Closed Loop Oxygen Control

Abstract

The present disclosure provides a flow therapy device that can implement one or more closed-loop control systems to control the flow of gas through the flow therapy device. The flow therapy device can monitor a patient's blood oxygen saturation (SpO2) and control the percentage of oxygen (FdO2) delivered to the patient. The flow therapy device can automatically adjust FdO2 to achieve a target SpO2 value for the patient.

Description

[Technical field]

[0001] The present disclosure relates to methods and systems for controlling oxygen delivery in a flow therapy device. [Background technology]

[0002] Respirators are used to deliver a flow of gas to a user or patient in a variety of environments, such as hospitals, medical facilities, residential care, or home environments. Respirators or flow therapy devices may include an oxygen inlet to allow supplemental oxygen to be delivered along with the gas flow, and / or a humidifier to deliver heated and humidified gas. Flow therapy devices may allow for the regulation and control of characteristics of the gas flow, including flow rate, temperature, gas concentration such as oxygen concentration, humidity, pressure, and the like. Summary of the Invention

[0003] In accordance with certain features, aspects and advantages of a first embodiment disclosed herein, a ventilator for providing a flow of gas to a patient, the ventilator including: a controller configured to control the supply of gas to the patient using closed loop control, the controller configured to receive patient parameter data indicative of an oxygen saturation (SpO2) of the patient from at least one sensor; and execute a control phase, wherein operation of the ventilator during a treatment session is based, at least in part, on the patient parameter data; and a gas composition sensor configured to determine at least an oxygen content (FdO2) of the gas flow during operation of the ventilator, the gas composition sensor being an ultrasonic sensor system.

[0004] In some configurations of the first embodiment, the respirator includes a patient interface selected from at least one of a face mask, a nasal mask, a nasal pillows mask, a tracheostomy interface, a nasal cannula, or an endotracheal tube.

[0005] In some configurations of the first embodiment, the nasal cannula is a non-sealing nasal cannula.

[0006] In some configurations of the first embodiment, the ventilator is configured to supply a flow of gas to the patient at a nasal high flow (NHF).

[0007] In some configurations of the first embodiment, the at least one sensor is a pulse oximeter.

[0008] In some configurations of the first embodiment, the controller is configured to receive instrument parameter data indicative of the oxygen concentration of the gas stream.

[0009] In some configurations of the first embodiment, the respirator includes a supplemental gas inlet valve.

[0010] In some configurations of the first embodiment, the controller is configured to control operation of the supplemental gas inlet valve.

[0011] In some configurations of the first embodiment, the supplemental gas inlet valve is a proportional valve.

[0012] In some configurations of the first embodiment, the supplemental gas inlet valve is an oxygen inlet valve.

[0013] In some configurations of the first embodiment, the supplemental gas inlet valve includes a swivel connector.

[0014] In some configurations of the first embodiment, the respirator includes an ambient air inlet.

[0015] In some configurations of the first embodiment, the oxygen inlet valve is in fluid communication with the filter module, and the respirator is configured to inhale oxygen received from the oxygen inlet valve along with ambient air from the ambient air inlet in the filter module.

[0016] In some configurations of the first embodiment, the gas composition sensor is positioned downstream of the blower module of the respirator.

[0017] In some configurations of the first embodiment, the filter module is positioned upstream of the blower module of the respirator.

[0018] In some configurations of the first embodiment, the blower module mixes ambient air with oxygen.

[0019] In some configurations of the first embodiment, the closed-loop control includes using a first closed-loop control model configured to determine a target fraction of delivered oxygen (FdO2).

[0020] In some configurations of the first embodiment, the target FdO2 is determined based at least in part on the target SpO2 and the measured SpO2.

[0021] In some configurations of the first embodiment, the target FdO2 is further based, at least in part, on the measured FdO2.

[0022] In some configurations of the first embodiment, the target FdO2 is further based, at least in part, on a previous target FdO2.

[0023] In some configurations of the first embodiment, the closed-loop control includes using a second closed-loop control model configured to determine a control signal for the oxygen inlet valve based at least in part on the difference between the target FdO2 and the measured FdO2.

[0024] In some configurations of the first embodiment, the control signal for the oxygen valve is determined based at least in part on the target FdO2 and the measured FdO2.

[0025] In some configurations of the first embodiment, the control signal for the oxygen valve is determined further based at least in part on the gas flow rate.

[0026] In some configurations of the first embodiment, the gas flow rate is a total gas flow rate.

[0027] In some configurations of the first embodiment, the controller is configured to transition to a manual operating mode when the signal quality of at least one sensor falls below a threshold.

[0028] In some configurations of the first embodiment, the controller is configured to generate a notification to a user indicating that the signal quality of the at least one sensor is below a threshold.

[0029] In some configurations of the first embodiment, the notification requests input of a user instruction as to whether to transition to a manual operating mode.

[0030] In some configurations of the first embodiment, the controller is configured to transition to a manual operating mode when the patient SpO2 is outside of defined limits.

[0031] In some configurations of the first embodiment, the controller is configured to trigger an alarm when the patient SpO2 is outside of defined limits.

[0032] In some configurations of the first embodiment, controlling the supply of gas includes controlling the FdO2 of the gas flow, and the controller is configured to receive an indication of a signal quality of at least one sensor and apply a weighting to the control of the FdO2 based at least in part on the signal quality.

[0033] In some configurations of the first embodiment, the signal quality indication corresponds to a particular SpO2 reading.

[0034] In some configurations of the first embodiment, the control phase is configured to be performed using a patient-specific model.

[0035] In some configurations of the first embodiment, the patient-specific model is generated during a learning phase of a treatment session.

[0036] In some configurations of the first embodiment, the patient-specific model is generated during a treatment session.

[0037] In some configurations of the first embodiment, the patient-specific model is updated during a treatment session.

[0038] In some configurations of the first embodiment, the control phase is configured to be performed using PID control based at least in part on a patient-specific model.

[0039] In some configurations of the first embodiment, the patient-specific model includes the patient's oxygen efficiency.

[0040] In some configurations of the first embodiment, oxygen efficiency is determined based at least in part on the measured SpO2 and the measured FdO2.

[0041] In some configurations of the first embodiment, oxygen efficiency is determined based, at least in part, on the measured SpO2 divided by the measured FdO2.

[0042] In some configurations of the first embodiment, oxygen efficiency is determined based, at least in part, on a non-linear relationship between the patient's measured SpO2 and measured FdO2.

[0043] In some configurations of the first embodiment, the controller is configured to predict the patient's SpO2 based at least in part on the measured FdO2.

[0044] In some configurations of the first embodiment, a previous predicted value of SpO2 is compared to the actual SpO2 to calculate a model error.

[0045] In some configurations of the first embodiment, the model error is weighted by the signal quality of at least one sensor.

[0046] In some configurations of the first embodiment, the model error is used to correct the current SpO2 estimate.

[0047] In some configurations of the first embodiment, the predicted SpO2 is based, at least in part, on a Smith predictor.

[0048] In some configurations of the first embodiment, the controller is configured to receive an input identifying a characteristic of the patient.

[0049] In some configurations of the first embodiment, the patient characteristics include at least one of patient type, age, weight, height, or gender.

[0050] In some configurations of the first embodiment, the patient type is one of normocapnic, hypercapnic or user-defined.

[0051] In some configurations of the first embodiment, the controller is further configured to record data corresponding to the measured FdO2 and the measured SpO2.

[0052] In some configurations of the first embodiment, the respiratory apparatus includes a humidifier.

[0053] In some configurations of the first embodiment, the respirator includes an integrated blower and humidifier.

[0054] In some configurations of the first embodiment, the respirator is configured to be portable.

[0055] In some configurations of the first embodiment, the respirator is configured to have a controlled variable flow rate.

[0056] In some configurations of the first embodiment, the respirator includes a heated breathing tube.

[0057] In some configurations of the first embodiment, the ultrasonic sensor system includes a first ultrasonic transducer and a second ultrasonic transducer.

[0058] In some configurations of the first embodiment, the first ultrasonic transducer and the second ultrasonic transducer are a receiver and a transmitter, respectively.

[0059] In some configurations of the first embodiment, the first ultrasonic transducer and the second ultrasonic transducer transmit pulses bidirectionally.

[0060] In some configurations of the first embodiment, the first ultrasonic transducer is a transmitter and the second ultrasonic transducer is a receiver.

[0061] In some configurations of the first embodiment, at least one of the first ultrasonic transducer or the second ultrasonic transducer sends a pulse along the gas flow.

[0062] In some configurations of the first embodiment, at least one of the first ultrasonic transducer or the second ultrasonic transducer sends a pulse across the gas flow.

[0063] In some configurations of the first embodiment, the controller is configured to display the first oxygen efficiency characteristic on a display of the respirator.

[0064] In some configurations of the first embodiment, the controller is configured to display a second oxygen efficiency characteristic on a display of the ventilator, and the second displayed value of oxygen efficiency is based at least in part on the patient's oxygen efficiency and the measured respiratory rate.

[0065] In some configurations of the first embodiment, the second oxygen efficiency characteristic is calculated by dividing the measured SpO2 by the measured FdO2 and dividing the resulting value by the measured respiration rate.

[0066] In some configurations of the first embodiment, the controller is configured to display a graph or trend line illustrating at least one of the first oxygen efficiency characteristic or the second oxygen efficiency characteristic over a defined period of time.

[0067] In accordance with certain features, aspects, and advantages of a second embodiment disclosed herein, a ventilator for providing a flow of gas to a patient, the ventilator including a controller configured to control the delivery of gas to the patient using closed loop control, the controller configured to: control an oxygen concentration (FdO2) of the gas flow to the patient; receive data indicative of a measured oxygen saturation (SpO2) of the patient from at least one patient sensor; receive data indicative of the measured FdO2 of the gas flow; receive a target SpO2 for the patient; and implement a step change in the FdO2 of the gas flow, the magnitude of the step change being based, at least in part, on the measured SpO2, the target SpO2, and oxygen efficiency of the patient.

[0068] In some configurations of the second embodiment, oxygen efficiency is determined based at least in part on the measured SpO2 and the measured FdO2.

[0069] In some configurations of the second embodiment, oxygen efficiency is determined based, at least in part, on the measured SpO2 divided by the measured FdO2.

[0070] In some configurations of the second embodiment, oxygen efficiency is determined based, at least in part, on a non-linear relationship between the patient's measured SpO2 and measured FdO2.

[0071] In some configurations of the second embodiment, the magnitude of the step change is based at least in part on the recent change to the target FdO2 before the step change.

[0072] In some configurations of the second embodiment, the magnitude of the step change is based at least in part on the recent change to the target FdO2 before the step change.

[0073] In some configurations of the second embodiment, the new target FdO2 is calculated based at least in part on the previous target FdO2.

[0074] In some configurations of the second embodiment, the controller is configured to execute a feedforward stage after the step change.

[0075] In some configurations of the second embodiment, the controller is further configured to maintain the target FdO2 for the entire duration of the feedforward stage immediately after the step change.

[0076] In some configurations of the second embodiment, the feedforward stage terminates when the measured SpO2 meets or exceeds the target SpO2.

[0077] In some configurations of the second embodiment, the feedforward stage terminates when a defined maximum period is reached.

[0078] In some configurations of the second embodiment, the ventilator includes a patient interface selected from at least one of a face mask, a nasal mask, a nasal pillows mask, a tracheostomy interface, a nasal cannula, or an endotracheal tube.

[0079] In some configurations of the second embodiment, the nasal cannula is a non-sealing nasal cannula.

[0080] In some configurations of the second embodiment, the ventilator is configured to supply a flow of gas to the patient at a nasal high flow (NHF).

[0081] In some configurations of the second embodiment, the at least one patient sensor is a pulse oximeter.

[0082] In some configurations of the second embodiment, the respirator includes a humidifier.

[0083] In some configurations of the second embodiment, the ventilator includes a gas composition sensor configured to determine a measured FdO2 during operation of the ventilator, and the gas composition sensor is an ultrasonic transducer system.

[0084] In some configurations of the second embodiment, the controller is further configured to perform a control phase after the feedforward stage.

[0085] In some configurations of the second embodiment, in the control phase, the controller is further configured to control the FdO2 of the gas flow to achieve a target FdO2 using feedback control.

[0086] In some configurations of the second embodiment, the controller is further configured to receive an indication of signal quality of the at least one patient sensor and apply a weighting to the control of FdO2 based at least in part on the signal quality.

[0087] In some configurations of the second embodiment, the controller is further configured to execute the control phase using a predicted SpO2 of the patient.

[0088] In some configurations of the second embodiment, the ventilator is configured to be portable.

[0089] In some configurations of the second embodiment, the controller is configured to display the first oxygen efficiency characteristic on a display of the respirator.

[0090] In some configurations of the second embodiment, the controller is configured to display a second oxygen efficiency characteristic on a display of the ventilator, and the second displayed value of the oxygen efficiency is based at least in part on the patient's oxygen efficiency and the measured respiratory rate.

[0091] In some configurations of the second embodiment, the second oxygen efficiency characteristic is calculated by dividing the measured SpO2 by the measured FdO2 and dividing the resulting value by the measured respiration rate.

[0092] In some configurations of the second embodiment, the controller is configured to display a graph or trend line illustrating at least one of the first oxygen efficiency characteristic or the second oxygen efficiency characteristic over a defined period of time.

[0093] In accordance with certain features, aspects, and advantages of a third embodiment disclosed herein, a ventilator providing a flow of gas to a patient, the ventilator including a controller configured to control the delivery of gas to the patient using closed loop control, the controller configured to: receive device parameter data indicative of an oxygen concentration (FdO2) of the gas flow; receive patient parameter data indicative of an oxygen saturation (SpO2) reading of the patient from at least one sensor, the patient's SpO2 being affected by the FdO2 of the gas flow; receive an indication of a signal quality of the at least one sensor; and apply a weighting to the control of the FdO2 based at least in part on the signal quality.

[0094] In some configurations of the third embodiment, the signal quality indication corresponds to a particular SpO2 reading.

[0095] In some configurations of the third embodiment, the ventilator includes a patient interface selected from at least one of a face mask, a nasal mask, a nasal pillows mask, a tracheostomy interface, a nasal cannula, or an endotracheal tube.

[0096] In some configurations of the third embodiment, the nasal cannula is a non-sealing nasal cannula.

[0097] In some configurations of the third embodiment, the ventilator is configured to supply a flow of gas to the patient at a nasal high flow (NHF).

[0098] In some configurations of the third embodiment, the at least one sensor is a pulse oximeter.

[0099] In some configurations of the third embodiment, the controller is configured to receive an input identifying a characteristic of the patient.

[0100] In some configurations of the third embodiment, the controller is configured to control the delivery of gas using a predicted SpO2 of the patient.

[0101] In some configurations of the third embodiment, the predicted SpO2 is based, at least in part, on a Smith predictor.

[0102] In some configurations of the third embodiment, the controller is configured to control the delivery of gas using a patient-specific model.

[0103] In some configurations of the third embodiment, the model is a patient-specific model that is generated during a learning phase of the patient's treatment session.

[0104] In some configurations of the third embodiment, the patient-specific model is generated during a treatment session based at least in part on the default model.

[0105] In some configurations of the third embodiment, the patient-specific model is updated during a treatment session.

[0106] In some configurations of the third embodiment, the model includes a delay time.

[0107] In some configurations of the third embodiment, the model includes an exponential decay.

[0108] In some configurations of the third embodiment, the model includes the patient's oxygen efficiency.

[0109] In some configurations of the third embodiment, oxygen efficiency is determined based at least in part on the measured SpO2 and the measured FdO2.

[0110] In some configurations of the third embodiment, oxygen efficiency is determined based, at least in part, on the measured SpO2 divided by the measured FdO2.

[0111] In some configurations of the third embodiment, oxygen efficiency is determined based, at least in part, on a non-linear relationship between the patient's measured SpO2 and measured FdO2.

[0112] In some configurations of the third embodiment, the ventilator is configured to be portable.

[0113] In accordance with certain features, aspects and advantages of a fourth embodiment disclosed herein, a ventilator for providing a flow of gas to a patient, the ventilator including a controller configured to control the delivery of gas to the patient using closed loop control, the controller configured to: control an oxygen concentration (FdO2) of the gas flow to the patient; receive data indicative of a measured oxygen saturation (SpO2) of the patient from at least one patient sensor; receive data indicative of the measured FdO2 of the gas flow; receive a target SpO2 for the patient; execute a wait stage, during which the controller is configured to determine whether to execute a feedforward stage before moving to a control phase, the target FdO2 of the gas flow being held constant during the wait stage; and execute a control phase, during which the FdO2 is controlled to achieve the target SpO2 using feedback control.

[0114] In some configurations of the fourth embodiment, the controller is further configured to determine whether to execute a feedforward stage based at least in part on the target SpO2 and the measured SpO2.

[0115] In some configurations of the fourth embodiment, the controller is further configured to determine whether to execute a feedforward stage based at least in part on the patient's oxygen efficiency.

[0116] In some configurations of the fourth embodiment, oxygen efficiency is determined based at least in part on the measured SpO2 and the measured FdO2.

[0117] In some configurations of the fourth embodiment, oxygen efficiency is determined based, at least in part, on the measured SpO2 divided by the measured FdO2.

[0118] In some configurations of the fourth embodiment, oxygen efficiency is determined based, at least in part, on a non-linear relationship between the patient's measured SpO2 and measured FdO2.

[0119] In some configurations of the fourth embodiment, if the controller decides to execute the feedforward stage, the controller executes the feedforward stage after a wait stage, and if the controller decides not to execute the feedforward stage, the controller executes the control phase after a wait phase.

[0120] In some configurations of the fourth embodiment, the controller is further configured to maintain the target FdO2 for the entire duration of the feedforward stage.

[0121] In some configurations of the fourth embodiment, the feedforward stage terminates when the measured SpO2 meets or exceeds the target SpO2.

[0122] In some configurations of the fourth embodiment, the feedforward stage terminates when a defined maximum period is reached.

[0123] In some configurations of the fourth embodiment, the controller is further configured to perform a control phase after the feedforward stage.

[0124] In some configurations of the fourth embodiment, prior to execution of the feedforward stage, the controller is configured to determine whether to execute a step change to the FdO2 of the gas flow.

[0125] In some configurations of the fourth embodiment, the controller is further configured to determine whether to perform a step change based at least in part on a recent change to the target FdO2.

[0126] In some configurations of the fourth embodiment, the controller is further configured to determine whether to implement a step change based at least in part on the target SpO2 and the measured SpO2.

[0127] In some configurations of the fourth embodiment, the controller is further configured to determine whether to implement a step change based at least in part on the patient's oxygen efficiency.

[0128] In some configurations of the fourth embodiment, the magnitude of the step change is based at least in part on the patient's measured SpO2, target SpO2 and oxygen efficiency.

[0129] In some configurations of the fourth embodiment, the magnitude of the step change is based at least in part on the recent change to the target FdO2.

[0130] In some configurations of the fourth embodiment, the respirator includes a patient interface selected from at least one of a face mask, a nasal mask, a nasal pillows mask, a tracheostomy interface, a nasal cannula, or an endotracheal tube.

[0131] In some configurations of the fourth embodiment, the nasal cannula is a non-sealing nasal cannula.

[0132] In some configurations of the fourth embodiment, the ventilator is configured to supply a flow of gas to the patient at a nasal high flow (NHF).

[0133] In some configurations of the fourth embodiment, the at least one patient sensor is a pulse oximeter.

[0134] In some configurations of the fourth embodiment, the respirator includes a humidifier.

[0135] In some configurations of the fourth embodiment, the ventilator includes a gas composition sensor configured to determine a measured FdO2 during operation of the ventilator, and the gas composition sensor is an ultrasonic transducer system.

[0136] In some configurations of the fourth embodiment, the controller is further configured to receive an indication of signal quality of at least one patient sensor and apply a weighting to the control of FdO2 based at least in part on the signal quality.

[0137] In some configurations of the fourth embodiment, the controller is further configured to apply weighting during the control phase.

[0138] In some configurations of the fourth embodiment, the controller is further configured to execute the control phase using a predicted SpO2 of the patient.

[0139] In some configurations of the fourth embodiment, the respirator is configured to be portable.

[0140] In accordance with certain features, aspects, and advantages of a fifth embodiment disclosed herein, a ventilator for providing a flow of gas to a patient, the ventilator including a controller configured to control the delivery of gas to the patient using closed loop control, the controller configured to: deliver the gas flow at a nasal high flow (NHF) to the patient; receive data from at least one patient sensor indicative of a measured oxygen saturation (SpO2) of the patient; receive data indicative of a measured fraction of oxygen delivered in the gas flow (FdO2); determine an oxygen efficiency of the patient; and generate a patient-specific model based on the measured SpO2 and the measured FdO2, the patient-specific model using the oxygen efficiency of the patient.

[0141] In some configurations of the fifth embodiment, oxygen efficiency is determined based at least in part on the measured SpO2 and the measured FdO2.

[0142] In some configurations of the fifth embodiment, oxygen efficiency is determined based, at least in part, on the measured SpO2 divided by the measured FdO2.

[0143] In some configurations of the fifth embodiment, oxygen efficiency is determined based, at least in part, on a non-linear relationship between the patient's measured SpO2 and measured FdO2.

[0144] In some configurations of the fifth embodiment, the patient-specific model is generated based at least in part on the default model.

[0145] In some configurations of the fifth embodiment, the patient-specific model is generated during a learning phase.

[0146] In some configurations of the fifth embodiment, the patient-specific model is updated during a treatment session of the patient.

[0147] In some configurations of the fifth embodiment, the patient-specific model models the magnitude of change in SpO2 based at least in part on the change in FdO2.

[0148] In some configurations of the fifth embodiment, the patient-specific model uses the flow rate of the gas flow.

