and/or information based on comparing the data to a ventilator weaning protocol (e.g., a ventilator weaning protocol retrieved from a ventilator weaning protocol database 124). The control application 118 may transmit the generated graphics and/or information to the remote display devices 104 (or to healthcare computing devices 110) via the network 108.
[0069] For example, the control application 118 may generate indications of each patient’s ventilator settings as well as a visual system (red/yellow/green background) highlighting each patient’s trajectory on the ventilator as they progress in the ventilator weaning process for display via remote display devices 104 positioned outside of each ventilator patient’s room. That is, generally speaking, ventilator weaning may be dived into three phases: (1) preparing to wean, (2) weaning and (3) extubation, and the remote display device may display a patient’s current phase, as well as a status associated with that phase. For example, if a patient is weaning and their SpO2 is declining, the screen may display a ‘W’ with a red background. As another example, if a patient is preparing to wean, but making no progress, the screen may display a ‘P’ with a yellow background. Additionally, as another example, if a patient is ready to extubate, the screen may display an ‘E’ with a green background. Similarly, as another example, if a patient is successfully weaning, the screen may display a ‘W’ with a green background. Furthermore, as another example, if a patient is fully prepared to begin weaning, the screen may display a ‘P’ with a green background.
[0070] Moreover, in some examples, based on the based on comparing the various data (e.g., patient data, ventilator settings data, etc.) to a ventilator weaning protocol (e.g., a ventilator weaning protocol stored in the ventilator weaning protocol database 124), the control application 118 may generate indications of clinical guidance, e.g., to recommend/remind a treating healthcare professional (or team of healthcare professionals) of the need (when appropriate) for a spontaneous breathing trial (SBT) for a particular ventilator patient or other recommendations (e.g., a recommendation for extubation, a recommendation to modify ventilator settings, or various other recommendations related to ventilator weaning) and may transmit this generated indication to a remote display device 104 positioned outside of the room of the ventilator patient (or to a healthcare computing device 110 associated with the patient’s healthcare provider). The remote display device 104 or the healthcare computing device may then display the generated indication. Furthermore, in some examples, the control application 118 may generate the graphics and/or information and/or indications of clinical guidance discussed above based on applying a predictive model 120 to the data.
[0071] For example, the predictive model 120 may be trained using a predictive model training application 122. In some examples, the predictive model training application 122 may train a machine learning model (e.g., using Kalman filtering, support vector machine, logistic regression and boosting, etc.) to identify metrics such as readiness to wean, weaning parameters, time of extubation, factors associated with successful extubation, etc., e.g., using information stored in a historical ventilator patient database 126 and/or information stored in a historical ventilator operational database 128 as training data. For example, the historical ventilator patient database 126 and historical ventilator operational database 128 (or various other databases accessed by the computing device 106 but not shown in
[0072] In some examples, the predictive model training application 122 may train the predictive model 120 using machine learning techniques, while in other examples the predictive model training application 122 may train the predictive model 120 using a multiple hypothesis testing approach, or a mix of machine leaning approaches and multiple hypothesis approaches. That is, some variables associated with ventilator weaning are correlated and some of them are uncorrelated. In some examples, multiple hypothesis testing approaches may be used to determine the most accurate predictor for those variables and to evaluate the significance level of each. Advantageously, multiple hypothesis testing approaches treat type-I and type-II error separately, while most other approaches fail to make a difference when dealing with both.
[0073] The predictive model 120 may be trained (using the predictive model training application 122) to select the best indicators for weaning and to predict those weaning indices. The predictive model 120 may use real time forecasting approaches to predict the parameters during the day, providing an advantage over current methods in which the evaluating the readiness of patients is performed only once a day. The predictive model training application 122 may train the predictive model 120 to identify the best time for weaning from a ventilator during the day when dealing with the multi-scale time-series of different parameters. Additionally, the predictive model training application 122 may train the predictive model 120 by testing the optimal time to wean as well as the rate of chronic weaning can also be tested using multiple hypothesis testing approaches.
