Systems and methods for managing mechanical ventilation

Abstract

A system for managing mechanical ventilation administered to a patient by a ventilator, the system including a plurality of electrodes for attachment to the patient's chest and a controller in communication with the plurality of electrodes, the controller programmed to determine a patient metric from signals received from the electrodes, the metric including a measure of the patient's respiratory effort and one or both of the patient's heart rate and / or the patient's respiratory rate. The system further includes a user interface in communication with the controller, the controller adapted to receive a representation of the measure of the patient's respiratory effort and simultaneously communicate the metric to the user interface adapted to display the representation on a display and / or to utilize the measure of the patient's respiratory effort in a control algorithm governing operation of the ventilator to control operation of the ventilator.

Description

[Technical field]

[0001] The present invention relates to systems and methods for use in managing mechanical ventilation administered to a patient, and to systems and methods for causing a patient to cease mechanical ventilation. [Background technology]

[0002] Proper management of mechanical ventilation administered to a patient is important to a positive outcome for the patient. An important part of managing mechanical ventilation is having the patient weaned off mechanical ventilation. Weaning mechanical ventilation is a process used to describe the gradual reduction of ventilatory support provided to a patient. It is estimated that 40% of the duration of mechanical ventilation administered to a patient is dedicated to the process of weaning the patient off mechanical ventilation. Clinicians face a delicate balance between managing the ventilatory support provided to the patient and assessing the patient's readiness to wean off ventilatory support. Clinician failure to recognize the possibility that a patient may be weaned off the ventilator may result in one or more of increased time on mechanical ventilation, length of hospital stay, risk of complications (e.g., ventilator-associated pneumonia (VAP)), mortality, and general costs. Alternatively, being too aggressive in trying to wean puts the patient at risk as well. For example, failure to extubate is associated with approximately a seven-fold higher risk of VAP and approximately a three-fold higher risk of death. Summary of the Invention [Problem to be solved by the invention]

[0003] Several measurements are commonly used in the management of mechanical ventilation and in the process of weaning it. Such measurements include respiratory rate, inspiratory effort, inspiratory pressure, expiratory pressure, heart rate, etc. If a patient receiving mechanical ventilation appears ready to be weaned, they undergo a spontaneous breathing trial (SBT) once a day for 30 to 120 minutes. The SBT evaluates the patient's ability to breathe while on minimal or no ventilator support. The key criterion for the SBT is the change in the patient's work of breathing or distress. Studies have shown that current clinical assessments using the measurements mentioned above have low sensitivity for accurately identifying patients ready to be successfully weaned compared to protocolized weaning.

[0004] In view of at least the foregoing, there is a need for improved systems and methods for use in managing mechanical ventilation, as well as in systems and methods for use in weaning a patient from mechanical ventilation. [Means for solving the problem]

[0005] It is therefore an object of the present invention to provide an improved system and method for managing mechanical ventilation and weaning a patient from mechanical ventilation.

[0006] In one embodiment, a system for managing mechanical ventilation administered to a patient by a ventilator is provided, the system comprising: a plurality of electrodes, each configured to be selectively attached to a patient's chest, a controller in communication with the plurality of electrodes, the controller programmed to determine a plurality of metrics of the patient from signals received from the plurality of electrodes, the plurality of metrics comprising a measure of the patient's respiratory effort and one or both of a patient's heart rate and / or a patient's respiratory rate, and a user interface having a display and in communication with the controller, the controller configured to receive a representation of the measure of the patient's respiratory effort and simultaneously communicate the plurality of metrics to a user interface configured to display the representation on a display, and / or to control operation of a ventilator and / or utilize the measure of the patient's respiratory effort in a control algorithm that governs operation of the ventilator.

[0007] The controller may be programmed to determine a measure of the patient's respiratory effort from a measure of neural respiratory drive obtained from EMG signals from at least some of the plurality of electrodes, the EMG signals being obtainable from at least some of the plurality of electrodes when the at least some of the plurality of electrodes are positioned on a second surface of the patient.