[0149] In some configurations of the fifth embodiment, the patient-specific model includes a lag time between the change in FdO2 and the change in SpO2 of the patient.

[0150] In some configurations of the fifth embodiment, the delay time is based at least in part on a flow rate of the gas stream.

[0151] In some configurations of the fifth embodiment, the patient-specific model includes an exponential decay.

[0152] In some configurations of the fifth embodiment, the at least one patient sensor is a pulse oximeter.

[0153] In some configurations of the fifth embodiment, the respirator includes a humidifier.

[0154] In some configurations of the fifth embodiment, FdO2 is measured using an ultrasound transducer system.

[0155] In some configurations of the fifth embodiment, the ultrasonic transducer system includes a first ultrasonic transducer and a second ultrasonic transducer.

[0156] In some configurations of the fifth embodiment, the first ultrasonic transducer and the second ultrasonic transducer are a receiver and a transmitter, respectively.

[0157] In some configurations of the fifth embodiment, the first ultrasonic transducer and the second ultrasonic transducer transmit pulses bidirectionally.

[0158] In some configurations of the fifth embodiment, the first ultrasonic transducer is a transmitter and the second ultrasonic transducer is a receiver.

[0159] In some configurations of the fifth embodiment, at least one of the first ultrasonic transducer or the second ultrasonic transducer sends a pulse along the gas flow.

[0160] In some configurations of the fifth embodiment, at least one of the first ultrasonic transducer or the second ultrasonic transducer sends a pulse across the gas flow.

[0161] In some configurations of the fifth embodiment, the ventilator is configured to be portable.

[0162] In accordance with certain features, aspects and advantages of a sixth embodiment disclosed herein, a ventilator for providing a flow of gas to a patient, the ventilator including a controller configured to control the supply of gas to the patient using closed loop control, the controller configured to: control an oxygen concentration (FdO2) of the gas flow to the patient; receive data indicative of a measured oxygen saturation (SpO2) of the patient from at least one patient sensor; receive data indicative of the measured FdO2 of the gas flow; receive a target SpO2 for the patient; perform a step change to the FdO2 of the gas flow to the target FdO2; perform a feedforward stage; and perform a control phase, wherein the FdO2 is controlled to achieve the target SpO2 using feedback control.

[0163] In some configurations of the sixth embodiment, the magnitude of the step change is based at least in part on the patient's measured SpO2, target SpO2 and oxygen efficiency.

[0164] In some configurations of the sixth embodiment, the target FdO2 is based at least in part on the recent change to the target FdO2 before the step change.

[0165] In some configurations of the sixth embodiment, the controller is further configured to maintain the target FdO2 immediately after the step change for the entire duration of the feedforward stage.

[0166] In some configurations of the sixth embodiment, the feedforward stage terminates when a defined maximum period is reached.

[0167] In some configurations of the sixth embodiment, the feedforward stage terminates when the measured SpO2 meets or exceeds the target SpO2.

[0168] In some configurations of the sixth embodiment, the controller is further configured to perform a control phase after the feedforward stage.

[0169] In some configurations of the sixth embodiment, the respirator includes a patient interface selected from at least one of a face mask, a nasal mask, a nasal pillows mask, a tracheostomy interface, a nasal cannula, or an endotracheal tube.

[0170] In some configurations of the sixth embodiment, the nasal cannula is a non-sealing nasal cannula.

[0171] In some configurations of the sixth embodiment, the ventilator is configured to supply a flow of gas to the patient at a nasal high flow (NHF).

[0172] In some configurations of the sixth embodiment, the at least one patient sensor is a pulse oximeter.

[0173] In some configurations of the sixth embodiment, the respirator includes a humidifier.

[0174] In some configurations of the sixth embodiment, the ventilator includes a gas composition sensor configured to determine a measured FdO2 during operation of the ventilator, the gas composition sensor being an ultrasonic transducer system.

[0175] In some configurations of the sixth embodiment, the controller is further configured to receive an indication of signal quality of the at least one patient sensor and apply a weighting to the control of FdO2 based at least in part on the signal quality.

[0176] In some configurations of the sixth embodiment, the controller is further configured to execute the control phase using a predicted SpO2 of the patient.

[0177] In some configurations of the sixth embodiment, the ventilator is configured to be portable.

[0178] In accordance with certain features, aspects, and advantages of a seventh embodiment disclosed herein, a ventilator providing a flow of gas to a patient, the ventilator including a controller configured to control the delivery of gas to the patient using closed loop control, the controller configured to: deliver the flow of gas to the patient using a nasal high flow (NHF); control an oxygen concentration (FdO2) of the gas flow to the patient; receive data from at least one patient sensor indicative of a measured oxygen saturation (SpO2) of the patient; receive a target SpO2 for the patient; and implement a step change in the FdO2 of the gas flow, the magnitude of the step change being based at least in part on the measured SpO2 and the target SpO2 of the patient.

[0179] In some configurations of the seventh embodiment, the step change is further based at least in part on the patient's oxygen efficiency.

[0180] In some configurations of the seventh embodiment, oxygen efficiency is determined based at least in part on the measured SpO2 and the measured FdO2.

[0181] In some configurations of the seventh embodiment, oxygen efficiency is determined based, at least in part, on the measured SpO2 divided by the measured FdO2.

[0182] In some configurations of the seventh embodiment, oxygen efficiency is determined based, at least in part, on a non-linear relationship between the patient's measured SpO2 and measured FdO2.

[0183] In some configurations of the seventh embodiment, the magnitude of the step change is based, at least in part, on the change in target FdO2 within a defined period of time prior to the step change.

[0184] In some configurations of the seventh embodiment, the new target FdO2 is calculated based at least in part on the previous target FdO2.

[0185] In some configurations of the seventh embodiment, the controller is configured to execute a feedforward stage after the step change.

[0186] In some configurations of the seventh embodiment, the controller is further configured to maintain the FdO2 at the target FdO2 for the entire duration of the feedforward stage.

[0187] In some configurations of the seventh embodiment, the feedforward stage terminates when the measured SpO2 meets or exceeds the target SpO2.

[0188] In some configurations of the seventh embodiment, the feedforward stage terminates when a defined maximum period is reached.

[0189] In some configurations of the seventh embodiment, the respiratory apparatus includes a patient interface selected from at least one of a face mask, a nasal mask, a nasal pillows mask, a tracheostomy interface, a nasal cannula, or an endotracheal tube.

[0190] In some configurations of the seventh embodiment, the nasal cannula is a non-sealing nasal cannula.

[0191] In some configurations of the seventh embodiment, the at least one patient sensor is a pulse oximeter.

[0192] In some configurations of the seventh embodiment, the respiratory apparatus includes a humidifier.

[0193] In some configurations of the seventh embodiment, the ventilator includes a gas composition sensor configured to determine a measured FdO2 during operation of the ventilator, and the gas composition sensor is an ultrasonic transducer system.

[0194] In some configurations of the seventh embodiment, the controller is further configured to perform a control phase after the feedforward stage.

[0195] In some configurations of the seventh embodiment, in the control phase, the controller is further configured to control the FdO2 of the gas flow to achieve a target FdO2 using feedback control.

[0196] In some configurations of the seventh embodiment, the controller is further configured to receive an indication of signal quality of the at least one patient sensor and apply a weighting to the control of FdO2 based at least in part on the signal quality.

[0197] In some configurations of the seventh embodiment, the controller is further configured to execute the control phase using a predicted SpO2 of the patient.

[0198] In some configurations of the seventh embodiment, the ventilator is configured to be portable.

[0199] In some configurations of the seventh embodiment, the controller is configured to display the first oxygen efficiency characteristic on a display of the respirator.

[0200] In some configurations of the seventh embodiment, the controller is configured to display a second oxygen efficiency characteristic on a display of the ventilator, and the second displayed value of the oxygen efficiency is based at least in part on the patient's oxygen efficiency and the measured respiratory rate.

[0201] In some configurations of the seventh embodiment, the second oxygen efficiency characteristic is calculated by dividing the measured SpO2 by the measured FdO2 and dividing the resulting value by the measured respiration rate.

[0202] In some configurations of the seventh embodiment, the controller is configured to display a graph or trend line illustrating at least one of the first oxygen efficiency characteristic or the second oxygen efficiency characteristic over a defined period of time.

[0203] In accordance with certain features, aspects and advantages of at least one of the embodiments disclosed herein, a ventilator for providing a flow of gas to a patient includes a controller configured to control the supply of gas to the patient using closed loop control, the controller being configured to receive patient parameter data indicative of an oxygen saturation (SpO2) of the patient from at least one sensor, and to execute a control phase, wherein operation of the ventilator during a treatment session is based, at least in part, on the patient parameter data.

[0204] In some configurations, the respiratory apparatus includes a patient interface selected from at least one of a face mask, a nasal mask, a nasal pillows mask, a tracheostomy interface, a nasal cannula, or an endotracheal tube.

[0205] In some configurations, the ventilator is configured to deliver a flow of gas to the patient at a nasal high flow (NHF).

[0206] In some configurations, the at least one sensor is a pulse oximeter.

[0207] In some configurations, the respirator includes a supplemental gas inlet valve.

[0208] In some configurations, the controller is configured to control operation of the supplemental gas inlet valve.

[0209] In some configurations, the supplemental gas inlet valve is a proportional valve.

[0210] In some configurations, the supplemental gas inlet valve is an oxygen inlet valve.

[0211] In some configurations, the respirator includes an ambient air inlet.

[0212] In some configurations, the oxygen inlet valve is in fluid communication with the filter module, and the respirator is configured to inhale oxygen received through the oxygen inlet valve along with ambient air from the ambient air inlet in the filter module.

[0213] In some configurations, the respirator includes a gas composition sensor configured to determine the oxygen content of at least the gas stream during operation of the respirator.

[0214] In some configurations, the gas composition sensor is an ultrasonic transducer system.

[0215] In some configurations, the gas composition sensor is positioned downstream of the blower module of the respirator.

[0216] In some configurations, the filter module is positioned upstream of the blower module of the respirator.

[0217] In some configurations, the closed loop control includes using a first closed loop control model configured to determine a target percentage of delivered oxygen (FdO2).

[0218] In some configurations, the target FdO2 is determined based at least in part on the patient's target SpO2 and SpO2.

[0219] In some configurations, the target FdO2 is further based, at least in part, on the measured FdO2.

[0220] In some configurations, the closed loop control includes using a second closed loop control model configured to determine a control signal for the oxygen inlet valve.

[0221] In some configurations, the control signal for the oxygen valve is determined based at least in part on the target FdO2 and the measured FdO2.

[0222] In some configurations, the control signal for the oxygen valve is determined further based at least in part on the gas flow rate.

[0223] In some configurations, the controller is configured to transition to a manual operating mode when the signal quality of at least one sensor falls below a threshold.

[0224] In some configurations, the controller is configured to transition to a manual operating mode when the patient's SpO2 is outside of defined limits.

[0225] In some configurations, the controller is configured to receive an indication of signal quality and apply a weighting to control of FdO2 based at least in part on the signal quality.

[0226] In some configurations, the signal quality indication corresponds to a particular SpO2 reading.

[0227] In some configurations, the controller is configured to execute a number of phases during a respiratory treatment session, the controller executing a learning phase, during which the controller is configured to generate a patient-specific model and to execute a control phase based at least in part on the patient-specific model.

[0228] In some configurations, during the learning phase, the controller is configured to receive device parameter data indicative of the oxygen concentration of the gas flow provided to the patient, and to receive patient parameter data indicative of the patient's oxygen saturation from the at least one sensor.

[0229] In some configurations, the controller is configured to generate the patient-specific model based, at least in part, on a relationship between the oxygen concentration of the gas flow and the patient's oxygen saturation.

[0230] In some configurations, the learning phase has a maximum duration.

[0231] In some configurations, the learning phase is performed multiple times during a treatment session.

[0232] In some configurations, the controller is further configured to vary the oxygen concentration during the learning phase.

[0233] In some configurations, the controller is further configured to vary the oxygen concentration after the controller detects that the measured oxygen saturation of the patient parameter is stable.

[0234] In some configurations, the change is to increase the oxygen concentration.

[0235] In some configurations, the change is to decrease the oxygen concentration.

[0236] In some configurations, the patient-specific model is based, at least in part, on sensor signal quality data recorded during a learning phase.

[0237] In some configurations, the patient-specific model determines a lag time, which is the period of time between when a change in oxygen concentration of the gas flow occurs and the response of the patient's oxygen saturation.

[0238] In some configurations, the patient-specific model calculates an exponential decay.

[0239] In some configurations, the parameters of the patient-specific model include at least one of a delay time, an exponential decay rate, a change in oxygen concentration, and a change in blood oxygen saturation.

[0240] In some configurations, the controller is further configured to execute a control phase after the patient-specific model meets defined characterization criteria.

[0241] In some configurations, the defined characterization criteria define, for each of one or more of the parameters of the patient-specific model, a range of acceptable values ​​for the parameter.

[0242] In some configurations, the control phase is configured to be performed using PID control based at least in part on a patient-specific model.

[0243] In some configurations, the controller is configured to receive instrument parameter data indicative of an oxygen concentration of the gas stream.

[0244] In some configurations, the controller is configured to predict an oxygen saturation of the patient based at least in part on the oxygen concentration of the gas flow.

[0245] In some configurations, the predicted value is based at least in part on one or more patient parameter readings.

[0246] In some configurations, previous predicted values ​​of the patient parameters are compared to the actual patient parameter readings to calculate a model error.

[0247] In some configurations, the model error is weighted by the signal quality.

[0248] In some configurations, the model error is used to correct the current prediction.

[0249] In some configurations, the prediction is based on a model.

[0250] In some configurations, the model is patient-specific.

[0251] In some configurations, the model is generated during a learning phase of a treatment session.

[0252] In some configurations, the control phase is configured to be performed using a predictive algorithm to predict the patient's oxygen saturation.

[0253] In some configurations, the prediction algorithm is a Smith predictor.

[0254] In some configurations, the output of the predictive algorithm is based at least in part on a patient-specific model.

[0255] In some configurations, the controller is configured to receive an input identifying a characteristic of the patient.

[0256] In some configurations, the patient characteristics include at least one of patient type, age, weight, height, or gender.

[0257] In some configurations, the patient type is one of normocapnic, hypercapnic, or user-defined.

[0258] In some configurations, the controller is configured to: execute a learning phase, during which the controller receives equipment parameter data indicative of an oxygen concentration of the gas flow provided to the patient, receives patient parameter data indicative of an oxygen saturation level of the patient from the at least one sensor, and is configured to calculate one or more model parameters for a patient-specific model based on the equipment parameter data and the patient parameter data; determine that at least one of the one or more parameters does not meet patient characterization criteria for generation of the patient-specific model; and execute a control phase, during which operation of the ventilator during the treatment session is based at least in part on a default patient model.

[0259] In some configurations, the default patient model is selected from a plurality of default patient models based at least in part on one or more characteristics of the patient.

[0260] In some configurations, the default patient model is selected from a plurality of default patient models based at least in part on the type of patient.

[0261] In some configurations, the controller is further configured to record data corresponding to the measured oxygen concentration and the measured oxygen saturation.

[0262] In some configurations, the controller is further configured to stop recording data after a defined period of time.

[0263] In some configurations, the controller is further configured to stop recording data after the patient-specific model meets defined characterization criteria.

[0264] In some configurations, the respirator includes a humidifier.

[0265] In some configurations, the respirator includes an integrated blower and humidifier.

[0266] In some configurations, the ventilator is configured to be portable.

[0267] In some configurations, the ventilator is configured to have a controlled variable flow rate.

[0268] In some configurations, the target FdO2 is further based at least in part on signal quality.

[0269] In some configurations, the ventilator is configured to vary the flow rate by varying the blower motor speed.

[0270] In accordance with certain features, aspects, and advantages of at least one of the embodiments disclosed herein, a method of providing a flow of gas to a patient includes receiving, by a respiratory controller, patient parameter data from at least one sensor indicative of an oxygen saturation level of the patient, and controlling operation of a respiratory therapy device using closed loop control during a control phase of a treatment session based at least in part on the patient parameter data.

[0271] In some configurations, the method includes performing a learning phase during a treatment session, the learning phase including receiving device parameter data indicative of an oxygen concentration of the gas flow provided to the patient and patient parameter data indicative of the patient's oxygen saturation from at least one sensor, and generating a patient-specific model based, at least in part, on a relationship between the oxygen concentration of the gas flow and the patient's oxygen saturation.

[0272] In some configurations, the method includes controlling operation of the respiratory therapy device during a control phase of the treatment session based at least in part on the patient-specific model.

[0273] In some configurations, the method includes recording data corresponding to the measured oxygen concentration and the measured oxygen saturation.

[0274] In some configurations, the method includes stopping recording of data after a defined period of time.

[0275] In some configurations, the method includes generating a patient-specific model based, at least in part, on signal quality data of the at least one sensor recorded during the learning phase.

[0276] In some configurations, the parameters of the patient-specific model include at least one of a delay time, an exponential decay rate, a change in oxygen concentration, and a change in blood oxygen saturation.

[0277] In some configurations, the method includes executing a control phase after the patient-specific model meets the defined characterization criteria.

[0278] In some configurations, the defined characterization criteria define, for each of one or more of the parameters of the patient-specific model, a range of acceptable values ​​for the parameter.

[0279] In some configurations, the method includes performing the control phase using PID control based at least in part on the patient-specific model.

[0280] In some configurations, the method includes performing the control phase using a predictive algorithm to predict oxygen saturation of the patient.

[0281] In some configurations, the method includes using the predicted oxygen saturation during the control phase.

[0282] In some configurations, the prediction algorithm is a Smith predictor.

[0283] In some configurations, the output of the predictive algorithm is based at least in part on a patient-specific model.

[0284] In some configurations, the method includes receiving an input identifying a characteristic of the patient.

[0285] In some configurations, the patient characteristics include at least one of patient type, age, weight, height, or gender.

[0286] In some configurations, the method includes varying the oxygen concentration during the learning phase.

[0287] In some configurations, the method includes varying the oxygen concentration during the learning phase after detecting that the measured oxygen saturation of the patient parameter is stable.

[0288] In some configurations, the change is to increase the oxygen concentration.

[0289] In some configurations, the change is to decrease the oxygen concentration.

[0290] In some configurations, the method includes performing the learning phase multiple times during a treatment session.

[0291] In some configurations, the method includes transitioning to a manual operating mode when a signal quality of the at least one sensor falls below a threshold.

[0292] In some configurations, the method includes transitioning to a manual mode of operation when the patient's SpO2 is outside of defined limits.

[0293] In some configurations, the method includes determining the target FdO2 using a first closed control loop.

[0294] In some configurations, the target FdO2 is determined based at least in part on the patient's target SpO2 and SpO2.

[0295] In some configurations, the target FdO2 is further based, at least in part, on the measured FdO2.

[0296] In some configurations, the method includes determining a control signal for the oxygen inlet valve using a second closed control loop.

[0297] In some configurations, the control signal is determined based at least in part on the target FdO2 and the measured FdO2.

[0298] In some configurations, the control signal for the oxygen valve is further based at least in part on the gas flow rate.

[0299] In some configurations, the method includes adjusting the oxygen inlet valve based on the control signal.

[0300] In some configurations, the method includes drawing oxygen through an oxygen inlet valve along with ambient air from an ambient air inlet in a filter module of the respirator.

[0301] In some configurations, the method includes receiving an indication of signal quality and applying a weighting to control of FdO2 based at least in part on the signal quality.

[0302] In some configurations, the method includes determining at least the oxygen content of the gas flow during operation of the ventilator.

[0303] In some configurations, the target FdO2 is further based at least in part on signal quality.

[0304] In accordance with certain features, aspects, and advantages of at least one of the embodiments disclosed herein, a ventilator for providing a flow of gas to a patient, the ventilator including a controller configured to control the supply of gas to the patient, the controller configured to: perform a learning phase, during which the controller receives device parameter data indicative of an oxygen concentration of the gas flow provided to the patient, receives patient parameter data indicative of an oxygen saturation of the patient from at least one sensor, and is configured to generate a patient-specific model based, at least in part, on a relationship between the oxygen concentration of the gas flow and the oxygen saturation of the patient; and perform a control phase, during which operation of the ventilator during a treatment session is based, at least in part, on the patient-specific model.

[0305] In some configurations, the respiratory apparatus includes a patient interface selected from at least one of a face mask, a nasal mask, a nasal pillows mask, a tracheostomy interface, a nasal cannula, or an endotracheal tube.

[0306] In some configurations, the ventilator is a device that delivers a flow of gas at nasal high flow (NHF).

[0307] In some configurations, the sensor is a pulse oximeter.

[0308] In some configurations, the controller is further configured to record data corresponding to the measured oxygen concentration and the measured oxygen saturation.

[0309] In some configurations, the controller is further configured to stop recording data after a defined period of time.

[0310] In some configurations, the patient-specific model is based, at least in part, on sensor signal quality data recorded during a learning phase.

[0311] In some configurations, the patient-specific model determines a delay time, which is the period between the time of change in oxygen concentration of the gas flow and the response of the patient's oxygen saturation.

[0312] In some configurations, the patient-specific model calculates an exponential decay.

[0313] In some configurations, the parameters of the patient-specific model include at least one of a delay time, an exponential decay rate, a change in oxygen concentration, and a change in blood oxygen saturation.

[0314] In some configurations, the controller is further configured to execute a control phase after the patient-specific model meets defined characterization criteria.

[0315] In some configurations, the defined characterization criteria define, for each of one or more of the parameters of the patient-specific model, a range of acceptable values ​​for the parameter.

[0316] In some configurations, the control phase is configured to be performed using closed-loop control.

[0317] In some configurations, the control phase is configured to be performed using PID control based at least in part on a patient-specific model.