[0074] Hundreds of variables may be analyzed, including patient factors (SpO2>92%, tapering/low doses of vasopressors, vital signs acceptable [e.g., BP>=90 systolic, HR=55 to 135 bpm] age, weight, race, sex, surgical, mortality, PIM3, heart rate, etc.), ventilator factors (FiO2<=50%, PEEP<=5 ∼8cm H2O, hemodynamic stability, oxygenation and ventilation, PETCO2, f total, breath/min, etc.), ABG Parameters (PaO2>=75 mmHg, pH>7.25, etc.), other factors (gas exchange, breathing pattern, FVC>15 ml/kg, CROP index, IWI, CORE, P0.1/Plmax>0.3, Mechanical ventilation score, Ventilation AV and Breathing frequency goal, Oxygenation VILI, AO, LRP, LRVT, PIP, PEEP, ICU LOS, Hospital LOSetc.), etc.
[0075] Furthermore, the predictive model training application 122 may use multiple hypothesis testing approaches to select the top significant variables may be selected while controlling the type-I error at 5%, with a confidence level for each variable. Additionally, the predictive model training application 122 may use machine learning approaches to select variables that are most important for prediction accuracy. Additionally, the predictive model training application 122 may use feature engineering in artificial intelligence to create the significant variables based on the given information. Accordingly, after this selection process, there will be some number (n) of selected variables (e.g., V.sub.1, V.sub.2, V.sub.3, ..., V.sub.n).
[0076] While machine learning models provide great accuracy of predicting the readiness to wean and different features/variables, in practice, different types of error have different importance. That is, in practice, the false positives and false negatives are of different importance; but most machine learning approaches fails to handle the difference. However, using multiple hypothesis testing, it is possible to provide the optimal solution. In particular, multiple hypothesis testing approaches may be used to determine type I error and type II error separately, and with certain error boundaries for both, or with certain optimal weight for both, in order to obtain an optimal solution for patients.
[0077] Moreover, in some examples, due to anticipated data imbalances, the predictive model training application 122 may apply several different data balancing processes, followed by machine learning and real time forecasting approaches (e.g., Kalman filtering, support vector machine, logistic regression and boosting). Furthermore, the predictive model training application 122 may train and test the predictive model 120 on different balanced datasets. Reduction of Type I & II errors may be accomplished via multivariate hypothesis techniques. Additionally, the predictive model training application 122 may refine the predictive model 120 as new data is collected by ventilators (i.e., by ventilators that are part of the medical devices 102), remote display devices 104, and/or healthcare computing device 110 and added to databases 126 and 128.
[0078] The success criteria for prediction is the ability of the predictive model 120 to predict the weaning outcomes based on the EMR and ventilator settings (i.e., delta in inspired fraction of Oxygen (ΔFiO2), delta in tidal volume, pressure support or pressure controlled (ΔVt, ΔPS or ΔPC) or delta in positive end expiratory pressure set (ΔPEEP)). Example variables used in the model are detailed in
[0079] In some examples, the predictive model training application 122 transforms data from the linear format into a table, where the clinical variables are the column labels and the patient codes are stored as the row labels. Since the readings for the various variables involved are not all set at the same frequency, the data for the different variables will require alignment along the rows time-steps. Then, only the rows at which at least one of the setting variables is modified will be preserved in the data file. Binning of the target variable data into several classes (e.g., scoring for readiness to wean) allows for better classification performance. For all time-steps, key values will be validated and kept in the database if other metrics from monitors in each row are within 10% of other sensors measuring the same data points. In some cases, rows containing readings which do not fit this condition will be removed. The number of rows will be randomly distributed between the training and test databases, without considering the number of patients in each dataset.
[0080] In any case, the control application 118 may apply the trained predictive model 120 to a particular patient’s current patient data and/or current ventilator settings (e.g., obtained from ventilators that are part of the medical devices 102,, remote display devices 104, healthcare computing device 106, etc.) in order to identify parameters with a high likelihood of leading to successful extubation for that particular patient. The control application 118 may then use the identified parameters to generate graphics and/or information, including indications of the patient’s trajectory on the ventilator and/or indications of clinical guidance or other recommendations for the patient, and transmit the generated graphics and/or information to the remote display device 104 associated with that patient (or to a healthcare computing device 110 associated with the patient’s healthcare provider).
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[0082] As shown in
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[0084] As shown in