[0008] The controller is configured to receive a number of further measurements from the ventilator, the further measurements comprising one or more of a patient's inspiratory effort, an inspiratory pressure, and / or an expiratory pressure, wherein the controller is further programmed to determine a spontaneous breathing trial score calculated from the plurality of metrics and the further measurements, and to communicate the calculated spontaneous breathing trial score to a user interface, the user interface being configured to display the calculated spontaneous breathing trial score instead of or in addition to a representation of the measure of the patient's breathing effort. The further measurements may comprise a patient's inspiratory effort, an inspiratory pressure, and an expiratory pressure.

[0009] The plurality of electrodes may be coupled together in a sensor patch. The system may further include an SpO2 sensor coupled to the plurality of electrodes in the sensor patch. The controller may be further configured to simultaneously display an SpO2 value of the patient determined from a signal received from the SpO2 sensor, the patient's heart rate, and the patient's respiratory rate.

[0010] The representation of the patient's respiratory effort measure displayed on the user interface may comprise a numerical value of the respiratory effort measure.

[0011] The representation of the measure of the patient's effort of breathing displayed on the user interface may comprise a graphical value of the measure of effort of breathing.

[0012] A representation of the patient's respiratory effort measure displayed on a user interface may have a directional arrow indicating the recent trend in the value of the respiratory effort measure.

[0013] The controller may be configured to receive a number of further measurements from the ventilator, the further measurements comprising one or more of the patient's inspiratory effort, inspiratory pressure and / or expiratory pressure, wherein the controller is further programmed to determine a spontaneous breathing trial score calculated from the plurality of metrics and the further measurements, and to utilize the spontaneous breathing trial score as a measure of the patient's respiratory effort for use in a control algorithm governing operation of the ventilator.

[0014] In another embodiment, there is provided a method of managing mechanical ventilation administered to a patient by a ventilator comprising one or both of the steps of receiving signals from a plurality of electrodes positioned on the patient's chest, determining a plurality of patient metrics from the plurality of electrodes positioned on the patient's chest, the plurality of metrics comprising a measure of the patient's respiratory effort and one or both of a patient's heart rate and / or a patient's respiratory rate, and communicating the plurality of metrics to a user interface configured to receive and simultaneously display a representation of the measure of the patient's respiratory effort, and / or utilizing the measure of the patient's respiratory effort in a control algorithm governing operation of the ventilator to control operation of the ventilator.

[0015] The method further comprises positioning a first electrode of the plurality of electrodes on a second intercostal space of the patient, positioning a second electrode of the plurality of electrodes on a second intercostal space of the patient, and positioning a third electrode of the plurality of electrodes on a sternum of the patient. The positioning of each of the first electrode, the second electrode, and the third electrode is performed by positioning a single patch arrangement of electrodes on the patient's chest. The method may further comprise determining an SpO2 level of the patient from an SpO2 sensor positioned on the patient.

[0016] These and other objects, features and characteristics of the present disclosure, as well as the method of operation and function of the associated elements of construction and combination of parts and economies of manufacture, will become more apparent from a consideration of the following description and the appended claims, taken in conjunction with the accompanying drawings, all of which form part of this specification. Like reference numerals indicate corresponding parts in the various drawings. It is to be expressly understood, however, that the drawings are for the purpose of illustration and description only and are not intended to define the limits of the invention. [Brief description of the drawings]

[0017] [Figure 1]FIG. 1 illustrates a system for managing ventilation of a patient, according to an exemplary embodiment of the present invention, including a non-invasive monitoring system for determining the patient's neural respiratory drive (NRD) in combination with other metrics that are typically measured non-invasively. [Diagram 2] FIG. 2 is a flow chart of a method for managing ventilation of a patient, according to an exemplary embodiment of the invention. [Diagram 3] FIG. 3 illustrates an output display according to an exemplary embodiment of the invention, as provided via a user interface such as shown in the system of FIG. [Figure 4] FIG. 4 is a decision tree illustrating the general steps / decisions of an algorithm used in automatically adjusting ventilator operational settings based on output from a system such as shown in FIG. 1 and / or a method such as shown in FIG. 2, in accordance with an exemplary embodiment of the invention. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0018] In the specification, unless the context clearly dictates otherwise, the absence of a plural statement includes the plural.

[0019] In the specification, when two or more parts or components are said to be "coupled," it means that those parts are joined or operate together, either directly or indirectly, i.e., through one or more intermediate parts or components, so long as they are connected.