[0318] In some configurations, the control phase is configured to be performed using a predictive algorithm to predict the patient's oxygen saturation.

[0319] In some configurations, the controller is further configured to use the predicted oxygen saturation during the control phase.

[0320] In some configurations, the prediction algorithm is a Smith predictor.

[0321] In some configurations, the output of the predictive algorithm is based at least in part on a patient-specific model.

[0322] In some configurations, the controller is configured to receive an input identifying a characteristic of the patient.

[0323] In some configurations, the patient characteristics include at least one of patient type, age, weight, height, or gender.

[0324] In some configurations, the controller is further configured to vary the oxygen concentration during the learning phase.

[0325] In some configurations, the controller is further configured to vary the oxygen concentration after the controller detects that the measured oxygen saturation of the patient parameter is stable. In some configurations, the variation is to increase the oxygen concentration. In some configurations, the variation is to decrease the oxygen concentration.

[0326] In some configurations, the learning phase is performed multiple times during a treatment session.

[0327] Further in accordance with certain features, aspects and advantages of at least one of the embodiments disclosed herein, a ventilator for providing a flow of gas to a patient, the ventilator being configured to deliver a flow of gas to the patient at a nasal high flow (NHF), the ventilator including a controller configured to control operation of the ventilator during a treatment session of the ventilator and to execute a plurality of phases, the controller being configured to execute a learning phase, during which the controller is configured to generate a patient-specific model, and execute a control phase, during which operation of the ventilator during the treatment session is based at least in part on the patient-specific model.

[0328] In some configurations, during the learning phase, the controller is further configured to measure a characteristic of the gas flow provided to the patient, hi some configurations, the characteristic is the oxygen concentration of the gas flow.

[0329] In some configurations, during the learning phase, the controller is further configured to measure a physiological parameter of the patient using the at least one sensor, hi some configurations, the physiological parameter is oxygen saturation of the patient.

[0330] In some configurations, the controller is further configured to receive device parameter data indicative of an oxygen concentration of the gas flow provided to the patient, and to receive patient parameter data indicative of an oxygen saturation of the patient from the at least one sensor. In some configurations, during the learning phase, the controller is further configured to generate a patient-specific model based, at least in part, on a relationship between the oxygen concentration of the gas flow and the oxygen saturation of the patient.

[0331] In some configurations, the at least one sensor is a pulse oximeter.

[0332] In some configurations, the controller is further configured to vary the oxygen concentration during the learning phase. In some configurations, the controller is further configured to vary the oxygen concentration after the controller detects that the measured oxygen saturation of the patient parameter is stable. In some configurations, the change is to increase the oxygen concentration. In some configurations, the change is to decrease the oxygen concentration.

[0333] In some configurations, the controller is further configured to record data corresponding to the measured oxygen concentration and the measured oxygen saturation.

[0334] In some configurations, the controller is further configured to stop recording data after a defined period of time.

[0335] In some configurations, the controller is further configured to stop recording data after the patient-specific model meets the defined characterization criteria.

[0336] In some configurations, the patient-specific model is based, at least in part, on sensor signal quality data recorded during a learning phase.

[0337] In some configurations, the error value for the sensor data may be weighted by the corresponding signal quality data.

[0338] In some configurations, the patient-specific model determines a delay time, which is the period between the time of change in oxygen concentration of the gas flow and the response of the patient's oxygen saturation.

[0339] In some configurations, the patient-specific model calculates an exponential decay.

[0340] In some configurations, the parameters of the patient-specific model include at least delay time, exponential decay rate, change in oxygen concentration, and change in blood oxygen saturation.

[0341] In some configurations, the control phase is configured to be performed using closed-loop control.

[0342] In some configurations, the control phase is configured to be performed using PID control based at least in part on a patient-specific model.

[0343] In some configurations, the control phase is configured to be performed using a predictive algorithm for predicting a physiological parameter of the patient.

[0344] In some configurations, the controller is further configured to use the predicted oxygen saturation during the control phase.

[0345] In some configurations, the prediction algorithm is a Smith predictor.

[0346] In some configurations, the output of the predictive algorithm is based at least in part on a patient-specific model.

[0347] In some configurations, the learning phase is performed multiple times during a treatment session.

[0348] In some configurations, the controller is configured to receive an input identifying a characteristic of the patient. In some configurations, the patient characteristic includes at least one of a patient type, age, weight, height, or gender. In some configurations, the patient type is one of normocapnic, hypercapnic, or user-defined.

[0349] Further in accordance with certain features, aspects, and advantages of at least one of the embodiments disclosed herein, a respirator for providing a flow of gas to a patient, the respirator including a controller configured to control the delivery of gas to the patient, the controller configured to: receive device parameter data indicative of an oxygen concentration of the gas stream; receive patient parameter data indicative of an oxygen saturation reading of the patient, the patient's oxygen saturation being affected by the oxygen concentration of the gas stream; and predict the patient's oxygen saturation based at least in part on the oxygen concentration of the gas stream.

[0350] In some configurations, the respiratory apparatus includes a patient interface selected from at least one of a face mask, a nasal mask, a nasal pillows mask, a tracheostomy interface, a nasal cannula, or an endotracheal tube.

[0351] In some configurations, the ventilator is a device that delivers a flow of gas at nasal high flow (NHF).

[0352] In some configurations, the sensor is a pulse oximeter.

[0353] In some configurations, the predicted value is based at least in part on one or more patient parameter readings. In some configurations, a previous predicted value of the patient parameter is compared to an actual patient parameter reading to calculate a model error.

[0354] In some configurations, the model error is weighted by the signal quality.

[0355] In some configurations, the model error is used to correct the current prediction.

[0356] In some configurations, the prediction is based on a model.

[0357] In some configurations, the model is patient-specific.

[0358] In some configurations, the model is generated during a learning phase of a treatment session.

[0359] In some configurations, the patient-specific model determines a delay time, which is the period between the time of change in oxygen concentration of the gas stream and the response of the patient's oxygen saturation.

[0360] In some configurations, the patient-specific model includes an exponential decay.

[0361] In some configurations, the controller is further configured to use the predicted oxygen saturation during the control phase.

[0362] In some configurations, the prediction is based on a Smith predictor.

[0363] In some configurations, the controller is configured to perform control of the supply of gas using closed loop control.

[0364] In some configurations, the model is based, at least in part, on sensor signal quality data recorded during a learning phase.

[0365] Further in accordance with certain features, aspects, and advantages of at least one of the embodiments disclosed herein, a ventilator for providing a flow of gas to a patient, the ventilator including a controller configured to control the delivery of gas to the patient using closed loop control, the controller configured to: receive device parameter data indicative of an oxygen concentration of the gas flow; receive patient parameter data indicative of an oxygen saturation reading of the patient, the patient's oxygen saturation being affected by the oxygen concentration of the gas flow; receive an indication of signal quality; and apply a weighting to the control of the oxygen concentration based at least in part on the signal quality.

[0366] In some configurations, the signal quality indication corresponds to a particular oxygen saturation reading.

[0367] In some configurations, the respiratory apparatus includes a patient interface selected from at least one of a face mask, a nasal mask, a nasal pillows mask, a tracheostomy interface, a nasal cannula, or an endotracheal tube.

[0368] In some configurations, the sensor is a pulse oximeter.

[0369] In some configurations, the controller is configured to control the delivery of gas using a predictive algorithm to predict oxygen saturation of the patient. In some configurations, an output of the predictive algorithm is based at least in part on a model. In some configurations, the model is patient specific. In some configurations, the model is generated during a learning phase of a therapy session. In some configurations, the model includes a delay time. In some configurations, the model includes an exponential decay. In some configurations, the predictive algorithm is a Smith predictor.

[0370] In some configurations, the controller is configured to receive an input identifying a characteristic of the patient.

[0371] Further in accordance with certain features, aspects and advantages of at least one of the embodiments disclosed herein, a ventilator providing a flow of gas to a patient, the ventilator including a controller configured to control the supply of gas to the patient, the controller configured to: perform a learning phase, during which the controller receives equipment parameter data indicative of an oxygen concentration in the gas flow provided to the patient, receives patient parameter data indicative of an oxygen saturation level of the patient from at least one sensor, and is configured to calculate one or more model parameters for a patient-specific model based on the equipment parameter data and the patient parameter data; determine that at least one of the one or more parameters does not meet patient characterization criteria for generation of the patient-specific model; and perform a control phase, wherein operation of the ventilator during a treatment session is based at least in part on a default patient model.

[0372] In some configurations, the respiratory apparatus includes a patient interface selected from at least one of a face mask, a nasal mask, a nasal pillows mask, a tracheostomy interface, a nasal cannula, or an endotracheal tube.

[0373] In some configurations, the ventilator is a device that delivers a flow of gas at nasal high flow (NHF).

[0374] In some configurations, the sensor is a pulse oximeter.

[0375] In some configurations, the controller is further configured to record data corresponding to the measured oxygen concentration and the measured oxygen saturation.

[0376] In some configurations, the one or more modal parameters include at least one of a delay time, an exponential decay rate, a change in oxygen concentration, or a change in blood oxygen saturation.

[0377] In some configurations, the default patient model is selected from one of a plurality of default patient models.

[0378] In some configurations, the controller is configured to receive an input of one or more patient characteristics. In some configurations, the patient characteristics include at least one of a patient type, age, weight, height, or gender. In some configurations, the patient type is one of normocapnic, hypercapnic, or user-defined. In some configurations, the default patient model is selected from a plurality of default patient models based at least in part on the one or more patient characteristics. In some configurations, the default patient model is selected from a plurality of default patient models based at least in part on the patient type.

[0379] In some configurations, the control phase is configured to be performed using closed-loop control.

[0380] In some configurations, the control phase is configured to be performed using PID control based at least in part on a default patient model.

[0381] In some configurations, the control phase is configured to be performed using a predictive algorithm to predict the patient's oxygen saturation.

[0382] In some configurations, the controller is further configured to use the predicted oxygen saturation during the control phase to control the delivery of gas to the patient.

[0383] In some configurations, the prediction algorithm is a Smith predictor.

[0384] In some configurations, the output of the predictive algorithm is based at least in part on a default patient model.

[0385] Further in accordance with certain features, aspects, and advantages of at least one of the embodiments disclosed herein, a method of providing a flow of gas to a patient includes performing, by a controller of a respiratory therapy device, a learning phase during a treatment session, the learning phase including receiving equipment parameter data indicative of an oxygen concentration of the gas flow provided to the patient, receiving patient parameter data from at least one sensor indicative of an oxygen saturation of the patient, and generating a patient-specific model based, at least in part, on a relationship between the oxygen concentration of the gas flow and the oxygen saturation of the patient; and controlling operation of the respiratory therapy device during a control phase of the treatment session based, at least in part, on the patient-specific model.

[0386] The method may include recording data corresponding to the measured oxygen concentration and the measured oxygen saturation.

[0387] The method may include stopping recording of data after a defined period of time.

[0388] The method may include generating a patient-specific model based, at least in part, on signal quality data of the at least one sensor recorded during the learning phase.

[0389] The parameters of the patient-specific model include at least one of a delay time, an exponential decay rate, a change in oxygen concentration, and a change in blood oxygen saturation.

[0390] The method may include executing a control phase after the patient-specific model satisfies defined characterization criteria. The defined characterization criteria may define, for each of one or more of the parameters of the patient-specific model, a range of acceptable values ​​for the parameter.

[0391] The method may include performing a control phase using PID control based at least in part on the patient-specific model.

[0392] The method may include performing a control phase using a predictive algorithm for predicting oxygen saturation of the patient. The method may include using the predicted oxygen saturation during the control phase. The predictive algorithm may be a Smith predictor. An output of the predictive algorithm may be based at least in part on a patient-specific model.

[0393] The method can include receiving an input identifying a characteristic of the patient. The patient characteristic can include at least one of a patient type, an age, a weight, a height, or a gender.

[0394] The method may include varying the oxygen concentration during the learning phase. The method may include varying the oxygen concentration during the learning phase after detecting that the measured oxygen saturation of the patient parameter is stable. The change may be to increase the oxygen concentration. The change may be to decrease the oxygen concentration.

[0395] The method may include performing the learning phase multiple times during a treatment session.

[0396] Features from one or more embodiments or configurations may be combined with features from one or more other embodiments or configurations. Additionally, two or more embodiments may be used together during the process of providing respiratory assistance to a patient.

[0397] As used herein, the term "comprising" means "consisting at least in part of." When interpreting each sentence in this specification containing the term "comprise," there may be other features present than the feature preceding the term. Related words such as "comprise" and "comprises" are to be interpreted in the same manner.

[0398] Reference to a range of numerical values ​​disclosed herein (e.g., 1-10) also incorporates reference to every rational number within that range (e.g., 1, 1.1, 2, 3, 3.9, 4, 5, 6, 6.5, 7, 8, 9, and 10) and also to any range of rational numbers within that range (e.g., 2-8, 1.5-5.5, and 3.1-4.7), and therefore every subrange of the entire range expressly disclosed herein is intended to be expressly disclosed herein. These are merely examples of what is specifically intended, and all possible combinations of numerical values ​​between the minimum and maximum values ​​recited are likewise considered to be expressly set forth in this application.

[0399] It is to be understood that alternative embodiments or configurations may include any or all combinations of two or more of the parts, elements or features illustrated, described or referenced herein.

[0400] The invention may also be broadly described as consisting in the parts, elements and features referred to or shown in the specification of this application, individually or collectively, and in any or all combinations of any two or more of said parts, elements or features.

[0401] Those skilled in the art to which the present invention pertains will be aware that many variations in configuration and widely different embodiments and applications of the present invention will be suggested, without themselves departing from the scope of the present invention as defined in the appended claims. The disclosures and descriptions herein are purely illustrative and are not intended to be limiting in any way. Where a particular integral having a known equivalent in the art to which the present invention pertains is described herein, such known equivalent is deemed to be incorporated herein as if it were individually described. [Brief description of the drawings]

[0402] [Figure 1A] 1 illustrates a schematic configuration of a flow therapy device. [Figure 1B] 1 illustrates a sensing circuit board including a flow sensor that may be used in a flow therapy device. [Fig. 1C-1D]1A-1D show schematic diagrams of various ultrasonic transducer configurations for a sensor system using a cross flow beam. [Fig. 1E-1F] FIG. 1 shows schematic diagrams of various ultrasonic transducer configurations for a sensor system using an along-flow beam. [Diagram 2] 1 shows a graph illustrating the operating phases of a flow therapy device. [Diagram 3] 1 shows a graph illustrating fitted trend lines for a patient model. [Figure 4] 1 shows a graph illustrating replicate trend lines for a patient model. [Diagram 5] 1 shows a graph illustrating the signal time difference between predicted and actual SpO2 values. [Figure 6] 1 shows a Smith Predictor being used in conjunction with a PID controller. [Figure 7] 1 shows a graph of predicted SpO2 values ​​with lag time. [Figure 8] 1 shows a graph illustrating the output of different computational models for a PID controller. [Figure 9A] 1 illustrates a process flowchart for a method of controlling operation of a flow therapy device during a flow therapy session. [Figure 9B] 1 shows a flowchart of the sub-processes for the learning phase of a flow therapy session. [Figure 9C] 1 shows a flowchart of the sub-processes for the control phase of a flow therapy session. [Figure 10] FIG. 1 is a schematic diagram of a closed loop control system. [Figure 11] 1 illustrates a process for calculating oxygen efficiency for a patient. [Figure 12] 1 shows a graph illustrating the operating phases of a flow therapy device. [Figure 13A] 1 illustrates a process flowchart for a method of controlling operation of a flow therapy device during a flow therapy session. [Figure 13B] 1 illustrates a flowchart of the sub-processes for the set-up phase of a flow therapy session. [Figure 13C] 1 shows a flowchart of the sub-processes for the control phase of a flow therapy session. [Figure 14] 1 is a perspective view of a first underside of a main housing of a flow therapy device showing an interior recess of the housing for a motor and / or sensor module subassembly. [Figure 15] FIG. 13 is a perspective view of a second underside of the main housing of the flow therapy device showing a recess for a motor and / or sensor module subassembly. [Figure 16] FIG. 13 is a perspective view of the motor and / or sensor subassembly on the underside of the main housing and fixed elbow of the flow therapy device. [Figure 17] FIG. 1 is an exploded perspective view of components of a motor and / or sensor subassembly, shown generally by the arrows showing gas flow paths through the subassembly. [Figure 18] FIG. 13 is a view of the underside of the cover and sensing PCB of the motor and / or sensor subassembly showing the location of the sensors. [Figure 19] A rear perspective view of a flow therapy device shown in cross section adjacent the rear edge of the device, showing the arrangement of a portion of the main housing that provides a recess for receiving a motor and / or sensor subassembly. [Figure 20] FIG. 1 illustrates a left front perspective view of a flow therapy device. [Figure 21] FIG. 1 illustrates a left front perspective view of a flow therapy device. [Figure 22] FIG. 2 is a partially cutaway front left perspective view showing the valve module and the filter module. [Diagram 23] 1 is a schematic diagram of the gas flow paths for the filter and valve modules, where the solid arrows represent oxygen (or other gas) flow and the dashed arrows represent ambient air flow. [Figure 24] FIG. 2 is a cross-sectional view showing the gas flow path through the filter module and the valve module. [Diagram 25] FIG. 2 is a rear overhead perspective view of the valve module in a first configuration. [Figure 26]FIG. 2 is a rear overhead perspective view showing the gas flow paths through the valve module in a first configuration, with solid arrows representing oxygen (or other gas) flow and dashed arrows representing ambient air flow. [Figure 27] FIG. 2 is a cross-sectional view through a valve module in a first configuration. [Figure 28] FIG. 2 is a cross-sectional view showing the coupling of valves and valve manifolds of a valve module in a first configuration and the gas flow paths therethrough. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0403] Patients suffering from a variety of health conditions and diseases may benefit from oxygen therapy. For example, patients suffering from chronic obstructive pulmonary disease (COPD), pneumonia, asthma, bronchopulmonary dysplasia, heart failure, cystic fibrosis, sleep apnea, lung disease, trauma to the respiratory system, acute respiratory distress, receiving pre- and post-operative oxygenation, and other conditions or diseases may benefit from oxygen therapy. A common way to treat such problems is to prevent the patient's blood oxygen saturation (SpO2) from dropping too low (e.g., below about 90%) by providing the patient with supplemental oxygen. However, providing too much oxygen to the patient can over-oxygenate the blood, which is also considered dangerous. Generally, the patient's SpO2 is kept in the range of about 80% to about 99% and preferably about 92% to about 96%, although these ranges may vary depending on the patient's condition. Due to various factors such as respiratory rate, lung tidal volume, heart rate, activity level, height, weight, age, gender, and other factors, there is no one prescribed supplemental oxygen level that allows for consistent achievement of a target range SpO2 response for each patient. The percentage of oxygen delivered to each patient (FdO2) must be periodically monitored and adjusted to ensure that each individual patient is receiving an accurate FdO2 to achieve the target SpO2. Achieving an accurate and consistent SpO2 is a key element in treating patients with various health conditions or diseases. Additionally, patients suffering from these health problems may find benefit from a system that automatically controls oxygen saturation. The present disclosure is applicable to a variety of patients who require rapid and accurate oxygen saturation control.

[0404] The percentage of oxygen delivered to the patient (FdO2) may be manually controlled. A clinician may manually adjust an oxygen delivery valve to change the flow rate or percentage of oxygen being delivered to the patient. A clinician may determine the patient's SpO2 level using a patient monitor, such as a pulse oximeter. The clinician may continue to manually adjust the amount of oxygen delivered to the patient until the patient's SpO2 level reaches the determined level.

[0405] One problem with current methods is that when a clinician is attempting to achieve a particular SpO2 level, the clinician must change the FdO2, wait for the SpO2 reading to settle, and then make another change to FdO2 until the SpO2 is at the desired level. The repeated process of changing the FdO2 and waiting for the SpO2 to settle can become a significantly time consuming process, especially when multiple patients require the same treatment.

[0406] Another issue is the accuracy of SpO2 that can be achieved. The accuracy of SpO2 control can depend on how fine the increments are for the displayed SpO2 and the selectable FdO2. Accuracy can be hindered by the longer time required to obtain increasingly accurate values, since a clinician may determine that no further changes to FdO2 are necessary once the ideal SpO2 is approached.

[0407] Another problem is that other factors may change a patient's SpO2 level over time, even if there is no change in FdO2. Patients need to be checked periodically and FdO2 adjusted to maintain the SpO2 at the correct value. This process can be quite time consuming for clinicians. Furthermore, if too long a time passes between adjustments, the patient may be at risk for the SpO2 to deviate too far from the target level.

[0408] There are several systems that attempt to do something similar, but many of them face additional problems due to the difficulty in measuring a patient's oxygen saturation. Pulse oximeters and similar devices produce signals that correspond with significant delays to changes in the percentage of oxygen delivered. Furthermore, oxygen saturation readings can be inaccurate due to a variety of factors.

[0409] The present disclosure provides closed-loop control of a flow therapy device that allows the patient or clinician to set a target SpO2 instead of a target FdO2. The flow therapy device can automatically change the FdO2 of the flow therapy device to achieve the target SpO2 based on the target SpO2, current SpO2, and current FdO2 values. Automatically controlling the FdO2 can help quickly and accurately adjust the FdO2 until the target SpO2 is achieved. In some configurations, the system can generate a patient-specific model for each patient that begins a therapy session. The flow therapy device can have higher accuracy in achieving the target SpO2 by adjusting the FdO2 as needed to stay within the target SpO2 range without constant monitoring by the clinician.

[0410] The present disclosure provides flow therapy devices capable of implementing one or more closed loop control systems, the features of which may be combined with the features of one or more of the configurations disclosed herein.

