Respiratory Drive Modulation in Ventilation to Limit Lung Pressure
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Solution Overview
Problem
Current mechanical ventilation methods, including positive pressure ventilation and high flow nasal cannula, cause ventilator-induced diaphragm dysfunction (VIDD) and lung injury (VILI), particularly in critically ill patients and premature babies, due to inadequate control of respiratory drive and lung distending pressures, with insufficient lung recruitment and inefficient ventilatory assist.
Innovation Solution
A mechanical ventilation system with multiple sub-systems that modulate respiratory drive by detecting neural signals, applying non-pressurizing inspiratory flow, synchronized airway CO2 dilution, and sub-diaphragmatic unloading to reduce lung distending pressures and promote spontaneous breathing, using a controller to adjust therapeutic contributions based on respiratory drive measurements.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Productivity
If positive pressure mechanical ventilation is applied to achieve efficient ventilation and respiratory muscle unloading, then ventilation efficiency is improved, but lung-distending pressures and volumes increase causing ventilator induced lung injury (VILI)
Solution Approach 1:
The invention segments the ventilatory assist into two independent components: (1) a flow assist component that provides non-pressurizing inspiratory flow to reduce work of breathing, and (2) a separate positive pressure component that can be applied independently for lung recruitment. This segmentation allows the flow assist to improve ventilation efficiency without necessarily increasing lung-distending pressures, thereby resolving the contradiction between ventilation efficiency and lung injury prevention.
Solution Approach 2:
The invention replaces the traditional pressure-based mechanical ventilation system with a flow-based assist system. Instead of delivering positive pressure to inflate lungs, the system delivers non-pressurizing high flow gas that follows the patient's spontaneous breathing effort. This substitution reduces lung-distending pressures while maintaining ventilation efficiency, addressing the VILI problem.
2Object-affected harmful factors
If non-invasive ventilatory assist is applied to avoid intubation complications, then patient morbidity and mortality are reduced, but patient-ventilator asynchrony occurs reducing assist efficiency
Solution Approach 1:
The invention incorporates feedback mechanisms that continuously monitor patient breathing effort and adjust the flow assist delivery accordingly. The system detects patient-ventilator asynchrony and modifies assist parameters in real-time to maintain synchronization. This feedback control ensures efficient assist delivery while maintaining non-invasive ventilation, resolving the contradiction between avoiding intubation complications and maintaining assist efficiency.
3Force
If continuous high flow is applied through nasal cannula to reduce work of breathing, then work of breathing is reduced, but lung hyperinflation occurs causing complications
Solution Approach 1:
The invention makes the flow assist dynamic by synchronizing it with the patient's spontaneous breathing effort. The flow delivery is triggered and modulated based on detected patient inspiratory effort, ensuring that flow is delivered only during actual patient inspiration. This dynamic adaptation prevents lung hyperinflation while effectively reducing work of breathing, resolving the contradiction between these two objectives.
Solution Approach 2:
The system applies flow assist in periodic bursts synchronized with each patient breath rather than as continuous flow. The flow is delivered during the patient's inspiratory phase and ceased during expiration, creating a periodic action pattern. This approach reduces work of breathing during inspiration while preventing lung hyperinflation by allowing full exhalation, addressing the contradiction.
Data Source
AI summary
A mechanical ventilation system comprises a plurality of ventilation therapy sub-systems. Each of the ventilation therapy sub-systems is adapted to assist a respiratory function of the patient. The system also comprises a detector of the respiratory drive of the patient, an operator interface receiving one or more control parameters, and a main controller. The main controller assigns a therapeutic contribution to each of the ventilation therapy sub-systems based on the respiratory drive of the patient and on the control parameters. The controller modulates the respiratory drive of a patient by controlling each of the plurality of the ventilation therapy sub-systems according to its assigned therapeutic contribution. Distinct ventilation therapy sub-systems may apply negative pressure on the abdomen of the patient, deliver a non-pressurizing inspiratory flow to the patient, or induce a positive pressure in the airways of the patient.