[0020] As used herein, the term "controller" refers to a number of programmable analog and / or digital devices (including associated memory portion or portions) that can store, retrieve, execute, and process data (e.g., software routines and / or information used by such routines), including, but not limited to, a field programmable gate array (FPGA), a complex programmable logic device (CPLD), a programmable system on a chip (PSOC), an application specific integrated circuit (ASIC), a microprocessor, a microcontroller, a programmable logic controller, or any other suitable processing device or apparatus. The memory portion may be any one or more of various types of internal and / or external storage media that provide storage registers, i.e., non-transitory machine-readable media, for data and program code storage in the manner of a computer's internal storage area, such as, but not limited to, RAM, ROM, EPROM, EEPROM, flash, etc., and may be volatile or non-volatile memory.

[0021] As used herein, "number" means an integer that is one, or greater than one (i.e., plural).

[0022] In this specification, "sniff" is intended to mean a deep, sharp inspiration that the patient perceives as requiring maximal inspiratory effort. With respect to the calculation of the Neural Respiratory Drive (NRD) index, in the specification, "relative" shall indicate that the NRD index is calculated using characteristics of the EMG signal detected during both rhythmic respiratory activity and sniff activity, and "absolute" shall indicate that the NRD index is calculated using characteristics of the EMG signal detected only during rhythmic respiratory activity.

[0023] Directional expressions used in the specification, such as, by way of example and not limitation, top, bottom, left, right, upper, lower, front, rear and derivatives thereof, relate to the orientation of the elements illustrated in the figures and do not limit the claims, unless expressly stated otherwise.

[0024] The present invention, as described in detail herein in connection with certain exemplary embodiments, provides systems and methods for use in directly (i.e. automatically) and / or indirectly (i.e. via human interaction) managing mechanical ventilation administered to a patient by monitoring / using the value of a measure of the patient's respiratory effort in addition to the patient's traditional metrics (e.g. heart rate, respiratory rate, etc.) in the decision-making process for managing mechanical ventilation.

[0025] Monitoring respiratory muscle activity according to the disclosed systems and methods allows a patient's Neural Respiratory Drive (NRD) index to be calculated by the controller. The NRD index provides an objective measure of respiratory effort and a more accurate depiction of the patient's respiratory status than other non-invasive parameters used to determine the patient's respiratory status, such as respiratory rate alone or considered in combination with other non-invasive measurements. Exemplary embodiments of the methods and systems disclosed herein determine the NRD index using measurements of EMG signals monitored on the patient's upper thoracic inspiratory muscles, since EMG measurements obtained during inspiration are taken into account, which indicate the balance between respiratory muscle load and respiratory muscle capacity. It is noted that while methods and systems for invasively determining NRD are known, the methods and systems disclosed herein for calculating the NRD index utilize only non-invasive sensors, such as, for example, EMG electrodes and accelerometers. This NRD index can be considered a non-invasive surrogate for invasive NRD measurements.

[0026] For the sake of brevity of this disclosure, the phrase "monitoring the NRD index" (and variations thereof, e.g., "monitoring the NRD index") is used herein to encompass the act of monitoring respiratory muscle activity with EMG electrodes and then calculating the NRD index based on the sensed EMG signal. Note that the NRD index is not a value directly output by the EMG electrodes. The non-invasive nature of the methods and systems disclosed herein for monitoring the NRD index allows a variety of other vital signs / metrics of the patient to be monitored along with the NRD index using a single patch.

[0027] Referring now to FIG. 1, a system 2 for use in managing ventilation of a patient is shown according to an exemplary embodiment of the present invention. The system 2 includes a non-invasive patient monitoring system 10 with NRD monitoring capability according to an exemplary embodiment of the present invention. The monitoring system 10 includes a sensor patch 12, a controller 18, and a user interface 20. The sensor patch 12 includes a number of electrodes, e.g., several EMG signal electrodes 14 and a reference electrode 16, and is configured to be affixed to the skin of a patient P, e.g., but not limited to, via an adhesive layer (not numbered) included on a patient-facing side of the sensor patch 12. In an exemplary embodiment, the sensor patch 12 is configured to be affixed to the upper torso of the patient P such that the EMG signal electrode 14 is positioned above the patient's second intercostal space and the reference electrode 16 is positioned on the sternum slightly higher than the EMG signal electrode 14 (i.e., slightly higher toward the patient's head) to optimally monitor respiratory muscle activity of the patient P. However, it should be understood that arranging the EMG signal electrode 14 and the reference electrode 16 in other locations within the upper chest suitable for monitoring respiratory muscle activity may be implemented without departing from the scope of the present invention. The EMG signals sensed by the EMG signal electrodes 14 are then used to determine the NRD index, as described below with respect to the method 100 shown in FIG.