[0411] The flow therapy device may operate in an automatic mode or a manual mode. In the automatic mode, the controller may automatically control FdO2 based on a target FdO2 determined based on a target SpO2 and / or a measured SpO2. The valve at the oxygen inlet may be connected to a controller that may control the oxygen concentration in the gas flow based on the target FdO2. The controller may execute a control algorithm that may measure the FdO2 output by the flow therapy device. The FdO2 measurement may be performed periodically at a prescribed frequency, such as the maximum sample rate of the gas concentration sensor, or at a lower frequency, or the measurement may be performed aperiodically. The controller may continue to adjust the valve at the oxygen inlet until the measured FdO2 reaches the target FdO2. The measured FdO2 may be determined by a gas composition sensor.

[0412] In manual mode, the controller may receive a target FdO2 from a clinician or patient, for example, via a user interface. The controller may automatically control the FdO2 based on the received target FdO2. The controller may control the oxygen concentration in the gas flow by controlling the oxygen inlet valve based on the target FdO2. The controller may execute a control algorithm that may use the measured FdO2 output by the flow therapy device (e.g., by a gas composition sensor of the flow therapy device) as an input to the controller. The FdO2 measurements may be taken periodically at a prescribed frequency, such as the maximum sample rate of the gas concentration sensor, or at a lower frequency, or the measurements may be taken aperiodically. The controller may continue to adjust the valve at the oxygen inlet to drive the measured FdO2 toward the target FdO2. The measured FdO2 may be determined by a gas composition sensor.

[0413] The flow therapy device may be configured to change from automatic mode to manual mode when the patient's SpO2 is not within the patient's tolerance range. Optionally, the flow therapy device returns to manual mode when the patient's SpO2 is outside (above or below) the patient's limits or if the patient's SpO2 does not move within the limits within a defined period of time after the start of a therapy session. The flow therapy device may return to manual mode when the patient sensor's signal quality falls below a threshold level for a defined period of time. In some configurations, the flow therapy device may trigger an alarm when switching from automatic mode to manual mode. In some configurations, the flow therapy device may trigger an alarm when the patient sensor's signal quality falls below a threshold level for a defined period of time. After the alarm is triggered, the flow therapy device may continue to function in automatic mode. The flow therapy device may provide the user with the option to disable the alarm or exit automatic mode via a graphical user interface.

[0414] In automatic mode, the controller may utilize two control loops. A first control loop may determine a target FdO2 based on the target SpO2. A second control loop may output an oxygen inlet valve control signal using the target FdO2 output by the first control loop and the measured FdO2. In manual mode, the controller may only use the second control loop, which may receive a target FdO2 output or a default value from a user input.

[0415] During a high-flow therapy session, the oxygen concentration measured by the device, the fraction of oxygen delivered (FdO2), can be substantially the same as the oxygen concentration when the user is breathing, the fraction of inspired oxygen (FiO2), when the flow rate of the delivered gas meets or exceeds the patient's peak inspiratory demand. This means that the amount of gas delivered by the device to the patient during inspiration meets or exceeds the amount of gas inhaled by the patient during inspiration. High-flow therapy helps prevent the inhalation of ambient air when the patient inhales and the flushing of the patient's airway by exhalation. As long as the flow rate of the delivered gas meets or exceeds the patient's peak inspiratory demand, the inhalation of ambient air is prevented and the gas delivered by the device, FdO2, is substantially the same as the gas the patient inhales, FiO2.

[0416] Flow Therapy Device A flow therapy device 10 is shown in FIG. 1A. The device 10 may include a main housing 100 enclosing a flow generator 11 in the form of a motor / impeller arrangement (e.g., a blower), an optional humidifier 12, a controller 13, and a user interface 14 (e.g., including a display and one or more input devices such as one or more buttons, a touch screen, etc.). The controller 13 may be configured or programmed to control the operation of the device. For example, the controller may control components of the device including, but not limited to, operating the flow generator 11 to generate a flow of gas (gas flow) for delivery to a patient, operating the humidifier 12 (if present) to humidify and / or heat the generated gas flow, controlling the flow of oxygen to the blower of the flow generator, receiving user input from the user interface 14 for reconfiguration and / or user-defined operation of the device 10, and outputting information (e.g., on a display) to a user. The user may be a patient, a health care professional, or any other person interested in using the device. As used herein, "gas flow" may refer to any gas flow that may be used in a respiratory assistance or breathing apparatus, such as an ambient air flow, a flow containing substantially 100% oxygen, a gas flow containing some combination of ambient air and oxygen, etc.

[0417] The patient breathing conduit 16 is coupled at one end to a gas outlet 21 of the housing 100 of the flow therapy device 10. The patient breathing conduit 16 is coupled at another end to a patient interface 17, such as a non-sealing nasal cannula with a manifold 19 and nasal prongs 18. Additionally or alternatively, the patient breathing conduit 16 may be coupled to a face mask, a nasal mask, a nasal pillow mask, an endotracheal tube, a tracheotomy interface, or the like. The gas flow generated by the flow therapy device 10 may be humidified and delivered to the patient through the cannula 17 via the patient conduit 16. The patient conduit 16 may have a heater wire 16a for heating the gas flow passing through the patient. The heater wire 16a may be under the control of the controller 13. The patient conduit 16 and / or the patient interface 17 may be considered part of the flow therapy device 10 or alternatively as its peripherals. The flow therapy device 10, the breathing conduit 16 and the patient interface 17 together may form a flow therapy system.

[0418] The controller 13 may control the flow generator 11 to generate a gas flow at a desired rate. The controller 13 may also control a supplemental oxygen inlet to allow for the supply of supplemental oxygen, the humidifier 12 (if present) may humidify and / or heat the gas flow to an appropriate level, etc. The gas flow is directed to the patient through a patient conduit 16 and a cannula 17. The controller 13 may also control a heating element in the humidifier 12 and / or a heating element 16a in the patient conduit 16 to heat the gas to a desired temperature for a desired level of therapy and / or patient comfort. The controller 13 may be programmed with or may determine a suitable target temperature for the gas flow.

[0419] The oxygen inlet port 28 includes a valve through which pressurized gas may enter the flow generator or blower. The valve may control the flow of oxygen into the blower of the flow generator. The valve may be any type of valve, such as a proportional valve or a binary valve. The oxygen source may be an oxygen tank or a hospital oxygen source. Medical grade oxygen is generally 95% to 100% pure. Lower purity oxygen sources may also be used. Examples of valve modules and filters are disclosed in U.S. Provisional Patent Application No. 62 / 409,543, entitled "Valve Modules and Filter," filed October 18, 2016, and U.S. Provisional Patent Application No. 62 / 488,841, entitled "Valve Modules and Filter," filed April 23, 2017, both of which are incorporated herein by reference in their entireties. Valve modules and filters are described in more detail below with reference to Figures 17-25.

[0420] The flow therapy device 10 can measure and control the oxygen content of the gas being delivered to the patient, and therefore the oxygen content of the gas inhaled by the patient. During high flow therapy, the high flow rate of gas delivered meets or exceeds the patient's peak inhalation demand. This means that the amount of gas delivered by the device to the patient during inspiration meets or exceeds the amount of gas inhaled by the patient during inspiration. Thus, high flow therapy helps prevent the inhalation of ambient air when the patient inhales and the flushing of the patient's airway by exhalation. As long as the flow rate of delivered gas meets or exceeds the patient's peak inhalation demand, the inhalation of ambient air is prevented, and the gas delivered by the device is substantially the same as the gas inhaled by the patient. As such, the oxygen concentration measured by the device, the fraction of oxygen delivered (FdO2), will be substantially the same as the oxygen concentration the user inhales, the fraction of inspired oxygen (FiO2), and as such, both terms can be considered equivalent.

[0421] Operational sensors 3a, 3b, 3c, such as flow, temperature, humidity and / or pressure sensors, may be located at various locations within the flow therapy device 10. Additional sensors (e.g., sensors 20, 25) may be located at various locations on the patient conduit 16 and / or cannula 17 (e.g., there may be a temperature sensor 29 at or near the end of the inspiratory tube). Output from the sensors may be received by the controller 13 to assist the controller in operating the flow therapy device 10 to provide a suitable therapy. In some configurations, providing a suitable therapy includes being at the peak inspiratory demand of the patient. The device 10 may have a transmitter and / or receiver 15 that enables the controller 13 to receive signals 8 from the sensors and / or control various components of the flow therapy device 10 or accessories or peripherals associated with the flow therapy device 10, including, but not limited to, the flow generator 11, the humidifier 12 and the heater wire 16a. Additionally or alternatively, the transmitter and / or receiver 15 may provide data to a remote server or enable remote control of the device 10 .

[0422] Oxygen may be measured after mixing of the oxygen with ambient air is complete by placing one or more gas composition sensors (e.g., an ultrasonic transducer system, also called an ultrasonic sensor system) in the device, in the supply conduit, in the patient interface, or at any other suitable point.

[0423] The oxygen concentration may also be measured by using flow sensors in at least two of the ambient air inlet conduit, the oxygen inlet conduit, and the final supply conduit to determine the flow rates of at least two gases. By determining the flow rates of both inlet gases or the flow rate of one inlet gas and the total flow rate of one in conjunction with the assumed or measured oxygen concentration of the inlet gases (approximately 20.9% for ambient air and approximately 100% for oxygen), the oxygen concentration of the final gas composition may be calculated. Alternatively, flow sensors may be placed in all three of the ambient air inlet conduit, the oxygen inlet conduit, and the final supply conduit, allowing for redundancy and testing that each sensor is working correctly by checking for consistency of readings. Other methods of measuring the oxygen concentration delivered by the flow therapy device 10 may also be used.

[0424] The flow therapy device 10 may include a patient sensor 26 or patient monitoring system, such as a pulse oximeter, to measure one or more physiological parameters of the patient, such as the patient's blood oxygen saturation (SpO2), heart rate, respiratory rate, perfusion index, and provide an indication of signal quality. The sensor 26 may communicate with the controller 13 by a wired connection or communication with a wireless transmitter in the sensor 26. The sensor 26 may be a disposable adhesive sensor designed to be connected to the patient's finger. The sensor 26 may be a non-disposable sensor. Sensors are available designed for different age groups and connected to different locations on the patient and may be used with the flow therapy device. The pulse oximeter is attached to the user, typically the user's finger, although other locations, such as the earlobe, are also options. The pulse oximeter is connected to a processor within the device and constantly provides a signal indicative of the patient's blood oxygen saturation. The patient sensor 26 may be a hot-swappable device and may be attached or replaced during operation of the flow therapy device 10. For example, the patient sensor 26 may be connected to the flow therapy device 10 using a USB interface or using a wireless communication protocol (e.g., near field communication, WiFi, or Bluetooth, etc.). If the patient sensor 26 is disconnected during operation, the flow therapy device 10 may continue to operate in its previous operating state for a defined period of time. After the defined period of time, the flow therapy device 10 may trigger an alarm, transition from an automatic mode to a manual mode, and / or exit a control mode (e.g., automatic or manual mode) entirely. The patient sensor 26 may be a bedside monitoring system or other patient monitoring system that communicates with the flow therapy device 10 by a physical or wireless interface.

[0425] The flow therapy device 10 may include a high-flow therapy device. As used herein, "high-flow" therapy refers to the administration of gas to a patient's airways at a relatively high flow rate that meets or exceeds the patient's peak inspiratory demand. The flow rate used to achieve "high flow" may be any of the flow rates listed below. For example, in some configurations, for an adult patient, "high-flow therapy" may refer to the delivery of gas to a patient at a flow rate of about 10 liters per minute (10 LPM) or greater, such as from about 10 LPM to about 100 LPM, or from about 15 LPM to about 95 LPM, or from about 20 LPM to about 90 LPM, or from about 25 LPM to about 75 LPM, or from about 25 LPM to about 85 LPM, or from about 30 LPM to about 80 LPM, or from about 35 LPM to about 75 LPM, or from about 40 LPM to about 70 LPM, or from about 45 LPM to about 65 LPM, or from about 50 LPM to about 60 LPM. In some configurations, for neonatal, infant or pediatric patients, "high flow therapy" may refer to the delivery of gas to the patient at a flow rate of greater than 1 LPM, such as from about 1 LPM to about 25 LPM, or from about 2 LPM to about 25 LPM, or from about 2 LPM to about 5 LPM, or from about 5 LPM to about 25 LPM, or from about 5 LPM to about 10 LPM, or from about 10 LPM to about 25 LPM, or from about 10 LPM to about 20 LPM, or from about 10 LPM to 15 LPM, or from about 20 LPM to 25 LPM. For adult, neonatal, infant or pediatric patients, a high flow therapy device may deliver gas to the patient at a flow rate of from about 1 LPM to about 100 LPM or any of the subranges outlined above. The flow therapy device 10 may deliver any concentration of oxygen (e.g., FdO2) up to 100% at any flow rate from about 1 LPM to about 100 LPM. In some configurations, any of the flow rates may be combined with oxygen concentrations (FdO2) of about 20%-30%, 21%-30%, 21%-40%, 30%-40%, 40%-50%, 50%-60%, 60%-70%, 70%-80%, 80%-90%, and 90%-100%. In some combinations, the flow rates may be about 25 LPM to 75 LPM combined with oxygen concentrations (FdO2) of about 20%-30%, 21%-30%, 21%-40%, 30%-40%, 40%-50%, 50%-60%, 60%-70%, 70%-80%, 80%-90%, and 90%-100%.In some configurations, the flow therapy device 10, when operating in manual mode, may include a safety threshold that prevents the user from over-oxygenating the patient.

[0426] High flow therapy may be administered to the user's nares and / or orally or via a tracheotomy interface. High flow therapy may deliver gas to the user at a flow rate above the intended peak inspiratory flow condition of the user. High flow therapy may create a flushing effect in the nasopharynx, causing the anatomical dead space of the upper airway to be flushed with a high inflow gas flow. This may create a reservoir of fresh gas available for each breath while minimizing rebreathing of nitrogen and carbon dioxide. Demand for inspiration and flushing of the airway are even more important when trying to control the patient's FdO2. High flow therapy may be delivered by a non-sealing patient interface, such as, for example, a nasal cannula. A nasal cannula may be configured to deliver respiratory gas to the user's nares at a flow rate above the intended peak inspiratory flow condition of the user.

[0427] As used herein, the term "non-sealed patient interface" may refer to an interface that provides a pneumatic link between the patient's airway and a source of gas flow (e.g., from the flow generator 11) that does not completely occlude the patient's airway. A non-sealed pneumatic link may include less than about 95% occlusion of the patient's airway. A non-sealed pneumatic link may include less than about 90% occlusion of the patient's airway. A non-sealed pneumatic link may include between about 40% and about 80% occlusion of the patient's airway. The airway may include one or more of the patient's nostrils or mouth. In a nasal cannula, the airway is through the nares.

[0428] The flow generator or blower 11 may include an ambient air inlet port 27 that draws ambient room air into the blower. The flow therapy device 10 may also include an oxygen inlet port 28 that leads to a valve through which pressurized gas may enter the flow generator or blower 11. The valve may control the flow of oxygen to the flow generator blower 11. The valve may be any type of valve, including a proportional valve or a binary valve.

[0429] The blower may operate at a motor speed of greater than about 1,000 RPM and less than about 30,000 RPM, greater than about 2,000 RPM and less than about 21,000 RPM, or between any of the values ​​mentioned above. The operation of the blower may mix the gas entering the blower through the inlet port. Using the blower as a mixer may reduce the pressure drop that may occur in systems with separate mixers, such as static mixers that include baffles, since mixing requires energy.

[0430] 1B, a sensing circuit board 2200 is shown that may be implemented in the flow therapy device 10. The sensing circuit board 2200 may be positioned within the sensor chamber such that the sensing circuit board 2200 is at least partially immersed in the gas flow. The gas flow may flow from the blower 11 through a conduit and into a flow path in the sensor chamber. At least some of the sensors on the sensing circuit board 2200 may be positioned within the gas flow to measure properties of the gas in the flow. After passing through the flow path in the sensor chamber, the gas may flow to the humidifier 12 described above.

[0431] The sensing circuit board 2200 may be a sensing printed circuit board (PCB). Alternatively, the circuit on the board 2200 may be assembled with wires connecting electronic components rather than printed on a circuit board. At least a portion of the sensing circuit board 2200 may be mounted outside the gas flow. The gas flow may be generated by the flow generator 11 described above. The sensing circuit board 2200 may include an ultrasonic transducer 2204. The sensing circuit board 2200 may include one or more thermistors 2205. The thermistor 2205 may be configured to measure the temperature of the gas flow. The sensing circuit board 2200 may include a thermistor flow sensor 2206. The sensing circuit board 2200 may include other types of sensors, such as humidity sensors, including humidity-only sensors and combined humidity and temperature sensors used with a separate temperature sensor, sensors for measuring atmospheric pressure, sensors for measuring differential pressure, and / or sensors for measuring sensor gauge pressure. The thermistor flow sensor 2206 may include a hot wire anemometer, such as a platinum wire, and / or a thermistor, such as a negative temperature coefficient (NTC) or positive temperature coefficient (PTC) thermistor. Other non-limiting examples of heated temperature sensing elements include glass or epoxy encapsulated or unencapsulated thermistors. The thermistor flow sensor 2206 may be configured to measure the flow rate of the gas by being powered with a constant power or to maintain a constant sensor temperature or a constant temperature difference between the sensor and the gas flow.

[0432] The sensing circuit board 2200 can include a first portion 2201 and a second portion 2202. The first portion 2201 can be positioned within the gas flow path, while the second portion 2202 can be positioned outside the gas flow path. The direction of gas flow is indicated by arrow 2203 in FIG. 1B. The direction of gas flow can be straight or curved as shown in FIG. 1B.

[0433] Positioning one or more of the thermistor 2205 and / or thermistor flow sensor 2206 downstream of a combined blower and mixer may take into account the heat supplied to the gas flow from the blower, and immersing a temperature-based flow sensor in the flow path may increase measurement accuracy since a sensor immersed in the flow may be more likely to be exposed to the same conditions, e.g., temperature, as the gas flows, and therefore may provide a better indication of the gas properties.

[0434] The sensing circuit board 2200 may include an ultrasonic transducer, transceiver, or sensor for measuring a gas property of a gas flow, such as the gas composition or concentration of one or more gases in a gas stream. Any suitable transducer, transceiver, or sensor may be mounted on the sensing circuit board 2200, as will be appreciated. In this configuration, the sensing circuit board includes an ultrasonic transducer system (also referred to as an ultrasonic sensor system) that utilizes ultrasonic or sound waves to determine gas concentration. Various sensor configurations are described below with reference to Figures 1C-1F.

[0435] The ultrasonic transducer system may determine the relative gas concentrations of two or more gases in a gas stream. The ultrasonic transducer system may be configured to measure the oxygen fraction in a bulk gas stream consisting of atmospheric air supplemented with supplemental oxygen, which is essentially a binary gas mixture of nitrogen (N2) and oxygen (O2). It is also understood that the ultrasonic transducer system may be configured to measure the gas concentrations of other supplemental gases blended with atmospheric air in the gas stream, including nitrogen (N2) and carbon dioxide (CO2). The ultrasonic transducer may determine the gas concentrations of gases in the gas stream at relatively high frequencies. For example, the ultrasonic transducer may output measured FdO2 values ​​at a maximum sample rate of the sensor or at frequencies lower than the maximum sample rate, such as about 1 Hz to 200 Hz, about 1 Hz to 100 Hz, about 1 Hz to 50 Hz, and about 1 Hz to 25 Hz.

[0436] In some configurations, the sensing circuit board 2200 includes a pair of ultrasonic transducers disposed on opposite sides of the sensing circuit board. Various alternative configurations of ultrasonic transducers can be used to sense properties of the gas stream by transmitting and receiving ultrasonic beams or pulses.

[0437] The distance between the ultrasonic transducers 2204 at both ends of the sensing circuit board 2200 may affect the measurement resolution. Generally, the actual measured length has a certain amount of error, and as the length increases, the percentage of error generated during the measurement is less than that for a shorter length, so increasing the distance between each of the ultrasonic transducers 2204 may reduce the proportional or partial error. Thus, the overall uncertainty of the measurement is reduced. Increasing the distance may also increase the measurement resolution and accuracy, since the acoustic signal between the ultrasonic transducers 2204 may be of a longer duration. However, as the distance increases, the signal may become weaker.

[0438] The ultrasonic transducers 2204 may be positioned such that the space between them at least partially coincides with the flow path. In some configurations, the ultrasonic transducers are positioned at opposing ends of the sensing circuit board. The entire face of the flow path is exposed to the acoustic path so that the sound waves propagate through all the gas in the flow path. Wave averaging may occur over the entire flow path rather than just one section of the flow path. Averaging over a longer distance reduces error and reduces dependency on air-oxygen mixing. The ultrasonic transducers may be configured to measure the gas properties from either angle relative to the flow path.

[0439] Positioning sensors within the flow path or module instead of outside the flow path or module allow both of the transducers 2204 to operate within a smaller temperature range relative to each other or both at substantially one temperature (i.e., the temperature of the gas flow). Because the transducers are temperature sensitive, making them a substantially homogenous temperature increases accuracy. Additionally, positioning sensors along the flow path allow measurements and calculations that account for the effect of gas velocity so that the effect of gas velocity can be removed from the sensor measurements.

[0440] The ultrasonic transducer system is configured as an ultrasonic binary gas sensing system. Binary gas analysis using ultrasound is based on sensing the velocity of an acoustic pulse through a gas sample, which in this case is the bulk or primary flow of a gas stream flowing through a sensing passage of a sensor housing. The speed of sound is a function of the average molecular weight of the gas and the temperature. The system can receive a sensor signal indicative of the temperature of the gas flowing between the beam paths between the ultrasonic transducers. Knowing the sensed speed of sound and the sensed temperature, the gas composition in the gas stream can be determined or calculated. In particular, the measurement of the speed of sound across the sensing passage can be used to infer the ratio of two known gases by referencing stored data in the form of empirical relationships, standard algorithms, or look-up tables, as is known in the field of ultrasonic binary gas analysis. It is understood that an estimate of the temperature of the gas stream in the beam path of the ultrasonic transducer can instead be used in the calculation of the binary gas analysis when no temperature sensor is utilized. In such an alternative embodiment, the temperature of the gas stream can be regulated or controlled within a narrow temperature band, allowing an estimate of the temperature of the gas stream in the beam path to be used.