[0028] The controller 18 is in electrical communication with the electrodes 14 and 16 of the sensor patch 12, as well as the user interface 20. Such an arrangement of these elements allows the controller 18 to receive and store signals measured by the EMG signal electrodes 14, and allows a clinician, caregiver, or patient P to receive results of any processing performed by the controller 18 and input commands to the controller 18 via the user interface 20. The sensor patch 12 is configured to non-invasively monitor a combination of metrics, i.e., NRD and at least one other metric, where the at least one other metric may include, for example, but is not limited to, heart rate and / or respiration rate (derived from EMG signals from the EMG signal electrodes 14 and 16). The sensor patch 12 may include several additional sensors 22 in addition to the EMG electrodes 14, 16. These several additional sensors 22 may include, for example, but are not limited to, one or more of an accelerometer, a chest SpO2 sensor, a core body temperature sensor, and / or other suitable sensors and / or sensor arrangements. It should be noted that while the depiction of the additional sensors 22 in FIG. 1 gives the impression that these additional sensors 22 are external to the sensor patch 12, such depiction of the additional sensors 22 in FIG. 1 is for the purpose of clearly setting forth that the sensor patch 12 includes one or more additional sensors in addition to the electrodes 14 and 16, and that such additional sensors 22 may be integrated with the sensor patch 12.

[0029] The user interface 20 may generally be any suitable device (e.g., without limitation, a display) for providing information to a clinician, care provider, patient, etc., and / or any suitable device (e.g., a touch screen, a keyboard, a microphone, etc.) for receiving information from a clinician, care provider, patient, etc. With respect to communication between the controller 18 and the user interface 20, it should be noted that although the controller 18 and the user interface 20 are depicted in FIG. 1 as two separate entities, in some exemplary embodiments, the user interface 20 is incorporated within the same physical construct as the controller 18, while in other exemplary embodiments, the controller 18 and the user interface 20 are in separate constructs. For example, without limitation, in a hospital, the user interface 20 may comprise a patient monitor or any other suitable device, while in an embodiment of the NRD monitoring system 10 implemented for use at home, the user interface 20 may comprise a smartphone, a tablet computer, or any other suitable device. It will be appreciated that the controller 18 may be implemented on-board the sensor patch 12 or external to the sensor patch 12. The controller 18 may optionally be configured to link data sensed by the sensor patch 12 (and / or additional sensors 22) to a computing cloud 24, for example as shown in the exemplary embodiment of FIG. 1.

[0030] 1 shows connections between the EMG electrodes 14, 16 and the controller 18 (and similarly between the additional sensor 22 and the controller 18), as well as connections between the controller 18 and the user interface 20, it should be noted that these shown connections are merely intended to represent electrical communications between such respective elements, and such communications may be facilitated via either wired or wireless communication means without departing from the scope of the present invention. In some exemplary embodiments, the sensor patch 12 may be a passive patch such that measurements can only be made when the patch 12 is provided with external power, while in other exemplary embodiments, the sensor patch 12 may be an active patch including an on-board power source and processing means. In one non-limiting example of implementing the sensor patch 12 as an active patch, the controller 18 is incorporated into the sensor patch 12 such that the on-board power source and processing means described above are provided by the controller 18. In such exemplary embodiments, the controller 18 and the user interface 20 are configured to communicate via wireless means such that a caregiver or patient may review the results of any processing performed by the controller 18.