[0441] In some configurations, the flow therapy device may also include a humidity sensor disposed in the flow path and configured to generate a humidity signal indicative of the humidity of the gas stream flowing through the sensor assembly. In such embodiments, the gas composition may be determined by the sensed speed of sound and the sensed temperature and / or the sensed humidity. The humidity sensor may be a relative humidity sensor or an absolute humidity sensor. In some embodiments, the gas composition may be determined based on the sensed speed of sound and the sensed humidity without the need for a temperature sensor.

[0442] Ultrasonic transducer systems can be used to measure the respective ratios of any two known gases in a gas composition. Ultrasonic transducer systems can determine the relative gas concentrations in a mixture of air blended with supplemental oxygen, which is substantially equivalent to a nitrogen / oxygen mixture. In such a binary gas mixture, by monitoring the speed of sound and taking into account the temperature, the average molecular weight of the gas can be determined, and therefore the relative concentrations of the two gases. From this ratio, the oxygen or nitrogen percentage of the gas stream can be derived.

[0443] 1C-1F, various configurations of ultrasonic transducers are described for a gas composition sensing system for sensing the speed of sound through a gas stream by transmitting and receiving ultrasonic beams or pulses, with like reference numerals representing like components.

[0444] 1C, the transducer configuration 2300 provides an arrangement in which there is a pair of transducers 2302, 2304 positioned opposite each other and on opposite sides of a sensing passage 2306, generally indicating the direction of the gas flow path at 2308. In this configuration, each of the transducers 2302, 2304 is driven as either a dedicated transmitter or receiver such that ultrasonic pulses 2310 are transmitted unidirectionally across the gas flow path from the transmitter to the receiver transducer. As shown, the transducer pairs are aligned with the air flow path direction 2308 (i.e., not displaced upstream or downstream from each other) and are configured to transmit cross flow pulses that are substantially perpendicular to the gas flow path direction.

[0445] 1D, an alternative transducer configuration 2320 is shown in which a pair of transducers 2322, 2324 are provided facing each other on opposite sides of a sensing passage, but each transducer can act as both a transmitter and a receiver (i.e., the transducers are ultrasonic transmitter-receivers, or transceivers). In this configuration, a bidirectional ultrasonic pulse 2326 can be sent between the transducer pair 2322, 2324. For example, the pulses can be sent back and forth between the transducers, or in any other sequence or pattern. Again, the transducer pair is aligned with the gas flow path direction and configured to send cross-flow pulses that are substantially perpendicular to the gas flow path direction.

[0446] 1E, an alternative transducer configuration 2360 is shown having a pair of opposing transducers 2362, 2364 at opposite ends of a sensing passage 2306 with a gas flow path direction or axis generally indicated by 2308. In this configuration 2360, each of the transducers 2362, 2364 is driven as either a dedicated transmitter or receiver such that a flow-along ultrasonic pulse 2366 is transmitted unidirectionally in a beam path between the transmitter and receiver that is substantially aligned with or parallel to the gas flow path axis 2308 in the sensing passage 2306. In the illustrated embodiment, the transmitter is upstream of the receiver, although it will be understood that the opposite arrangement can also be utilized. In this configuration, a flow sensor is provided in the sensing passage to provide a flow signal indicative of the flow rate of the gas stream in the sensing passage. It is understood that the speed of sound in the sensing passage can be derived or determined in a similar manner as described above, and the flow signal is used in signal processing to remove or compensate for the gas flow rate in the calculated speed of sound signal.

[0447] Referring to FIG. 1F, an alternative transducer configuration 2370 is shown in which a pair of transducers 2372, 2374 are provided facing each other at opposite ends of the sensing passage as in FIG. 1E, but each transducer can act as both a transmitter and a receiver, i.e., an ultrasonic transmitter-receiver, i.e., a transceiver. In this configuration, along-flow ultrasonic pulses 2376 can be sent bidirectionally between the transducer pairs 2372 and 2374. For example, the pulses can be sent back and forth between the transducers, or in any other sequence or pattern. Again, the transducer pairs are aligned with the gas flow path axis 2308 and configured to transmit along-flow pulses in one or more beam paths substantially aligned with or parallel to the gas flow path axis 2308 in the sensing passage 2306. In this configuration, a separate flow sensor need not necessarily be provided, as the flow component of the sound speed signal can be derived or determined directly from processing of the transmitted and received acoustic pulses.

[0448] Some examples of flow therapy devices are disclosed in International Application No. PCT / NZ2016 / 050193, filed December 2, 2016, entitled "Flow Path Sensing for Flow Therapy Apparatus," and International Application No. PCT / IB2016 / 053761, filed June 24, 2016, entitled "Breathing Assistance Apparatus," both of which are incorporated by reference in their entireties. Aspects of the present disclosure and example configurations of flow therapy devices that may be used are described in further detail below with respect to Figures 11-16.

[0449] Control System 1A, the controller 13 may be programmed or configured to implement a closed loop control system to control the operation of the flow therapy device. The closed loop control system may be configured to ensure that the patient's SpO2 reaches and consistently remains at or near a target level.

[0450] The controller 13 may receive one or more inputs from the user, which may be used by the controller 13 to implement a closed-loop control system. The target SpO2 value may be a single value or a range of values. The one or more values ​​may be preset or selected by the clinician or determined based on the type of patient, where the type of patient may refer to current pain and / or information about the patient, such as age, weight, height, sex and other patient characteristics. Similarly, the target SpO2 may be two values, each selected in any of the ways described above. The two values ​​represent a range of acceptable values ​​for the patient's SpO2. The controller may target a value within said range. The target value may be the midpoint of the range or any other value within the range, which may be preset or selected by the user. Alternatively, the range may be automatically set based on the target value of SpO2. The controller may be configured to make one or more set reactions when the patient's SpO2 value moves outside the range. The reactions may include raising an alarm, changing the FdO2 to manual control, changing the FdO2 to a particular value, and / or other reactions. The controller may have one or more ranges, where moving outside of each range produces one or more different reactions.

[0451] The graphical user interface of the flow therapy device may be configured to prompt the user to input a patient type, and the SpO2 limits are determined based on what the user selects. Additionally, the user interface may include a custom option that allows the user to define the limits.

[0452] Typically, SpO2 is controlled at about 80% to about 100%, or about 80% to about 90%, or about 88% to about 92%, or about 90% to about 99%, or about 92% to about 96%. SpO2 may be controlled between any two suitable values ​​from any two of the ranges described above. The target SpO2 may be about 80% to about 100%, or about 80% to about 90%, or about 88% to about 92%, or about 90% to about 99%, or about 92% to about 96%, or about 94%, or 94% or about 90%, or 90%, or about 85%, or 85%. The SpO2 target may be any value between any two suitable values ​​from any two of the ranges described above. The SpO2 target may correspond to the middle of the SpO2 for the defined range.

[0453] FdO2 may be configured to be controlled within a range. As previously mentioned, the oxygen concentration measured in the device (FdO2) is substantially the same as the oxygen concentration (FiO2) breathed by the patient as long as the flow rate meets or exceeds the patient's peak inspiratory demand, and as such, both terms may be considered equivalent. Each of the range limits may be pre-set, selected by the user, or determined based on the type of patient, where the type of patient may refer to current pain and / or information about the patient, such as age, weight, height, sex, and / or other patient characteristics. Alternatively, a single value for FdO2 may be selected, and the range may be determined at least in part based on this value. For example, the range may be a set amount above and below the selected FdO2. The selected FdO2 may be used as a starting point for the controller. The system may have one or more reactions if the controller attempts to move the FdO2 out of range. These responses may include raising an alarm, preventing attempts to move the FdO2 out of range, switching to manual control of the FdO2, and / or switching to a particular FdO2. The device may have one or more ranges, where reaching the limits of each range produces one or more different responses.

[0454] FdO2 may be controlled at about 21% to about 100%, or about 21% to about 90%, or about 21% to about 80%, or about 21% to about 70%, or about 21% to about 60%, or about 21% to about 50%, or about 25% to about 45%. FdO2 may be controlled between any two suitable values ​​from any two ranges described above. The FdO2 target may be between any two suitable values ​​from any two ranges described above. If the range is based on a single value, the upper and lower limits may be determined by adding / subtracting a certain amount to the selected value. The amount added or subtracted may be about 1%, or about 5%, or about 10%, or about 15%, or about 20%, or about 30%, or about 50%, or about 100%. The amount added / subtracted may vary relative to the selected value. For example, the upper limit can be 20% higher than the selected value, so that at a selected value of 50%, FdO2 has an upper limit of 60% for the control range. The percentages used for the ranges can be about 1%, or about 5%, or about 10%, or about 15%, or about 20%, or about 30%, or about 50%, or about 100%. The methods for calculating the lower and upper limits do not necessarily have to be the same. If a single value is used, the value can be about 21% to about 100%, or about 25% to about 90%, or about 25% to about 80%, or about 25% to about 70%, or about 25% to about 60%, or about 25% to about 50%, or about 25% to about 45%.

[0455] The graphical user interface 14 (GUI) may be configured to display a range of values ​​within which FdO2 and / or SpO2 are controlled. The range may be displayed by having two limits set apart from one another on the GUI with an indicator appearing within the range graphically showing the location of the current value relative to the limits of the range.

[0456] The GUI may display graphs of recent FdO2 and / or SpO2 data. The GUI may display the levels of each parameter over a defined period of time, such as an hour or more, in the same or different graphs. The length of time that the data is displayed may be adapted to the length of time that the data is currently available.

[0457] The displayed FdO2 data may be at least one of a target FdO2 or a measured FdO2. The SpO2 data may include a line indicating a target SpO2. Additionally or alternatively, the SpO2 and / or FdO2 data may include one or more lines or shaded portions indicating their respective control limits.

[0458] The graphs may be displayed on the default display. Alternatively, the graphs may be hidden with only the current data values ​​shown. The graphs are made available through interaction with the GUI, such as by selecting to view a graph for a defined parameter.

[0459] Closed Loop Control Referring to FIG. 10, a schematic diagram of a closed loop control system 1000 is shown. The closed loop control system may utilize two control loops. The first control loop may be implemented by an SpO2 controller. The SpO2 controller may determine a target FdO2 based in part on a target SpO2 and / or a measured SpO2. As discussed above, the target SpO2 value may be a single value or a range of acceptable values. The one or more values ​​may be pre-set or selected by a clinician or may be automatically determined based on client characteristics. Generally, the target SpO2 value may be received or determined before or at the beginning of a treatment session, although the target SpO2 value may be received at any time during a treatment session. During a treatment session, the SpO2 controller may also receive as inputs one or more measured FdO2 readings from a gas composition sensor and one or more measured SpO2 readings from a patient sensor and one or more signal quality readings. In some configurations, the SpO2 controller may receive the target FdO2 as an input, in which case the output of the SpO2 controller may be provided directly back to the SpO2 controller as an input. Based at least in part on the input, the SpO2 controller may output the target FdO2 to the second control loop.

[0460] The second control loop may be implemented by an FdO2 controller. The FdO2 controller may receive inputs of measured FdO2 and target FdO2. The FdO2 controller may then output an oxygen inlet valve control signal to control the operation of the oxygen valve based on the difference between these measured FdO2 and target FdO2 values. The FdO2 controller may receive the target FdO2 value output from the first control loop when the flow therapy device is operating in automatic mode. The FdO2 controller may also receive additional parameters such as flow rate values, gas properties and / or measured FdO2. The gas properties may include the temperature of the gas at the O2 inlet and / or the oxygen content of the source. The gas source connected to the oxygen inlet valve may be an oxygen-enriched gas stream, where the oxygen content of the source may be less than pure oxygen (i.e., 100%). For example, the oxygen source may be an oxygen-enriched gas stream having an oxygen content less than 100% and greater than 21%.

[0461] From at least some of the inputs, the FdO2 controller can determine the oxygen flow rate required to achieve the target FdO2. The FdO2 controller can use the flow rate input to modify the valve control signal. If the flow rate changes, the FdO2 controller can automatically calculate the new required oxygen flow rate required to maintain the target FdO2 at the new flow rate without having to wait for feedback from a gas concentration sensor, e.g., a measured FdO2 value. The FdO2 controller can then output a modified valve control signal to control the valve based on the new flow rate. In some configurations, the control signal of the FdO2 controller can set the current of the oxygen valve to control the operation of the oxygen valve. Additionally or alternatively, the FdO2 controller can detect changes in the measured FdO2 and modify the valve position accordingly. During manual mode, the second control loop can operate independently without receiving a target FdO2 from the first control loop. Rather, the target FdO2 can be received from a user input or a default value.

[0462] During the therapy session, the SpO2 and FdO2 controllers may continue to automatically control the operation of the flow therapy device until the therapy session ends or until an event triggers a change from automatic mode to manual mode.

[0463] Closed-loop control using a patient model FIG. 2 provides a graph 200 of SpO2 and FdO2 illustrating multiple phases of operation of a flow therapy device during a treatment session. Although FdO2 (percentage of oxygen delivered) is used in the graph, as previously mentioned, FdO2 is substantially the same as FiO2 as long as the flow rate meets or exceeds the patient's peak inspiratory demand. The operation phases include a learning phase 210 and a control phase 220. During the learning phase, the controller generates a patient-specific model. Due to differences between individual patients, there may be differences in how each patient's SpO2 responds to changes in FdO2. As a result, a patient-specific model may be generated to better control the patient's SpO2. The learning phase 210, also referred to as a model building phase, may include a waiting stage 212, a feedforward stage 214, and a model generation or patient characterization stage 216. The patient characterization stage occurs simultaneously with at least a portion of the feedforward stage 214. During the patient characterization phase, the patient-specific model may be iteratively developed as data is collected during the feedforward stage 214. The learning phase is complete after the generation of the patient-specific model. After the learning phase, the flow therapy device operates in the control phase until the end of the treatment session. As described below, the flow therapy device may be configured to return to the learning phase during the treatment session. In some configurations, the learning phase is optional, and the patient-specific model may be generated without a defined learning phase. For example, in such configurations, a default model may be used initially. Thus, the default model may be updated to the patient-specific model during the treatment session. The patient-specific model may be updated at defined intervals, at defined events, periodically, aperiodically, and / or continuously during the treatment session.

[0464] Learning Phase When the flow therapy device is first powered on, it may start in manual or automatic mode. If the device is in manual mode, it may be switched to automatic mode. When starting in automatic mode or when switched to automatic mode, the flow therapy device may begin with a treatment session after the user provides one or more operating settings (e.g., FdO2 limit, SpO2 limit, flow rate, etc.). When this session begins, the controller may begin a wait stage 212. During the wait stage 212, the position of the oxygen inlet valve is based on the FdO2 setting before the start of the learning phase, which may result in the valve remaining in the same position or a change in the valve position (e.g., open or closed). The patient's SpO2 may change in response to the high-flow therapy. The controller may wait until the SpO2 stabilizes and settles to a fairly constant value before proceeding to the feedforward stage 214. The wait stage 212 may last for a defined period of time. The controller may be configured to begin the feedforward stage 214 without the wait stage 212.

[0465] During the feedforward stage 214, the controller may change the level of FdO2, for example, raising or lowering the level. The new FdO2 value may be preset or determined based on factors such as the patient's current SpO2. The new FdO2 may be selected by a clinician, who selects the FdO2 based on the clinician's own experience and knowledge. The selected FdO2 may bring the patient's SpO2 closer to a target SpO2 level. The FdO2 may be automatically determined by the controller 13.

[0466] During the feedforward stage 214, the controller measures and records the patient's SpO2. The controller can measure and record FdO2. A graph shows a step change in FdO2 to the target FdO2 value. The actual FdO2 can rise to the target FdO2 over a defined period of time. With respect to SpO2 and FdO2, the actual measured data can be incorporated into the evaluation and generation of a model of the relationship between SpO2 and FdO2. Signal quality indicators from the patient sensor 26 can also be recorded.

[0467] The feedforward stage 214 may last for at least a defined minimum period of time and may automatically terminate after a defined maximum period of time. In some configurations, the minimum period of time may be about 30 seconds, about 1 minute, about 2 minutes, 3 minutes, or another value within the values ​​mentioned above. The maximum period of time may be about 3 minutes, about 4 minutes, about 5 minutes, about 6 minutes, or another value within the values ​​mentioned above. The minimum and maximum values ​​may be a combination of any two suitable values ​​mentioned above. After the minimum period of time, the controller may determine whether the patient is sufficiently characterized based on an analysis of the defined patient characterization criteria. If the patient is not sufficiently characterized and the maximum period of time is reached, the feedforward stage terminates and the control phase is initiated using a default patient model. The default model may depend on the patient type (e.g., normocapnic, hypercapnic, user-defined, or other type). The default patient model may be based, at least in part, on one or more of the received characteristics of the patient. Reasons for failure to characterize a patient are explained in more detail below.

[0468] During the feedforward stage 214, the controller may analyze the relationship between FdO2 and SpO2. The controller may be configured to model the relationship using an exponential decay function, where the exponential decay constant is varied to best fit the model to the data. The initial and final FdO2 values ​​used in the exponential decay function may be set by the initial and final target FdO2 values. Fitting the model to the FdO2 data allows for an analytical evaluation of the SpO2 model, which may be quicker and less computationally burdensome. An example of what both sets of trend fits may look like is shown in FIG. 3. Optionally, the controller may determine the relationship between the actual FdO2 and the amount of time from the change in the target FdO2.

[0469] 3, a graph 301 shows a fitted trend for an SpO2 graph 302 and an FdO2 graph 305. The graphs also include an indication of the patient monitor's signal quality 304. To fit a trend to the SpO2 data, a model may be generated that represents the behavior of the SpO2 data, and at least one constant parameter of the model may be determined. The model may correlate each change in FdO2 with a time-based change in SpO2.

[0470] After a change in FdO2, SpO2 does not show any change due to the change in FdO2 for a period of time, which may be called the lag time. The lag time is due to a combination of various factors. One possible factor is the time it takes for the device to change FdO2 and become apparently consistent. Another possible factor is the time it takes for gas to travel from the device to the interface, which may depend on the flow rate selected. Another possible factor is the time it takes for gas to travel from the user interface to the patient's lungs. This may depend on the flow rate selected, but also on the restriction of the patient's airway and the length of the passage from the interface to the patient's lungs. Another possible factor is the time it takes for oxygenated blood to travel from the patient's lungs to the measurement site (i.e., the location of the patient sensor). This depends on the speed of blood travel, which varies based on the patient's physiology and heart rate. Additionally, the length of this time may depend on the distance between the patient's lungs and the type of patient sensor used. The distance may vary depending on the location of the patient sensor. Additionally or alternatively, the distance may vary depending on the size of the patient.

[0471] After the delay time, SpO2 may show an exponential decay curve, where SpO2 asymptotically approaches a new value, where the overall change is proportional to the overall change in FdO2. In some embodiments, there are four parameters of the model that may affect its shape (in addition to the effect of the change in FdO2 supply). The first parameter is the delay time between the change in FdO2 and the first change in SpO2. The second parameter is the initial value of SpO2. The third parameter is the magnitude of the total change in SpO2 relative to the magnitude of the change in FdO2. The fourth parameter is the exponential decay rate, which defines how quickly SpO2 reaches its final value after the delay time.

[0472] Due to FdO2 changing over time, instead of showing a single change, the SpO2 model can be evaluated as an integral of the effect of various FdO2 changes over time. A model that can be used is shown below in Equation (1).

number

[0473] Equation (1) includes five parameters for the model that can be evaluated and determined when generating the model: FdO2, which is the initial FdO2 0 , initial SpO2 SpO2 0 , DT is the delay time, τ is the exponential decay constant, and a is the ratio of the change in SpO2 to FdO2. 0 can be determined from the initial target FdO2. The remaining four parameters can be varied to find the model that best fits the data.

[0474] The fit can be quantified by a method known as least squares fitting, which involves looking at each data point and calculating an error, where the error is based on the difference between that data point and an associated point on the model. The errors for each data point can be added together to give an overall value for the error for the model.

[0475] The model may be determined by selecting the set of parameters that results in a model with the smallest possible total error. Values ​​for the set of parameters may be calculated using a suitable iterative method that seeks to get progressively closer to an ideal set of constant parameters. One algorithm is the Levenberg-Marquardt algorithm. With further reference to FIG. 4, a graph 401 showing iterations of a trend line before reaching a best fit 405 and a graph 404 of signal quality are shown.

[0476] Furthermore, when calculating the error, the error value of each individual data may be weighted by the corresponding signal quality for said each individual data. The signal quality of the patient sensor is shown in the graph 404. The weighting of each data point may give extra weight to more accurate data points when determining the constant parameters and fitting the trend line. Without weighting, the error of the data points in the model may be significantly affected by the inaccurate data points.

[0477] The results of the learning phase can be used to tune the controller to be optimal for the individual patient. A non-tuned controller that is not modeled specifically for the individual patient can show some drawbacks. In general, a slow / overdamped controller will take longer to reach the target SpO2 and may be slow to react to any fluctuations. On the other hand, a fast / underdamped controller will try to move too quickly towards the target value and risk overshooting it. This can lead to oscillation of the controller around the target and become unstable. Preferably, the controller is tightly damped, i.e. the model can reach the target SpO2 value quickly, but not so quickly that it substantially overshoots the target and becomes unstable. Using the model generated by the patient characterization, an analytical solution can be found that tightly damps the control algorithm.

[0478] Some of the analyses that may be performed during this learning phase are facilitated by systems that utilize high nasal flow. In other systems, such as ventilation via a mask or tracheotomy interface, the relationship between FdO2 and SpO2 is greatly affected by the patient's breathing rate. One reason for this is the portion of each breath that is rebreathed exhaled gas. When a patient takes short, fast breaths, the majority of the breath is rebreathed gas, and therefore the gas that enters the patient's lungs is comprised of a smaller amount of therapeutic gas. Similarly, when a patient takes slow, deep breaths, a smaller portion of the breath is rebreathed gas, and therefore the gas that enters the patient's lungs is comprised of a larger amount of therapeutic gas. This affects the oxygen concentration in the patient's lungs, which in turn affects SpO2.

[0479] As previously mentioned, nasal high flow has the effect of flushing the patient's airways with therapeutic gas, significantly reducing rebreathing. This means that regardless of the patient's breathing rate, rebreathing is minimal and the gas that enters the patient's lungs is much more similar in composition to the therapeutic gas delivered by the device.

[0480] Because the effect of respiratory rate on the FdO2 / SpO2 relationship is reduced, the device can utilize a learning phase upon start-up where data analysis allows optimal tuning of the controller and / or implementation of patient-specific predictive control without the need for computationally demanding constant learning.

[0481] When the characterization criteria are met, the patient is sufficiently characterized. After patient characterization 216, the learning phase 210 ends and the control phase 220 begins. The characterization criteria may define tolerance ranges for at least some of the parameters used in the calculation of the patient model. For example, the characterization criteria may include a range of acceptable values ​​for a determined delay time between a change in FdO2 and an initial change in SpO2, a range of acceptable values ​​for an initial value of SpO2, a range of acceptable values ​​for an exponential decay rate that defines how quickly SpO2 reaches its final value after the delay time, a range of acceptable values ​​for the ratio of changes between SpO2 and FdO2, and / or other parameters associated with the generation of the model. The characterization criteria may define only minimum or maximum values ​​for the parameters.

[0482] In some cases, the patient characterization may fail. In such a situation, the controller may begin the control phase with a default PID controller or may switch back to automatically maintaining FdO2 at a prescribed level. The default PID controller may be designed to be tightly damped or overdamped for most, if not all, patients. In general, an overdamped controller that moves slowly toward the SpO2 target is preferable to an underdamped controller that oscillates and becomes unstable. Each type of patient may have a different default PID controller.

[0483] Reasons for failure of patient characterization may include problems with the data set, such as low average signal quality, too small FdO2 increase, and / or too small SpO2 increase. Additionally or alternatively, failure may occur for reasons associated with modeling of the data, such as some parameters falling outside of a certain tolerance range. These parameters may include model fit / error, since a large amount of error between the model and the data reduces the validity of the model. Parameters may include changed parameters of the model mentioned above (initial SpO2, delay time, exponential decay constant, and increase in the ratio of FdO2 to SpO2), since unrealistic values ​​for any of these would indicate an error in the model. Additionally or alternatively, failure may occur during the tuning of the PID if any of the tuned PID values ​​fall outside a certain range.

[0484] The clinician would ideally be alerted by an alarm that this has occurred and the option to attempt another learning phase would be available. Additionally or alternatively, the device may itself initiate another learning phase in an attempt to characterize the patient. The number of automatic attempts may be limited to a prescribed number. Additionally or alternatively, a patient-specific model may be generated from a default model and then optionally updated during the treatment session.

[0485] The learning phase may be repeated two or more times during a treatment session. Even if the learning phase is successful, circumstances may arise during a treatment session that cause the controller to re-enter the learning phase. The controller may have a maximum time for which the patient model is valid. For example, in a hospital setting, the patient's condition may change over time, affecting the relationship between FdO2 and SpO2. As such, it may be useful to terminate the control phase and / or automatically start a new learning phase to re-characterize the patient after a certain time, such as one or more days. Additionally or alternatively, the patient-specific model may be updated and re-characterized during a treatment session. For example, the patient-specific model may be updated periodically, aperiodically, and / or continuously at defined intervals, defined events, during a treatment session.

[0486] The controller may test the error between the corresponding predicted and measured SpO2 values. A sufficiently large error, possibly over multiple error values ​​or a defined period of time, may indicate an incorrect patient model, and the controller may be configured to initiate a new learning phase. Optionally, if the patient's SpO2 falls outside the target range, the controller may terminate the control phase and trigger a new learning phase.

[0487] Predictive control during the control phase FIG. 5 shows a graph 500 of the signal time difference between the predicted SpO2 value and the SpO2 data. One of the difficulties in controlling FdO2 based on the SpO2 signal is the delay time and the resulting signal time difference. When FdO2 is changed in the device, gas with the new oxygen concentration needs to travel through a conduit to the patient interface, down the patient's airway to the patient's lungs, and perform gas exchange in the patient's lungs. Oxygenated blood then needs to travel through the patient's blood vessels to the pulse oximeter site to be measured by the patient sensor, and the measurement data is then received by the controller. By the time the measurement data is received by the controller, multiple additional cycles have already been processed, which may result in a significant overshoot of the target SpO2, which in turn may cause large oscillations in the patient's SpO2 and instability in the control. Furthermore, another aspect of nasal high flow is the use of a humidifier during the treatment session. Without a humidifier, the patient's airway dries out quickly. The humidification component may require a sufficient residence time to function, thereby increasing the delay time. This additional delay makes predictors in understanding delay times quite important.

[0488] Some ways to handle this include overdamping the controller, having low sensitivity and / or having a delay between each iteration of the control signal to allow previous changes in FdO2 to take full effect. Such a delay may be based, at least in part, on data measured in the learning phase discussed above. Such a system may create new problems due to being too slow to react to the patient's condition in order to properly handle signal delays. For example, when the device is first turned on, it may take significantly longer to reach the target SpO2, or the controller may be too slow to react to sudden changes in the patient's SpO2.

[0489] The controller may be configured to perform predictive control on the PID controller during the control phase. The predictive control may be a Smith predictor. The predictive control may be determined, at least in part, based on one or more parameters analyzed during the learning phase 210. Using the data received during the learning phase 210 to design or modify the predictive controller allows for much more efficient and patient-specific control. The purpose of the predictive control is to know the signal time difference to predict the SpO2 value and control the FdO2 based on the predicted SpO2 value instead of the actual measured SpO2. This results in a control algorithm that may be quite sensitive and stable.

[0490] The predicted value of SpO2 may represent SpO2 after a delay time has elapsed. The delay time is the period between when a change to FdO2 is made and when a response is seen in SpO2, i.e., a corresponding response is detected in the measured SpO2. Because any FdO2 change has no effect on SpO2 until after the delay time has elapsed, by the end of the delay time period, SpO2 may be predicted fairly accurately using currently available data of SpO2 and FdO2. The predictor may generate data that is substantially the same as the actual measured SpO2 data with the delay time removed, as shown in FIG. 5. The prediction does not predict the disturbances shown in the actual data, but the general shape of the curve is fitted.

[0491] The predictor may receive inputs including one or more actual FdO2 values, one or more target FdO2 values, one or more predicted SpO2 values, one or more actual SpO2 values, and / or one or more target SpO2 values. Each of the inputs may be a current value and / or a previous value that is at least temporarily stored by the processor. Each of the inputs may be paired with any associated data associated with the input data point, such as a signal quality measurement and / or a value related to the time at which the measurement is made.

[0492] From here, the PID controller functions in substantially the same way as described above, except that the PID controller uses an estimated SpO2 instead of the measured SpO2, and as such, the difference between this estimated value and the target is instead calculated. This value represents the change in SpO2. Due to the use of a predictor, the change in SpO2 takes into account previous changes in FdO2 that have not yet taken effect. The change in SpO2 is paired with the current FdO2 to determine a new target FdO2.

[0493] 6 shows a schematic 600 of a Smith Predictor utilized with a PID controller. Initially, the PID controller receives an input of the difference between the predicted patient SpO2 and the target SpO2, and outputs a target FdO2 to the FdO2 controller to move the patient's SpO2 closer to the target SpO2. The FdO2 controller outputs commands to control the valves of the flow therapy device based on the target FdO2 output by the PID controller.

[0494] This new FdO2 is delivered to the patient and may be combined with other disturbances to produce a patient response. These disturbances may include errors from any sensors or control mechanisms within the machine (such as the oxygen valve), resulting in an altered FdO2. Additional changes in the patient response may result from the patient's physiological and physical parameters (physical movement, changes in respiratory rate, etc.) which have an effect on the patient's SpO2. Thus, SpO2 is measured and its value is the patient's current SpO2 ± any error from the sensor. A signal quality indication is also output to the PID controller.

[0495] For reference, in a controller without a Smith Predictor, the measured SpO2 value is compared to the target SpO2, and the difference between the two is fed back to the PID. In the Smith Predictor model, first the controller makes a prediction of SpO2. This can be done using the same model generated during the learning phase or a default model (e.g., the patient cannot or has not been characterized), where SpO2 is estimated by integrating the effects of all changes in FdO2 over time and then adding them to the initial SpO2.

number

[0496] Here, DT and SpO2 0 , a, τ, FdO2 0 are constant parameters of the model that may be generated during the learning phase or may start as default values. The parameters may be unchanged throughout the treatment session or may be updated continuously, periodically or aperiodically. Importantly, DT is the delay time between the change in FdO2 and the onset of the SpO2 response. In the first step, the calculation is performed assuming that DT is 0. This results in an estimate of the patient's SpO2 after the delay time has elapsed. This value may be referred to as the predicted SpO2 without the delay time.

[0497] Following this, the same equation is processed again using the estimate for DT from the learning phase. The output of the model when using DT may be referred to as the delayed predicted SpO2, which predicts the current reading from the pulse oximeter. The delayed predicted SpO2 may also be calculated by referencing back to a previous estimate of SpO2 without a delay. For example, if the delay was 90 seconds, then the delayed SpO2 estimate is the undelayed SpO2 estimate made 90 seconds ago.

[0498] Then the difference between the SpO2 without the delay value and the measured SpO2 value is calculated. If the model is perfect, the difference will be 0. Generally, there will be some difference, and this represents both the error of the model as well as the error of the disturbances in SpO2 mentioned above.

[0499] 7 shows a graph 700 of the predicted value with delay included. Therefore, this error and disturbance value can be added to a first predicted value of SpO2 without delay and used to correct the predicted SpO2 using the measurement error between the actual SpO2 and the predicted SpO2. This final value represents the predicted SpO2 without delay plus disturbance.

[0500] Then, a delay time plus the difference between the undisturbed predicted SpO2 and the target SpO2 is calculated and the result is fed back to the PID controller and the process begins again.

[0501] Assumptions can be made to reduce the computational burden of modeling the SpO2 response. First, because FdO2 is changed in step increments with each iteration of the control cycle, the equation can be evaluated using discrete time points. Because of this, the model can be further rearranged into an iterative process where results from previous iterations of the model can be included in the evaluation of the current iteration of the model.

[0502] In some cases, the Smith predictor allows the PID controller to react to a prediction of the SpO2 reading rather than reacting to it. For example, the Smith predictor may predict SpO2 rising to a target level and settling there. However, when the actual SpO2 measurement comes in, it may indicate that the SpO2 is approaching the target faster than predicted and is now on the verge of overshooting the target based on the changes in FdO2 that have occurred previously. As such, the controller may quickly lower FdO2 to minimize or even prevent the occurrence of an overshoot. Without the Smith predictor, the control system would not respond to an overshoot until it has already occurred.

[0503] FIG. 8 shows different computational models for the PID controller. To demonstrate the difference that the Smith predictor makes, the computational model was set up to represent a COPD patient. The model included a sudden drop from a healthy SpO2 reading along with the random fluctuations in SpO2 that normally occur. The objective was to see how quickly the control system would bring the patient back to a healthy SpO2 reading and settle in at this point, as well as how well it could handle the random fluctuations. The same model with the same random fluctuations was tested with three different PID controllers, one with the Smith predictor 802, one with a normal PID tuned to a specific patient 804, and one with a default patient 806. The PID controllers can be tuned or untuned. The untuned PID controllers are referred to as default PID or untuned PID. The untuned controllers are referred to as PID controllers that are not tuned to a specific patient. However, the non-tunable controller may be tuned for stability or general patient type or specific patient type (e.g., normal, hypercapnic, etc.) and loaded into the controller prior to operation of the flow therapy device. Additionally, the tuned PID controller and the default PID controller may be referred to as a PID controller that does not incorporate a Smith Predictor. The Smith Predictor may be used to vary the tuned PID.

[0504] As noted above, the Smith PID 802 was able to return to a healthy SpO2 reading approximately four times faster than the default PID 806 and was more accurate at maintaining the target SpO2. The Synchronized PID 804 was better than the default PID 806, but not as good as the Smith PID 802.

[0505] Signal Weighting 3 and 4, graphs 304 and 404 provide a signal quality indicator of a patient sensor. During use, the quality of the SpO2 signal from a patient sensor may vary. Patient sensors, such as pulse oximeters, may be inaccurate in some situations, such as when the pulse oximeter is moved, resulting in poor quality data. Some patient sensors, such as pulse oximeters, may provide a signal quality indicator with each SpO2 reading. The signal quality indicator may be defined as an indication of the measurement accuracy of the patient sensor. The value of the signal quality indicator may be calculated on a defined scale, for example, 0 to 1, where 0 represents no signal and 1 represents the strongest signal. Data representing the signal quality from the patient sensor may be processed in one or more ways, including fitting from a different scale (such as 0 to 5) to a defined scale of the system (such as 0 to 1).

[0506] When tuning the PID controller (whether default, patient-specific or predicted), expected periodic perturbations can be analyzed. Periodic perturbations are variations in SpO2 due to factors beyond the controlled variable (FdO2) and include errors in the SpO2 measurements. When tuning the PID controller, expected periodic perturbations can be estimated and then the standard deviation of the SpO2 readings due to signal quality can also be estimated. SpO2 readings have a certain level of error between the measured value and the true value. This error can be represented by a measure of standard deviation. Standard deviation is inversely proportional to signal quality.

[0507] Changes in signal quality can affect the error of the SpO2 measurement, which in turn affects the periodic perturbations of the system. This means that the previously tuned PID goes from tight damping to overdamping (where the controller is unnecessarily slow) or underdamping (where the controller becomes unstable). Signal quality can be accounted for by weighting the control algorithm based on the signal quality readings from the patient sensor. The control output can be multiplied by the signal quality to reduce the impact of data points with low signal quality. The objective is to damp the PID controller when the signal quality decreases, and effectively retune the PID controller when the expected periodic perturbations change.

[0508] Weighting may be applied to the change in FdO2 output by the PID control. The change in FdO2 is scaled relative to the most recent signal quality reading. For example, if FdO2 is 30% and the signal from the pulse oximeter indicates that the patient's SpO2 has dropped, the PID may command a 4% increase in FdO2 to bring it to 34%. However, if the signal quality of the measurement is only 0.5 and linear weighting is used, the increase may be dampened to 2% so that the new FdO2 is only 32%. The weighting allows the controller to continue to control the patient's SpO2, but does so slowly so as not to overcompensate for poor quality measurements.

[0509] The relationship between signal quality and control algorithm weightings may be defined by any function designed to represent the increase in noise as signal quality decreases, and is not limited to a linear function as described above. The relationship between signal quality and control weightings may be based on the correlation between signal quality and the standard deviation of the error.

[0510] By weighting the SpO2 measurement based on signal quality, the PID controller may be less affected by disturbances in the SpO2 measurement, such as motion artifacts and inadequate perfusion. Weighting the control algorithm by signal quality may result in a more robust and stable controller that can compensate for noisy data when signal quality decreases, while providing fast and accurate control when signal quality is high and data is reliable.

[0511] Flow Therapy Device Control Process 9A-9C show a flowchart of a method of controlling operation of a flow therapy device during a high flow therapy session. Process 900 and sub-processes 910 and 930 may be performed by any system capable of controlling operation of a flow therapy device. For example, process 900 may be performed in whole or in part by controller 13. A number of different controllers may be configured to perform process 900. For example, different aspects of the process may be performed by a controller. A remotely located system may be configured to perform portions of the process. For example, a remotely located system may be configured to perform the learning phase 910 of the system, and the control phase 930 may be performed locally by controller 13. While any number of systems may perform process 900 in whole or in part, for ease of explanation, process 900 will be described with respect to specific components of controller 13 and flow therapy system 10.

[0512] In process 900, at block 902, a user may initiate a high flow therapy session with the flow therapy device 10. To initiate a therapy session, the flow therapy device may require specific information about the patient. For example, the input may include one or more patient characteristics, such as the type of patient (e.g., normocapnic, hypercapnic, or other type), age, weight, height, sex, and / or other patient characteristics. The flow therapy device 10 may also request the user to set a target SpO2 value or range of values ​​for the patient. The flow therapy device may automatically determine the target SpO2 value based, at least in part, on the received patient characteristics. After receiving the information, the therapy session may be initiated by the user, and the process may proceed to block 910.

[0513] At block 910, the controller can execute a learning phase sub-process. The learning phase can generate a patient-specific model for use during the control phase. In some cases, the learning phase may not result in a default patient model to be used during the control phase 930. As described herein, the patient-specific model can be generated from a default model and then optionally updated during a treatment session without a defined learning phase.

[0514] With further reference to FIG. 9B, the learning phase is described in further detail. In block 912, the controller executes a wait stage until the patient's SpO2 value stabilizes. During the wait stage 202, the oxygen inlet valve defaults to the previous FdO2 setting, and the valve may open and close as needed. The patient's SpO2 may change in response to high-flow therapy, and as such, the controller may wait until the SpO2 settles to a fairly constant value before proceeding to block 914. Optionally, the wait stage may be bypassed, and the process may proceed directly to block 914 without executing the wait stage in block 912.

[0515] In block 914, the controller may increase the oxygen concentration of the gas flow to a new level based on the target SpO2 level. The new FdO2 value may be preset or determined based on factors such as the patient's current SpO2. The new FdO2 may be selected by a clinician, who selects the FdO2 based on the clinician's own experience and knowledge. The selected FdO2 may bring the patient's SpO2 closer to the target SpO2 level. The FdO2 may be automatically determined by the controller 13.

[0516] In block 916, the controller measures and records patient and device parameters. The patient parameter may be SpO2 and the device parameter may be FdO2. The controller may measure and record FdO2 and SpO2 data. The actual FdO2 may be raised to the target FdO2 over a defined period of time. Signal quality indicators from the patient sensors may also be recorded.

[0517] In block 918, the controller may analyze the relationship between the patient and device parameters and model the relationship. For example, the relationship may be between FdO2 and SpO2, and the controller may determine the relationship between the measured FdO2 and the time since the change in the target FdO2. The relationship may be modeled using an exponential decay function, where the exponential decay constant is varied to best fit the model to the data. The initial and final FdO2 values ​​used in the exponential decay function may be set by the initial and final target FdO2 values. The modeling of the relationship may be performed as further described herein.

[0518] In block 920, the controller can determine whether patient characterization criteria are met. The characterization criteria may define tolerance ranges for at least some of the parameters used in the calculation of the patient model. For example, the characterization criteria may include a range of acceptable values ​​for a determined delay time between a change in FdO2 and an initial change in SpO2, a range of acceptable values ​​for an initial value of SpO2, a range of acceptable values ​​for an exponential decay rate that defines how quickly SpO2 reaches its final value after a delay time, a range of acceptable values ​​for the rate of change between SpO2 and FdO2, and / or other parameters associated with the generation of the model. The characterization criteria may define only minimum or maximum values ​​for the parameters. If the criteria are met, in block 922, the controller outputs a patient-specific model for use during the control phase. If the patient characterization criteria are not met, the process proceeds to block 924, where the controller determines whether a maximum time for the learning phase has been exceeded. If the time has not been exceeded, the controller continues to iterate on the model. If the time has been exceeded, the controller uses a default patient model for the patient in block 926. The controller may restart the learning phase sub-process 910 one or more times if the patient characterization criteria have not been met.

[0519] After the learning phase is complete, the model is output for use during the control phase, in sub-process 930. The control phase sub-process is further described with reference to Figure 9C.

[0520] In block 932, the controller executes a PID controller based on the patient model output during the learning phase. The PID controller may be configured to control FdO2 based on the target SpO2. In block 934, the PID can predict SpO2 using a predictive algorithm such as a Smith predictor. In block 936, the PID can determine an FdO2 value based on the predicted patient SpO2 value. In block 938, the PID controller can adjust the output of the FdO2 value based on a signal quality indicator associated with the patient sensor. In block 940, the model is adjusted based on the patient's response. The difference between the predicted SpO2 and the target SpO2 is calculated, and the result is fed back to the PID controller. In block 942, the controller determines whether the treatment session is complete. If the treatment session is not complete, the process begins again. If so, the treatment session is terminated.

[0521] Closed Loop Control Using Oxygen Efficiency In another configuration for implementing a closed loop control system for the flow therapy device 10 shown in Figure 10, the flow therapy device 10 determines an oxygen efficiency associated with a patient. The flow therapy device 10 may generate a patient model that uses the patient's oxygen efficiency during a therapy session.

[0522] The system estimates the patient's oxygen efficiency (ξ O2 ) along with other parameters. Generally, oxygen efficiency may be calculated based on the patient's measured SpO2 and measured FdO2. In one configuration, oxygen efficiency is determined based on the patient's measured SpO2 divided by the measured FdO2. In one configuration, oxygen efficiency is determined based on a non-linear relationship between the patient's measured SpO2 and measured FdO2.