[0031] The system 10 may further include a ventilator 26 as shown in FIG. 1 that is used to provide mechanical ventilation to the patient P. In such an embodiment, the ventilator 26 communicates with the controller 18 (e.g., via wired or wireless means) such that the controller 18 may communicate information regarding the patient P and / or details regarding the ventilation provided to the patient P (e.g., inspiratory pressure, expiratory pressure) and / or the controller 18 may communicate instructions / commands to the ventilator 26 to adjust the ventilation provided to the patient P by the ventilator 26. In such an example, the controller 18 and / or the user interface 20 may be integrated with the ventilator 26 such that, in addition to the functions described above, the controller 18 has the ability to also control the operation of one or more components or even the overall operation of the ventilator 26, while the user interface 20 is provided for inputting information to and / or receiving information from the ventilator 26.

[0032] 2, a flow chart of a general method 100 for managing ventilation of a patient is shown, in accordance with an exemplary embodiment of the present invention. Method 100 may be performed, for example, by NRD monitoring system 10 shown in FIG 1, and thus, in such examples, method 100 is described in conjunction with NRD monitoring system 10. However, it should be understood that method 100 may be used in conjunction with other devices without departing from the scope of the present invention.

[0033] The method 100 generally begins at step 101, where EMG electrodes 14, 16, for example, but not limited to, EMG electrodes 14, 16 incorporated into a sensor patch 12, are positioned on the patient P generally as shown in FIG. 1 (or as otherwise desired) to measure the patient P's respiratory muscle activity. When an embodiment of the NRD monitoring system 10 is used in which the controller 18 is not implemented on the on-board sensor patch 12, there is a wired or another suitable communication arrangement between the sensor patch 12 and the controller 18 during step 101. It should be appreciated that in other embodiments, no additional action by the user is required to establish electrical communication between the controller 18 and the user interface 20. Such embodiments include, for example, but not limited to, an embodiment in which the patient monitor includes both the controller 18 and the user interface 20, or in a home use situation, an embodiment in which the user interface 20 comprises a smartphone (or other suitable device) and the controller 18 comprises a computing cloud with which the smartphone is in communication. It should be appreciated that in step 101, preparation of the patient P's skin is required to optimize detection of the EMG signal. For example, the skin may need to be cleansed and / or shaved prior to application of the sensor / patch 12 to the patient P. In addition to the EMG electrodes 14, 16, step 101 includes placing one or more additional sensors 22 (such as, but not limited to, an SpO2 sensor) on the patient P, either included with the sensor patch 12 or separate from the sensor patch 12. It should be understood that while in this exemplary embodiment, step 101 is provided as the first step of method 100, such a step may be provided by another prior step without departing from the scope of the present invention, and that in such exemplary embodiment, method 100 instead begins with step 102, which will be described immediately below.

[0034] In step 102, EMG signals generated by the patient P (e.g., while the patient P is receiving minimal support from the ventilator 26) during either rhythmic breathing and / or sniff activity sensed by the EMG electrodes 14, 16 (e.g., of the sensor patch 12) are received at / by the controller 18. In an exemplary embodiment of the invention, the patient P takes one minute of rhythmic breathing followed by one minute of sniffing interspersed with rhythmic breathing, a sniff being defined as a deep, sharp inspiration that the patient P feels requires maximum inspiratory effort. In another exemplary embodiment of the invention, the patient P simply breathes rhythmically while being monitored. In an embodiment in which one or more additional sensors 22 are on the patient P, step 102 may include receiving at / by the controller 18 a signal from such additional sensors 22 positioned on the patient.

[0035] In step 103, multiple patient metrics, including a measure of the patient's respiratory effort, are determined by the controller 18 from the signals received in step 102. In an exemplary embodiment of the invention, the patient's respiratory effort is determined by several NRD index values ​​(as described herein above) determined by the controller 18 based on several characteristics of the rhythmic breathing and / or sniff EMG signals received in step 102. The NRD index is a quantification of NRD based on various characteristics of the EMG signals recorded during either or both rhythmic breathing and sniff activities performed by the patient P. In addition to such NRD index values, other patient metrics (e.g., heart rate, respiratory rate) may be determined from the received EMG signals, from one or more additional sensors 22 (e.g., oxygen saturation from an SpO2 sensor) and / or from the ventilator 26 (e.g., inspiratory effort, expiratory pressure). Furthermore, one or more advanced metrics (e.g., a calculated SBT score) may be determined from the several NRD index values ​​and other metrics (e.g., inspiratory effort, expiratory pressure).

[0036] After the metrics are determined in step 103, they are used in one or both of two ways. One such way in which the metrics are used is shown in step 104, where the metrics are communicated to the patient's care provider for use in the ventilation decision-making process. For example, one or more metrics may be communicated to the interface device 20, and the metrics are displayed on the display of the interface device for quick reference by the care provider (doctor, nurse, etc.), who can then use such information to determine how ventilator settings should be adjusted and can easily see the effect (positive or negative) of the changes. An example of such a display 200 according to an exemplary embodiment of the invention, as provided as a "patient dashboard" on a patient monitor (e.g., placed next to a hospital bed, in a nursing station, etc.) that serves as the user interface 20 of the system 2, is shown in FIG. 1. The display 200 includes multiple representations of measures of the patient's respiratory effort, e.g., as determined in step 103. Such representation of a measure of patient respiratory effort shown on display 200 includes a numerical value 201 (i.e., NRD%22), a graph 202 showing the variation of the value over time, and a progress arrow 203 showing the direction of change of the current value from the previous value. Display 200 further includes representations of other patient metrics 204 (e.g., pulse, temperature, SpO2, respiration rate, etc.). It should be understood that the values / information / arrangement of display 200 shown in the exemplary embodiment of FIG. 3 is shown for illustrative purposes only, and that either or both of the information provided on display 200 and / or the arrangement of display 200 may be altered without varying from the scope of the present invention.

[0037] 3, it should be appreciated that by considering a measure of the patient's respiratory effort in addition to / concurrently with other patient metrics (e.g., heart rate, respiratory rate, SpO2, etc.), an improved overall, near-instantaneous assessment of the patient and the patient's response to (and changes to) ventilation can be obtained / provided to the care provider / clinician, thereby enabling informed decisions to be made regarding management of ventilation. Such an assessment can provide an improved indication of the patient's readiness to breathe spontaneously, and therefore to cease ventilation.

[0038] Alternatively or in addition to what is described in step 104, different or additional methods using the metrics determined in step 103 are shown in step 105. In such steps, the respiratory measures (and optionally other metrics) are utilized in a control algorithm that manages the operation of the ventilator 26. For example, if it is determined from such metrics that the patient is ready to be turned off, the controller 26 can automatically proceed to turn off the patient ventilation. Referring again to FIG. 1, in such an embodiment, instead of (or in addition to) providing an indication to the patient and / or caregiver via the user interface 20, the controller 18 directly controls and / or provides instructions / commands to the ventilator 26. Thus, it should be understood that in such an arrangement of the system 2, the operation of the ventilator 26 is dependent on the determined measures of the patient's respiratory effort. An example of a decision tree 300 illustrating the general steps / decisions of an algorithm used by the controller 18 in automatically adjusting the ventilator's operational settings based on the output from a system, e.g., as shown in FIG. 1, and / or the method, e.g., as shown in FIG. 2, according to an exemplary embodiment of the present invention, is shown in FIG. 4.

[0039] From the foregoing description and illustrative examples, it should be appreciated that by considering a measure of the patient's respiratory effort in addition to other patient metrics (e.g., heart rate, respiratory rate, SpO2, etc.), an improved overall, near-instantaneous assessment of the patient is obtained, which is then used in making improved decisions regarding managing the ventilation administered to the patient.

[0040] In the claims, any reference signs placed between parentheses shall not be construed as limiting the claim. The word "comprises" or "including" does not exclude the presence of elements or steps other than those listed in the claims. In a device claim enumerating several means, several of these means may be embodied by one and the same item of hardware. The absence of a plurality of elements does not exclude the presence of a plurality of elements. In any device claim enumerating several means, several of these means may be embodied by one and the same item of hardware. The mere fact that several elements are recited in mutually different dependent claims does not indicate that these elements cannot be used in combination.

[0041] Although the present invention has been described in detail for purposes of illustration based on what are currently considered to be the most practical and preferred embodiments, it should be understood that such details are for illustrative purposes only, and that the present invention is not limited to the disclosed embodiments, but rather is intended to cover modifications and equivalent arrangements within the spirit and scope of the appended claims. For example, it should be understood that the present invention also contemplates that, to the extent possible, one or more features of any embodiment can be combined with one or more features of any other embodiment.