[0523] The oxygen efficiency of a patient who requires supplemental oxygen may be below that of a healthy person. For example, in a healthy person, a change in FdO2 may cause a change in SpO2 that is twice as large as the SpO2 in a patient with low oxygen efficiency. Having an indication of a patient's oxygen efficiency allows closed loop oxygen control systems to run more efficiently.

[0524] As shown in FIG. 11, the controller 13 can calculate the patient's oxygen efficiency. The controller can receive a measured SpO2 value and a measured FdO2 value. The measured FdO2 value can be received from a gas composition sensor. An instantaneous oxygen efficiency can then be calculated based on the measured SpO2 and FdO2 values. The patient's overall oxygen efficiency can then be estimated by applying an on-the-fly filter to the instantaneous oxygen efficiency data. Filtering the instantaneous oxygen efficiency data can reduce variability in the estimate of the patient's overall oxygen efficiency. The controller can also prioritize more recent data. The instantaneous oxygen efficiency data can be weighted by pulse oximeter signal quality such that instantaneous oxygen efficiency measurements made from data with low signal quality can have a reduced impact on the estimate of the patient's overall oxygen efficiency. The instantaneous oxygen efficiency data can also be weighted based on the size of a recent change to FdO2 such that instantaneous oxygen efficiency measurements made from data following a large change in FdO2 can have a reduced impact on the estimate of the patient's overall oxygen efficiency. This is because there is a delay between when a change in FdO2 is made and when the measured SpO2 changes. The controller may also take into account whether the patient is cannulated when estimating the patient's oxygen efficiency. For example, the controller may ignore efficiency data from periods when the patient is not cannulated.

[0525] The device may constantly monitor and update an estimate of the patient's overall oxygen efficiency. The patient's overall oxygen efficiency may be used by multiple parts of the closed loop control system, such as predictive models, tuning of PID coefficients, and / or step changes before the feed forward stage. The patient's overall oxygen efficiency may be constantly updated as the estimate of the patient's instantaneous oxygen efficiency changes. The controller may start with an initial estimate of the patient's oxygen efficiency based on the typical oxygen efficiency of patients who require supplemental oxygen. The overall oxygen efficiency may then be updated as data is received. A higher estimate of oxygen efficiency may result in a smaller change in FdO2, thereby reducing the risk of the patient receiving too much oxygen. A lower estimate may result in a larger change in FdO2, thereby allowing the controller to achieve the target SpO2 more quickly, but may cause overshoot.

[0526] In some configurations, the flow therapy device 10 may have an initial oxygen efficiency calculation phase to determine the patient's oxygen efficiency. In some configurations, the oxygen efficiency is not updated after the initial oxygen efficiency calculation.

[0527] Initiating a Closed-Loop Control Treatment Session A closed loop control treatment session may be initiated by a user using interaction with a graphical user interface of the flow therapy device 10 as described herein. Closed loop control requires that a patient sensor 26, such as a pulse oximeter, be connected to the patient and to the flow therapy device 10, and that the patient sensor signal quality is at an acceptable level. Before closed loop control begins, the user must set operating parameters for FdO2 and SpO2. Various methods for selecting these operating parameters are described herein.

[0528] FdO2 may have a control range with upper and lower control values. The user may select the upper and lower limits of the control range of FdO2. The difference between the upper and lower limits may be fixed. The control range may be fixed to a defined difference in oxygen concentration, such as 5%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45% and 50% and / or any other range of difference between the above values. Thus, the user may select a particular FdO2 range, such as 25%-45%, 52%-72%, 80%-100% or any other range. The user may change the value of the FdO2 control limit value in increments of 1%, 2%, 5% or other increments.

[0529] The flow therapy device may have a lower limit of 21% and an upper limit of 100% for the FdO2 control range. The FdO2 control range may be truncated by the limit of oxygen concentration that the device can conveniently deliver (e.g., 95%, 90% or lower). For example, the gas source connected to the oxygen inlet valve may be an oxygen-enriched gas stream, where the oxygen content of the source may be less than pure oxygen (i.e., 100%).

[0530] The flow therapy device may include various configuration options for setting the limits of the FdO2 control range. For example, a user can input the oxygen concentration of the oxygen source, the flow therapy device may be pre-programmed with an upper limit during manufacture that cannot be changed, the upper limit may be changed by a technician but not by a normal user, the user can input the oxygen source type (e.g., connector, oxygen bottle, etc.) and the flow therapy device can determine the appropriate limit, and / or the flow therapy device can measure the oxygen concentration of the gas coming from the oxygen source.

[0531] Additionally, the flow therapy device may issue an alarm if it is unable to achieve the target oxygen concentration. The alarm may act as a fail-safe in situations where a control range is selected that exceeds the concentration of the oxygen source. For example, if the control range is 80%-100% when connected to a 90% oxygen source, the flow therapy device will not be able to go above 90% and will trigger an alarm.

[0532] If the user attempts to lower the control range of FdO2 above the upper limit or below the lower limit, respectively, the control range may be truncated. For example, if the user attempts to lower the control limit from 21% to 41%, the upper limit may continue to be lowered, but the lower limit remains at 21%. This results in a control range that is narrower than 20% (e.g., 21% to 35%). The control range may also have a lower limit to its size (e.g., 5%, 10%, 15%, etc.). The lower limit may be based on the size of the control range. For example, the lower limit may be half the size of the control range. Specifically, when one of the limits of the control range is at its physical limit (i.e., 21% or 100%), the other limit may be at least 10% above or below the other limit. In such a configuration, the lowest and highest possible control ranges are 21% to 31% and 90% to 100%, respectively. The controller can vary the FdO2 between the upper and lower limits of the control range to maintain the SpO2 within the patient's target range.

[0533] As described herein, a user can manually set a target SpO2 range. In some configurations, instead of manually selecting a target SpO2 range, a user may select a patient type, and the controller then selects a pre-determined SpO2 control limit based on the patient type. Examples of patient types may include "normal," with a defined SpO2 control range of 90%-98%, 92%-98%, 92%-96%, or within another defined range, or "hypercapnic," with a defined control range of 88%-92%, 86%-90%, 88%-90%, or within another defined control range.

[0534] To maintain the patient's SpO2 within a target range, the controller may target the center of the patient's target range. The limits of the target range may further serve as alarm limits. For example, for a "normal" patient with an SpO2 target range of 92%-96%, the device may target an SpO2 value of 94%. The device may then alarm if the patient's SpO2 value falls outside the 92%-96% range. The flow therapy device may have additional alarms set at defined limits that are independent of the selected SpO2 control range. For example, the flow therapy device may alarm at 50%, 60%, 70%, 75% and / or 80% to indicate the patient's oxygen desaturation.

[0535] The flow therapy device 10 may include a configuration menu in which some or all of these values ​​may be changed. The configuration menu may be protected by a PIN or similar password feature to prevent certain users from accessing these settings. For example, the configuration menu may be intended to be inaccessible to general users (such as patients or nurses), but may instead be designed to be accessible to anyone who sets the configuration of the equipment (such as a technician or manufacturer).

[0536] In the configuration menu, the limits that can be selected for the FdO2 control range can be modified. For example, the device can be configured such that the upper limit of the FdO2 control range cannot exceed 90%. The set limits of the control range can serve as a safety feature by preventing the device from delivering too high and / or low oxygen concentrations. Additionally, the limits can be set based on what the device is capable of delivering. For example, if the device is connected to an oxygen enriched source that contains gas with an oxygen concentration of 90%, the device will not be able to achieve 100% FdO2. In this situation, the upper limit of the selectable FdO2 control range needs to be set to 90% or lower.

[0537] The size of the FdO2 control range may also be changed in a higher level menu. For example, the size of the control range may be set to 10%, 15%, 20%, 27%, 30%, 36%, 40%, 50%, 60%, 70%, 80%, 90%, 100% or any other control range. The control range may be reduced, for example by half, when one of the above mentioned limits is reached. For example, if the FdO2 lower limit is 21% and the range is set to 40%, the lowest selectable range is 21% to 41%.

[0538] The SpO2 target range may be manually set by the user. The SpO2 target range for each patient type may also be changeable in the configuration menu. Additionally, the device may have additional patient types that may be made selectable through the configuration menu. For example, the additional patient type may be classified as "other" and may include a customizable SpO2 target range. The upper and lower limits of the SpO2 target range for each patient type may be varied from 80% to 100% in 1% increments.

[0539] During a therapy session, the SpO2 controller and the FdO2 controller can automatically control the operation of the flow therapy device until the therapy session ends or an event causes a change from automatic mode to manual mode.

[0540] During a therapy session, the graphical user interface may display a graphical indicator of oxygen efficiency. The oxygen efficiency characteristic displayed in the graphical user interface may be an output value based on SpO2 and FdO2. Another oxygen efficiency characteristic may be a function of the determined oxygen efficiency and the patient's respiratory rate. If the oxygen efficiency characteristic is a function of the determined oxygen efficiency and the patient's respiratory rate, it may be calculated by dividing SpO2 by FdO2 and then dividing this value by the respiratory rate. The oxygen efficiency characteristic value may be recorded and displayed in a graph or trend line format to show how the value changes over time. The graphical user interface may be configured to display each of the oxygen efficiency characteristic and the respiratory rate oxygen efficiency characteristic individually or together. For example, values ​​associated with each characteristic may be displayed together on the same screen or on separate screens (e.g., a user may navigate to a different screen within the interface to view a different characteristic). The graphs or trend lines may be configured to display each characteristic individually or together on the same screen.

[0541] 12 shows a graph 1200 of SpO2 and FdO2 illustrating multiple phases of operation of a flow therapy device during a treatment session. FdO2 (fraction of oxygen delivered) is used in the graph, but as previously mentioned, FdO2 is substantially the same as FiO2, so long as the flow rate meets or exceeds the patient's peak inspiratory demand.

[0542] The operational phases include a wait stage 1212, a step change 1214, a feed forward stage 1216, and a control phase 1220. Once the control limits are set, the flow therapy device 10 may enter a wait stage 1212. The wait stage 1212 allows the SpO2 sensor to settle and allows for the collection of some initial data such as SpO2, FdO2, signal quality, and other parameters. In particular, an initial estimate of the patient's oxygen efficiency may be determined. If the patient is already using the device in manual oxygen control mode with an SpO2 sensor attached, the device may already have an estimate of the patient's oxygen efficiency. In that case, the collected data may be used to continue to update this estimate.

[0543] In this configuration, the wait stage 1212 may be extended for a predetermined period of time, which may be between 1 second and 60 seconds, or between 2 seconds and 30 seconds, or between 3 seconds and 15 seconds, or between 4 seconds and 10 seconds, 5 seconds, or any other period within the ranges mentioned above.

[0544] During the wait stage 1212, the device may also evaluate the data to determine what action to take during the subsequent feedforward stage 1216. Prior to the feedforward stage 1216, the controller may perform a step change 1214 in FdO2. The flow therapy device may make a step change in FdO2 in an attempt to bring the actual SpO2 into or close to a target range. After making a step change in FdO2, FdO2 may be held constant for a prescribed duration during the feedforward stage 1216 to allow the patient's SpO2 to settle.

[0545] Near the end of the wait stage 1212, data regarding several parameters may be evaluated to determine the magnitude of the step change 1214 and whether the feedforward stage 1216 will be performed. First, the patient's SpO2 may be compared to a target SpO2 range. When the patient's SpO2 is within or above the target range, the step change 1214 and the feedforward stage 1216 may be bypassed and the controller moves directly from the wait stage 1212 to the control phase 1220. If the patient's SpO2 falls below the target range, the controller may determine whether a step change 1214 is required. For example, a recent large change in FdO2 may mean that a step change 1214 in FdO2 is not required. If a step change 1214 is required, the device proceeds to the step change 1214 following the end of the wait stage 1212.

[0546] In step change 1214, the controller decides to implement a change in FdO2. The magnitude of the step change is based at least in part on the current SpO2, the target SpO2, and oxygen efficiency.

[0547] Due to the delay between the change in FdO2 and when the change appears in SpO2, there may be changes in FdO2 that do not yet have an effect when calculating oxygen efficiency. The flow therapy device 10 may take into account any recent changes in FdO2 when determining the predicted SpO2, oxygen efficiency, and magnitude of the step change.

[0548] During the feedforward stage 1216, the controller may maintain FdO2 at the determined FdO2. If no step change 1214 occurs, FdO2 may be maintained at the current FdO2 value. If there is a step change 1214, the determined FdO2 is the previous measured FdO2 plus the magnitude of the step change. The feedforward stage 1216 may continue until a maximum time specified for the feedforward stage is reached (e.g., 60 seconds, 120 seconds, or another specified maximum duration) or until the measured SpO2 is at the target SpO2 value and / or within the target SpO2 range. After the feedforward stage 1216 ends, the control phase 1220 begins.

[0549] Predictive control during the control phase During the control phase 1220, the controller varies FdO2 within the control range to achieve the target SpO2. In rate form, the equation for determining the target FdO2 during the control phase is given below:

number

[0550] In the formula, E SpO2 is the error function, and K P , K I and K D are the PID coefficients. The error function represents how far the patient's SpO2 is from the target SpO2, and is calculated differently depending on whether a Smith Predictor is used. In some configurations, the error function may also be filtered with a first order low pass Butterworth filter to remove random measurement errors.

[0551] As described herein, the PID coefficients may be tuned to better achieve a patient's target SpO2. Additionally, the PID coefficients may also be weighted by the inverse of the patient's oxygen efficiency, causing the controller to provide greater changes in the patient's FdO2 at lower oxygen efficiencies to achieve consistent changes in SpO2.

[0552] If the default PID or a tuned PID is used, the error function is: E SpO2 (t)=SpO2 Measured (t)-SpO2 Target

[0553] As described herein, the PID coefficients may be tuned based on patient characteristics. Additionally, a Smith predictor may be used to remove the pure time delay between when a change in FdO2 is made and when a corresponding change in SpO2 is detected. The delay time may be estimated based on the flow rate of the flow therapy device 10.

[0554] The Smith Predictor can use a model of the patient's SpO2 response based on changes in FdO2. Using the model, the Smith Predictor can make a prediction of what the SpO2 will be after a delay period.

[0555] The predicted value is continually corrected using a disturbance term that represents the error between the modeled and measured SpO2. Once an initial SpO2 prediction is made, the predicted value is adjusted by incorporating the disturbance term. Combining these parameters gives a disturbance-adjusted predicted SpO2 value. This value is then used to calculate the error function. If the model and estimated delay times are sufficiently accurate, the Smith Predictor PID will perform similarly to the default or tuned PID used with patients, without any delay times.

[0556] As described herein, in some configurations, the Smith predictor model may be evaluated for SpO2 using an accumulation of changes in FdO2 multiplied by a coefficient that represents the relationship between changes in FdO2 and changes in SpO2. The coefficient is patient-specific and is generated using an initial estimate. As such, the coefficient is continually updated based on live data (e.g., SpO2 and FdO2) received from the patient. The coefficient may be updated during all phases of the closed-loop control mode and is not limited to a particular learning phase.

[0557] A coefficient used in the Smith Predictor model may be the patient's oxygen efficiency, which is constantly evaluated and updated in the model's algorithm. As described herein, the oxygen efficiency estimate is updated throughout the wait stage, feedforward stage, and control phase, and during manual mode if a pulse oximeter is used.

[0558] PID Controller Weighting As described herein, the control signal may be weighted depending on the signal quality from the patient sensor 26. Additionally, the control signal may also be weighted depending on whether the measured SpO2 is above or below the target value. When the measured SpO2 is below the target, the weighting may be 1 or greater, 1-2, 1.1-1.75, 1.2-1.5, 1.25, or any value or range within the ranges described above. When the measured SpO2 is above the target, the weighting may be 1 or less, 0.25 and 1, 0.5-0.9, 0.75-0.85, 0.8, or any value or range within the ranges described above. This not only allows the controller to increase the oxygen concentration more quickly when the SpO2 is too low, but also reduces the chance of overshooting the SpO2 target when the SpO2 is too high and oxygen concentration is decreasing. This weighting process may help reduce the time the patient receives a lower concentration of oxygen.

[0559] Flow Therapy Device Control Process 13A-13C show a flow chart of a method of controlling operation of a flow therapy device during a high flow therapy session. Process 1300 and sub-processes 1310 and 1330 may be performed by any system capable of controlling operation of a flow therapy device. For example, process 1300 may be performed in whole or in part by controller 13. A number of different controllers may be configured to perform process 1300. For example, different aspects of the process may be performed by a controller. A remotely located system may be configured to perform portions of the process. For example, a remotely located system may be configured to perform system setup phase 1310, and control phase 1330 may be performed locally by controller 13. While any number of systems may perform process 1300 in whole or in part, for ease of explanation, process 1300 will be described with respect to specific components of controller 13 and flow therapy system 10.

[0560] In process 1300, at block 1302, a user may initiate a high flow therapy session with the flow therapy device 10. To initiate a therapy session, the flow therapy device may require specific information about the patient. For example, the input may include one or more patient characteristics, such as the type of patient (e.g., normocapnic, hypercapnic, or other type), age, weight, height, sex, and / or other patient characteristics. The flow therapy device 10 may also prompt the user to set a target SpO2 value or range of values ​​for the patient. The flow therapy device may automatically determine a target SpO2 value or range of values ​​for the patient based, at least in part, on the received patient characteristics. After receiving the information, if any information is required, the therapy session may be initiated by the user and the process may proceed to block 1310.

[0561] At block 1310, the controller may execute a setup phase. The setup phase subprocess 1310 is described with further reference to FIG. 13B. At block 1312, the controller waits for a defined period of time before proceeding. The wait time may provide a period for the patient's SpO2 value to settle. During the wait stage 1212, the oxygen inlet valve may default to the previous FdO2 setting, and the valve may open and close as needed.

[0562] In block 1314, during the waiting stage, the controller measures and records patient and device parameters. The patient parameter may be SpO2 and the device parameter may be FdO2. The controller may measure and record FdO2 and SpO2 data. The controller may determine oxygen efficiency based on SpO2 and FdO2.

[0563] In block 1316, the controller can determine whether the patient's SpO2 is within or above the target SpO2 range. If the target is already within or above the target SpO2 range, the process bypasses the step change and feedforward stages and proceeds directly to the control phase in block 1322. If the patient's SpO2 value is not within the target range, the process proceeds to block 1317.

[0564] In block 1317, the controller may determine whether FdO2 is at an acceptable level. If FdO2 is already at an acceptable level due to a recent change in FdO2, then no further adjustments to FdO2 are needed before the feedforward stage and the process bypasses the step change and proceeds directly to block 1320. If FdO2 is not at an acceptable level, the process proceeds to block 1318.

[0565] In block 1318, the controller can perform a step change in oxygen concentration. The controller can perform a step change to increase the oxygen concentration of the gas flow to a new level based on the target SpO2 level, FdO2, and oxygen efficiency. The new FdO2 value can be determined based on factors such as the patient's current SpO2. The new FdO2 can be selected by a clinician, who selects the FdO2 based on the clinician's own experience and knowledge. The selected FdO2 can bring the patient's SpO2 closer to the target SpO2 level. The FdO2 can be automatically determined by the controller 13.

[0566] At block 1320, the controller may execute a feedforward stage. During the feedforward stage 1216, the controller maintains FdO2 at a determined value for a determined time. When the controller bypasses a step change, the controller may proceed with the feedforward stage without changing FdO2. The feedforward stage 1216 may continue until a maximum time specified for the feedforward stage is reached (e.g., 120 seconds) or until the measured SpO2 is at the target SpO2 value and / or within the target SpO2 range. After completion of the feedforward stage, the process proceeds to block 1322 to begin the control phase sub-process 1330. The control phase sub-process 1330 is further described with reference to FIG. 13C.

[0567] In block 1332, the controller executes a control phase using a PID controller to control the performance of the flow therapy device 10. The PID controller may be configured to control FdO2 based on the target SpO2 and the measured SpO2. In block 1334, the controller may predict SpO2 using a predictive algorithm, such as a Smith predictor. In block 1336, the controller may determine a target FdO2 value based on the predicted patient SpO2 value. In block 1338, the controller may determine an oxygen efficiency based on the measured SpO2 value and the measured FdO2. In block 1340, the controller may adjust the output of the FdO2 value based on a signal quality indicator associated with the patient sensor. In block 1342, the controller control signal to the oxygen valve is adjusted. The difference between the predicted SpO2 and the target SpO2 is calculated, and the result is fed back to the PID controller to control the oxygen valve. In block 1344, the controller determines whether the therapy session is complete. If the therapy session is not complete, the process continues until the therapy session is finished.

[0568] Motor and / or sensor module configuration The configuration of flow therapy device 10 is shown in Figures 14 to 16. The flow therapy device includes a main housing 100. Main housing 100 has an upper main housing exterior frame 102 and a lower main housing exterior frame 202.

[0569] 14 and 15, the lower housing 202 has a motor recess 250 for receiving a removable or non-removable motor and / or sensor module 400 as shown in Figures 13-15 and described in further detail below. A recess opening 251 is provided in the bottom wall 230 adjacent its rear edge for receiving a removable or non-removable motor / sensor module 400 as shown in Figures 13 and 15 and described in further detail below.

[0570] 16-19 show in further detail the motor and / or sensor module or subassembly 400. As mentioned above, the lower housing 202 includes a recess 250 for receiving the motor and / or sensor module 400.

[0571] 16-19, the motor and / or sensor module 400 includes three main components: a base 403 of the subassembly 400 (on which the motor 402 is positioned), an outlet gas flow passage and sensing layer 420 positioned above the base 403, and a stacked arrangement of a cover layer 440. The base 403, sensing layer 420, and cover layer 440 are assembled to form a subassembly housing having a shape complementary to the shape of the recess 250 such that the subassembly 400 may be received in the recess 250. The base 403 is configured to close the recess opening 251 when the subassembly 400 is positioned within the recess 250. The subassembly 400 may be maintained in place within the recess in any suitable manner, such as, for example, with fasteners, clips, or quick release arrangements, or may be permanently secured thereto.