Claims

1. 1. A system for managing mechanical ventilation provided to a patient by a ventilator, the system comprising: a plurality of electrodes, each configured to be selectively attached to the patient's chest; a controller in communication with the plurality of electrodes, the controller being programmed to determine a plurality of metrics of the patient from signals received from the plurality of electrodes; and A user interface having a display and in communication with the controller. and the plurality of metrics comprises: a measure of the patient's respiratory effort; and one or both of the patient's heart rate and / or the patient's respiratory rate and the controller comprises: and / or communicating the plurality of metrics to the user interface configured to receive a representation of a measure of the patient's effort of breathing and simultaneously display the representation on the display; and / or controlling operation of the ventilator utilizing a measure of the patient's respiratory effort in a control algorithm governing operation of the ventilator. The system is configured to do one or both of the following:

2. 10. The system of claim 1, wherein the controller is programmed to determine a measure of the patient's respiratory effort from a measure of neural respiratory drive obtained from EMG signals from at least some of the plurality of electrodes.

3. The system of claim 2 , wherein the EMG signals are obtained from at least some of the plurality of electrodes when the at least some of the plurality of electrodes are positioned on a second intercostal space of the patient.

4. the controller is configured to receive a number of further measurements from the ventilator; the further measurements include one or more of the patient's inspiratory effort, inspiratory pressure, and / or expiratory pressure; the controller is further programmed to determine a spontaneous breathing trial score calculated from the plurality of metrics and the additional measurement, and to communicate the calculated spontaneous breathing trial score to the user interface; The system of claim 1 , wherein the user interface is configured to display the calculated spontaneous breathing trial score instead of or in addition to the representation of the measure of the patient's effort of breathing.

5. The system of claim 4 , wherein the further measurements include the patient's inspiratory effort, inspiratory pressure, and expiratory pressure.

6. The system of claim 1 , wherein the multiple electrodes are combined in a sensor patch.

7. The SpO ２ The system of claim 6 further comprising a sensor.

8. The controller: The SpO ２ and determining from a signal received from the sensor the patient's SpO2. ２ value, the patient's heart rate, and The patient's respiratory rate The system of claim 7 , further configured to simultaneously display:

9. The representation of the measure of the patient's effort of breathing displayed on the user interface comprises: The system of claim 1 , further comprising a numerical value for the respiratory effort measure.

10. The system of claim 1 , wherein the representation of the measure of the patient's effort of breathing displayed on the user interface comprises a graph illustrating variation in values ​​of the measure of effort of breathing over time.

11. The system of claim 1 , wherein the representation of the measure of the patient's respiratory effort displayed on the user interface includes a progress arrow indicating a direction of change in a current value of the measure of respiratory effort from a previous value.

12. the controller is configured to receive a number of further measurements from the ventilator, the further measurements comprising one or more of the patient's inspiratory effort, inspiratory pressure and / or expiratory pressure; 2. The system of claim 1, wherein the controller is further programmed to determine a spontaneous breathing trial score calculated from the plurality of metrics and the additional measurements, and to utilize the spontaneous breathing trial score as a measure of the patient's respiratory effort for use in a control algorithm that manages operation of the ventilator.

13. 1. A method of managing mechanical ventilation provided to a patient by a ventilator, the method comprising: receiving signals from a plurality of electrodes positioned on the patient's chest; determining a plurality of metrics of the patient from the plurality of electrodes positioned on the patient's chest, the plurality of metrics comprising: a measure of the patient's respiratory effort; and one or both of the patient's heart rate and / or the patient's respiratory rate The steps of communicating the plurality of metrics to a user interface configured to receive and simultaneously display a representation of a measure of the patient's effort of breathing and / or controlling operation of the ventilator using the measure of the patient's effort of breathing in a control algorithm governing operation of the ventilator. The method comprising:

14. positioning a first electrode of the plurality of electrodes over a second intercostal space of the patient; positioning a second electrode of the plurality of electrodes over a second intercostal space of the patient; and Positioning a third electrode of the plurality of electrodes on the patient's sternum. The method of claim 13 further comprising:

15. 15. The method of claim 14, wherein the steps of positioning each of the first electrode, the second electrode, and the third electrode are performed by positioning a single patch arrangement of electrodes on the patient's chest.

16. The SpO ２ The patient's SpO ２ The method of claim 15 further comprising the step of determining a level.

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