[0572] The sensing layer includes a gas flow passage with one or more sensors, the gas flow passage being arranged to supply gas to an outlet port of the housing.

[0573] The motor 402 has a body 408 that defines an impeller chamber that contains an impeller. The motor 402 may be any suitable gas blower motor, and may be, for example, a motor and impeller assembly of the type described in WO 2013 / 009193, the contents of which are incorporated herein by reference in their entirety.

[0574] The gas outlet 406 is in fluid communication with an outlet gas flow passage and a gas inlet of a sensing layer 420 stacked on top of the motor. The layer 420 includes a body 422 including a number of mounting feet 425 that can be inserted into a number of mounting slots (not shown) in the base 403 to secure the body 422 to the base 403. In one configuration, the body 422 defines a gas flow passage coupling the gas outlet 406 to the gas flow passage and the gas inlet of the sensing layer 420.

[0575] The body 422 defines a lower portion 426 of the sensing and gas flow passages. The cover layer 440 has a body 442 that defines an upper portion 446 of the sensing and gas flow passages, the shapes of the upper and lower portions 426, 446 substantially corresponding to one another.

[0576] 17 and 18, the gas flow path includes a linear, elongated gas flow section 428, 448. The inlet is in fluid communication with a tangential gas flow path inlet section 430, 450 disposed at or adjacent the inlet end of the linear, elongated gas flow path section 428, 448. Recesses 433, 453 and 434, 454 may be provided at opposite ends of the linear, elongated gas flow path section.

[0577] The gas outlet ports 452 extend vertically through the body 442 of the cover layer 440 and are located at or adjacent to the opposing outlet ends of the linear elongated portions 428, 448 of the gas flow passages. The gas outlet ports 452 are in fluid communication with the upper portion of the motor recess 250, which is in turn in fluid communication with the gas flow passages. Again, due to the configuration of the walls 252 and ceiling 262 of the recess 250, if there is a gas leak from the motor / sensor module 400, the gas will be vented to the atmosphere rather than entering the portion of the main housing 100 that contains most of the electronics and controls. The recess 250 may include one or more spacers, such as lugs projecting downwardly from the ceiling 262, as shown in FIG. 15, to maintain a suitable spacing for gas flow from the gas outlet ports 452 and the recess ceiling 262.

[0578] 17, it can be seen that at least a portion of the gas flow path through and exiting the motor and / or sensing module 400 has a serpentine or undulating configuration. For example, the direction of gas flow traveling through the elongated portions 428, 448 is generally opposite the direction of gas flow traveling through the elbow 324 from the gas outlet port 452 to the inlet of the gas flow path.

[0579] 18 and 19, the cover layer 440 includes a sensing printed circuit board (PCB) 456. The cover layer 440 may also include one or more temperature sensors, such as thermistors, mounted on the gas flow path elongated portions 428, 448. One sensor may measure the temperature of the gas and the other sensor may act as a redundant temperature sensor. Alternatively, one of the thermistors may be used as a reference flow sensor (e.g., by use as a constant temperature thermistor) and the measured temperature may be used to determine the gas flow rate through the gas flow path portions 428, 448. The one or more temperature sensors may be located on a portion of the sensing PCB 456 that faces the gas flow. The sensing PCB 456 may further include other sensors, including, but not limited to, pressure sensors, humidity sensors, and dew point sensors.

[0580] One or both of the electronics boards 272 are in electrical communication with or coupled to the sensors to process information received from the sensors and to operate the device 10 based on the information received from the sensors.

[0581] In an alternative configuration, the motor / impeller unit may be provided at a location remote from the device 10. In that configuration, the module received in the recess 250 may include only the gas flow path and various sensors to supply gas to the fixed elbow 324 and thereby to the liquid chamber 300. In an alternative configuration, the module received in the recess 250 may include only the motor and gas flow path and may not include sensors.

[0582] In another alternative configuration, the motor and / or sensor module 400 may not be removable from the recess 250, but rather may be permanently mounted therein. The benefits of isolating the gas from the electrical / electronic components are still provided in that configuration.

[0583] The flow paths are compact and have fewer curves / sharp turns, thereby reducing flow separation and lowering resistance to flow.

[0584] The motor and flow path arrangement provides another layer of insulation for the wall arrangement.

[0585] Having a modular motor and / or sensor module allows the various parts of the module to be disassembled if cleaning and / or repair is required.

[0586] Advantageously, there are no leak paths in the motor and / or sensor module, as there may be potential leak points in the motor and / or sensor module that would allow oxygen to be released into the atmosphere or liquid chamber in that area.

[0587] Valve Module 20-28 show a first configuration of valve module 4001. Valve module 4001 controls the flow of oxygen and / or other gases into the gas flow path of device 10 and enables device 10 to regulate the percentage of oxygen drawn into the air flow. The valve module is formed as a modular unit for ease of manufacture, assembly, repair or replacement, for example in the event of failure, routine maintenance or future upgrades / refurbishments.

[0588] The valve module 4001 is inserted vertically upward into the valve module receptacle 306 of the lower casing 202 of the main housing. In alternative configurations, the valve module may be insertable in different orientations into the housing, for example, forward, downward, rearward, or sideways. The valve module 4001 is removably engageable with the main housing of the device such that the valve module 4001 is substantially received in the housing and accessible from the exterior of the housing. In some configurations, the valve module 4001 can be fixed and not removable within the main housing. When the valve module is removably engaged with the housing, a portion of the valve module 4001 is disposed substantially flush with the exterior wall of the housing.

[0589] Because the valve module is modular and accessible from the exterior of the housing, the valve module can be replaced without significant disassembly of the device 10 and without compromising the seal of the housing of the device. Because the valve module 4001 is substantially received within the housing, when the valve module is engaged with the housing, the valve module becomes integral with the housing and does not increase the size or bulk of the housing. Furthermore, the components of the valve module, such as the valve 4003 and valve manifold 4011 described below, are protected during use because they are positioned within the valve support 4051 and the main housing of the device. This configuration significantly reduces the likelihood that the valve module and components of the valve module will be damaged if the device 10 is inadvertently knocked or dropped.

[0590] The valve module includes a flow control valve 4003 arranged to control the flow of gas through a valve manifold 4011. The valve is arranged to control the flow of gas to a portion of the apparatus. For example, the valve may be arranged to control the flow of gas to a filter module 1001. Alternatively, the valve 4003 may be arranged to control the flow of gas to another portion of the apparatus. The valve module 4001 and the filter module 1001 are positioned upstream of the blower 402 and the motor and / or sensor module 400. In some embodiments, the valve module 4001 and the filter module 1001 are positioned downstream of the blower 402.

[0591] Valve 4003 includes a cylindrical body 4005 and a valve member within the body.

[0592] The flow control valves may be, for example, solenoid valves, motor driven, or piezo operated.

[0593] In a solenoid valve, a valve member is actuated between an open and a closed position. A solenoid valve may be a proportional valve: the amount of gas flow through the valve (i.e. due to the valve opening size) is a function of the current supplied to the valve.

[0594] Alternatively, a solenoid valve may be controlled by a modulated input signal such that the valve is modulated between open and closed positions.

[0595] The valve 4003 can be a needle valve, a plunger valve, a gate valve, a ball valve, a butterfly valve, a globe valve, etc. The valve can be of the pressure compensated type.

[0596] In some configurations, the valve is a normally closed valve, i.e., the valve is closed when power is turned off, thereby preventing the connected gas supply line from constantly venting oxygen or other gases when the device is turned off. In some alternative configurations, the valve is a normally open valve.

[0597] In some configurations, the valve 4003 is an electrically actuated proportional solenoid valve. For example, the valve may be a μProp valve available from Staiger GmbH & Co. KG, Erligheim, Germany, or an Asco 202 series Preciflow valve available from Emerson / Asco Valves, New Jersey, or any other suitable type of valve.

[0598] The valve may have a coaxial inlet-outlet configuration.

[0599] The valve module 4001 includes a valve manifold 4011 having a body 4013 that defines a gas flow path 4015 between a valve manifold gas inlet 4017 and one or more valve manifold gas outlets 4019. The valve manifold gas inlet 4017 is axially disposed at or toward an end of the valve manifold. In some configurations, the valve manifold 4011 has a single gas outlet 4019 that is radially disposed about the valve manifold. In some configurations, the valve manifold 4011 includes multiple valve manifold gas outlets 4019 that are radially disposed about the valve manifold. The valve manifold outlets 4019 are positioned to deliver gas from the valve manifold gas inlet 4017 to the gas inlet of the filter module 1001. The radial positioning of the outlet(s) 4019 helps direct oxygen (or other gases) toward the filter module, minimizing oxygen loss and increasing draw efficiency. The valve 4003 is positioned to control the flow of gas from a valve manifold gas inlet 4017 to one or more valve manifold gas outlets 4019. When the valve is "closed", gas flow is prevented from the gas inlet 4017 to the one or more gas outlets 4019. When the valve is "open", gas flow is allowed from the gas inlet 4017 to the one or more gas outlets 4019.

[0600] An end 4018 of the valve manifold 4011 opposite the gas inlet receives and sealingly engages the valve 4003 such that the valve and the valve manifold are in fluid communication. The end 4018 includes a flange 4023 for attachment to the valve. The flange 4023 has an aperture 4023A that receives a fastener 4023F for fastening the manifold to the valve 4003. One or more O-rings are provided around the periphery of the interface between the valve 4003 and the valve manifold 4011 to sealingly engage the valve with the valve manifold.

[0601] The valve manifold 4011 directs / disperses the oxygen from the valves through radially arranged gas outlets 4019. In some embodiments, a single gas outlet 4019 is provided in the valve manifold. As the oxygen passes through the outlet or outlets, noise is generated. Because respirators may be used in close proximity to the patient in medical and / or home environments, it is desirable to minimize the noise generated.

[0602] Additionally or alternatively, a hood, duct, or channel may be formed around, near, or in fluid communication with one or more of the valve manifold outlets 4019 to reduce noise. Additionally and / or alternatively, foam or the like may be placed around the valve manifold and near the valve manifold outlets to reduce noise.

[0603] A small filter is provided within the inlet of the valve manifold gas inlet 4017 to prevent dust or particulates from being introduced into the valve.

[0604] The end of the valve manifold corresponding to the gas inlet 4015 is arranged to receive and connect to the connector 4031. In the form shown, the connector 4031 is a swivel connector. Alternatively, the connector 4031 may be arranged such that the gas inlet 4033 of the connector can move in a different manner, for example, a translational or pivotal motion.

[0605] The valve module 4001 is located at the beginning of the device's flow path. In the event that the valve 4003 becomes blocked (i.e., by dust, particulates, etc.), excess pressurized oxygen or other gas is "bulked out" from one or more ambient air inlet openings in the valve support 4051 so that it remains open (e.g., in FIG. 26, the openings are shown just below the swivel connector). This prevents any excess pressure from reaching the patient. As such, the system may be considered inherently pressure limited without the use of a pressure relief valve.

[0606] One or more openings 4051O are provided in the valve support 4051 to draw ambient air into the gas flow path of the device. The ambient air flow path passes near or adjacent to the valve. In the illustrated embodiment, the openings 4051O are located around the gas inlet of the swivel connector. Additionally or alternatively, the openings are located elsewhere in the valve support. When the blower motor 402 of the device is operated, suction is created through the filter module and the valve module, drawing ambient air into the device. The ambient air flow path passes through the valve module and allows ambient air to be sucked in along with the gas flow from the flow control valve. The ambient air flow path has a gas outlet adapted to supply ambient air so that the ambient air flows past one or more temperature sensors of the device to supply the gas flow.

[0607] The device may simultaneously draw gas and ambient air from a gas inlet of the valve manifold, or may pressurize gas from the gas inlet to force the gas through the filter. Gas flows out of the valve module and into the gas inlet in the filter. The device may be configured such that gas and ambient air from the gas inlet are dynamically drawn into / mixed in the device before being delivered to a gas outlet of the device.

[0608] The valve module may be configured to minimize pressure drop across the valve module to minimize turbulence and smooth the flow by having one or more of: large openings 4051O for ambient air located around the swivel connector and / or anywhere else; rounded / rounded / beveled edges in the flow path (i.e., for example, in the valve manifold).

[0609] The valve module 4001 described herein is positioned to mate directly with the filter 1001 to provide a gas flow path from the valve module to the filter. No hose connections are required between the valve module and the filter module. This minimizes component size and simplifies connection and disconnection of the modular valve module and filter module.

[0610] The filter and valve modules described herein may provide various gas flow paths to the device. For example, the valve module may control the flow of oxygen through the valve and filter modules and into the gas flow paths of the device. Alternatively, the valve module may be bypassed by direct connection of an alternative oxygen source to the filter module via the first subcompartment gas inlet (e.g., inlet 1011 of FIG. 24). This may be practical in situations where a user wishes to manually adjust the oxygen source (i.e., via a wall-fed rotameter, etc.).

[0611] It will be appreciated that the filter modules and valve modules described herein may be used separately in an apparatus for providing a flow of gas, or alternatively, the filter and valve modules may be used together as a filter and valve assembly for enhanced functionality.

[0612] In the illustrated configuration, the device 10 receives oxygen by at least one of the following: via a valve module (automatic oxygen adjustment by the device) or via an alternative gas inlet provided on top of the filter (allowing attachment of a manually adjustable oxygen source - i.e. by a wall-fed rotameter, etc.).

[0613] The various configurations described are merely example configurations: any one or more features from any of the configurations may be used in combination with any one or more features from any of the other configurations.

[0614] For example, a swivel connector used in a valve module may have additional functionality. In some configurations, the swivel connector may be arranged to swivel about two or more axes, and may have, for example, two adjacent swivel connection portions with axes of rotation perpendicular to one another, so that the gas inlet of the swivel connector can rotate about two axes. In some configurations, the swivel connector may include a ball joint arrangement or the like, allowing the gas inlet of the swivel connector to rotate in substantially any direction. In some configurations, the swivel connector may be arranged to provide both swivel rotational and translational motion, such that the swivel connector gas inlet may swivel about, for example, one or more axes, and also move linearly. This may be useful, for example, to translate the gas inlet from one part of a device to another, such as from one side of the device to the other side of the device. In some configurations, the gas inlet may be arranged to translate instead of rotate.

[0615] As another example, the motor and / or sensor subassembly recesses are described as being on the underside of the main housing, but could instead be on the rear, side, front or top of the housing. In such variations, the air and / or oxygen inlets could also be positioned differently as needed.

[0616] As another example, rather than being configured so that the liquid chamber is inserted into and removed from the chamber space from the front of the housing, the configuration may be such that the liquid chamber is inserted into and removed from the chamber space from the side, rear or top of the housing.

[0617] As another example, although the filter module is described as being inserted into the housing from above and the valve module is described as being inserted into the housing from below, either or both of those components may be inserted into any suitable portion of the housing, either at the top, bottom, side, front or rear.

[0618] The filter and valve modules are described with reference to a flow therapy device capable of delivering heated and humidified gas to a patient or user. The device may be suitable for treating chronic obstructive pulmonary disease (COPD). The device may be configured to deliver gas to a patient interface at high flow rates (high flow therapy), particularly nasal high flow therapy.

[0619] Alternatively, the filter module and / or valve module may be used in a device for different purposes. The device may be a high-flow therapy device or a low-flow therapy device. Features may also be provided in devices for providing continuous positive airway pressure (CPAP), which may deliver gas (humidified or otherwise) at positive pressure.

[0620] Alternatively, the filter module and / or valve module may be used with a device that does not require a humidifier, and thus does not require the features of the liquid chamber 300 or chamber space 108. For example, it will be understood that the configuration for isolating the motor and gas flow path from the electrical and electronic components has broad application in other types of gas delivery devices.

[0621] The term "flow therapy device" is intended to encompass all such variations.

[0622] The reference to any prior art in this specification is not, and should not be taken as, an acknowledgment or any form of suggestion that the prior art forms part of the general knowledge in the field of endeavor in any country throughout the world.

[0623] When reference is made herein to directional terms such as "upper," "lower," "front," "rear," "horizontal," "vertical," etc., these terms refer to the device when in a typical in-use position and are used to indicate and / or describe relative directions or orientations.

[0624] Unless the context clearly dictates otherwise, throughout the description and claims, the words "comprise," "including," and the like are to be construed in the inclusive sense, i.e., "including but not limited to," as opposed to exclusive or exhaustive.

[0625] As used herein, the terms "approximately," "about," and "substantially" refer to an amount close to the stated amount that still performs the desired function or achieves the desired result. For example, in some embodiments, where the context permits, the terms "approximately," "about," and "substantially" can refer to an amount within 10% or less, within 5% or less, and within 1% or less of the stated amount.

[0626] The reference in this specification to any prior art is not, and should not be taken as, an acknowledgment or any form of suggestion that the prior art forms part of the general knowledge in the field of endeavor in any country throughout the world.

[0627] The disclosed devices and systems may also be broadly described as consisting of the parts, elements and features referred to or shown in the specification of this application, individually or collectively, and in any or all combinations of two or more of said parts, elements and / or features.

[0628] Where the above description refers to components having wholes or their known equivalents, those wholes are incorporated herein as if individually set forth.

[0629] Depending on the embodiment, some acts, events, or functions of any of the algorithms, methods, or processes described herein may be performed in a different sequence, added, merged, or omitted entirely (e.g., not all acts or events described are necessary to implement an algorithm). Furthermore, in some embodiments, acts or events may be performed simultaneously rather than sequentially, such as by multithreading, interrupt processing, or multiple processors or processor cores, or on other parallel architectures.

[0630] It should be noted that various changes and modifications to the presently preferred embodiments described herein will be apparent to those skilled in the art. Such changes and modifications can be made without departing from the spirit and scope of the disclosed apparatus and system and without diminishing its attendant advantages. For example, various components can be rearranged as necessary. Accordingly, such changes and modifications are intended to be included within the scope of the disclosed apparatus and system. Moreover, not all of the features, aspects and advantages are necessarily required to implement the disclosed apparatus and system. Accordingly, the scope of the disclosed apparatus and system is intended to be defined solely by the scope of the following claims.

Claims

1. 1. A respiratory apparatus for providing nasal high flow gas to a patient via a non-sealing nasal cannula for providing nasal high flow therapy, comprising: a flow generator for mixing oxygen and ambient air to generate a gas flow for delivery to a patient, the gas flow comprising a mixture of oxygen and ambient air, the gas flow having an oxygen content (FdO2); a gas composition sensor configured to at least detect an oxygen content (FdO2) of a gas flow delivered to a patient during a treatment session, the gas composition sensor being an ultrasonic sensor system; a valve configured to control the flow of oxygen supplied to the flow generator to control the oxygen content (FdO2) of the gas stream; a controller configured to control at least the valve and the flow generator to control delivery of gas to the patient using closed loop control during the treatment session, receiving data from a pulse oximeter indicative of the patient's oxygen saturation (SpO2) as measured by said pulse oximeter; - adjusting the oxygen content (FdO2) of the gas flow delivered to the patient based at least on the measured oxygen saturation (SpO2) of the patient and the target value of the patient's oxygen saturation (SpO2) to achieve the target value of the patient's oxygen saturation (SpO2); and the controller, wherein the closed loop control comprises at least in part determining a target oxygen content (FdO2) which is a target value for the oxygen content (FdO2) of the gas flow delivered to the patient based on a target value for the patient's oxygen saturation (SpO2) and the measured patient's oxygen saturation (SpO2), and controlling the opening of the valve to control the flow of oxygen delivered to the flow generator so that the determined target oxygen content (FdO2) is achieved; A respiratory apparatus equipped with

2. 2. The respiratory apparatus of claim 1, wherein the controller is configured to control operation of the valve, the valve being a proportional valve.

3. 3. The respirator of claim 1 or 2, further comprising an ambient air inlet.

4. A respiratory ventilator according to any preceding claim, wherein the gas composition sensor is positioned downstream of the flow generator of the respiratory ventilator.

5. The closed loop control includes using a first closed loop control model configured to determine the target oxygen content (FdO2); 5. The respiratory apparatus of claim 1, wherein the target oxygen content (FdO2) is determined further based, at least in part, on an actual oxygen content (FdO2) measured by the gas composition sensor, and / or the target oxygen content (FdO2) is determined further based, at least in part, on a previous target oxygen content (FdO2).

6. 6. The respiratory apparatus of claim 5, wherein the closed loop control includes using a second closed loop control model configured to determine a control signal for the valve based at least in part on a difference between the target oxygen content (FdO2) and the measured oxygen content (FdO2), and the control signal for the valve is determined further based at least in part on a gas flow rate, the gas flow rate being a total gas flow rate.

7. 7. The respirator of any one of claims 1 to 6, wherein the controller is configured to transition to a manual mode of operation when the pulse oximeter signal quality falls below a threshold, and wherein the controller is configured to transition to a manual mode of operation when the measured patient oxygen saturation (SpO2) is outside defined limits.

8. The ventilator of any one of claims 1 to 7, wherein the controller is configured to trigger an alarm when the measured patient oxygen saturation (SpO2) is outside defined limits.

9. The respiratory apparatus of any one of claims 1 to 8, wherein the ultrasonic sensor system includes a first ultrasonic transducer and a second ultrasonic transducer.

10. 10. The respirator of claim 9, wherein each of the first and second ultrasonic transducers is a receiver and a transmitter, and the first and second ultrasonic transducers transmit pulses bidirectionally.

11. 11. The respiratory apparatus of claim 9 or 10, wherein at least one of the first ultrasonic transducer or the second ultrasonic transducer sends a pulse along the gas flow.

12. 11. The respiratory apparatus of claim 9 or 10, wherein at least one of the first ultrasonic transducer or the second ultrasonic transducer sends a pulse across the gas flow.

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