Methods and apparatus for optimizing therapeutic temperature control

Patent metadata

Field	Value
Publication number	US-10307288-B2
Application number	US-201515307690-A
Country	US
Kind code	B2
Filing date	Apr 29, 2015
Priority date	Apr 29, 2014
Publication date	Jun 4, 2019
Grant date	Jun 4, 2019

Abstract

Vascular pressures and oximetry are optimized through administration of fluids and other support prior to manipulating temperature in a therapeutic hypothermia procedure. Temperature and active hemodynamic management are utilized, through measurement and adjustment of temperature and hemodynamic parameters through the use of an internal cooling device, such as endovascular catheter, and/or an external temperature-altering device, to ensure that temperature management is optimized, and hemodynamics and tissue resuscitation are optimized prior to and during temperature manipulation.

First claim

What is claimed is:

1. A system for performing therapeutic hypothermia, comprising:
a controller;
one or more sensors and devices for at least one of measuring or adjusting hemodynamic parameters;
at least one of a group of an external pulse oximeter or an indwelling arterial catheter capable of continuous blood gas measurements;
an endovascular catheter providing oximetric values, wherein said one or more sensors and devices, and said endovascular catheter, are operatively controlled by said controller; and
said external pulse oximeter or said indwelling arterial catheter providing oxygen saturation data combinable with the oximetric values from the endovascular catheter to determine an oxygen extraction ratio (OER), the controller being operable to control the endovascular catheter to regulate temperature control based on the determined OER.

2. The system of claim 1 wherein one or more of said one or more sensors and devices and said endovascular catheter are connected with said controller by wireless communication.

3. The system of claim 1 , wherein said controller comprises one of a group of a stable multi-input multi-output (MIMO) fuzzy neural model controller, an optimal controller, an H-Infinity (robust) controller, a linear adaptive controller, a neural (non-fuzzy) controller, a PID controller, and a model-based controller.

4. The system of claim 1 , wherein said controller is configured to receive and process one or more of: desired values of hemodynamic and physiological parameters for a patient; actual values of hemodynamic and physiological parameters for said patient; error signals; and heuristic knowledge.

5. The system of claim 1 , wherein said system further comprises an update law unit.

6. The system of claim 1 , further comprising external means for cooling or warming said patient.

7. The system of claim 6 , wherein said external means includes heating or cooling pads as alternative to or adjuncts to endovascular temperature methods.

8. The system of claim 1 , wherein said one or more sensors and devices include an intravenous infusion system.

9. The system of claim 8 , wherein said intravenous infusion system is a medication or fluid delivery intravenous infusion system.

10. The system of claim 1 , further comprising an external temperature-altering device including at least one of a cooling surface, a cooling blanket, a cooling pad, a cooling pillow, a cooling wrap, a cooling garment, an evaporative cooling method, a heating surface, a heating blanket, a heating pad, a heating pillow, a heating wrap, or a heating garment.

11. The system of claim 1 , wherein the one or more sensors and devices for at least one of measuring or adjusting hemodynamic parameters includes sensors of at least one of a group including neural activity, consciousness, circadian physiology, and attentiveness.

12. A method of performing therapeutic temperature management, comprising:
measuring and adjusting hemodynamic parameters in a patient;
determining an oxygen extraction ratio (OER) using oximetry values from an endovascular catheter and arterial saturation data provided by one of an external pulse oximeter or an indwelling arterial catheter capable of continuous blood gas measurement; and
adjusting temperature in said patient using at least one of an internal temperature-altering device or external temperature-altering device, based on the OER.

13. The method of claim 12 , wherein the internal temperature-altering device includes an endovascular catheter.

14. The method of claim 12 , wherein the external temperature-altering device includes at least one of a cooling surface, a skin cooling pad, a cooling blanket, a cooling pad, a cooling pillow, a cooling wrap, a cooling garment, an evaporative cooling method, a heating surface, a skin heating pad, a heating blanket, a heating pad, a heating pillow, a heating wrap, or a heating garment.

15. The method of claim 12 , wherein said measuring and adjusting includes measuring one or more of vascular pressure and oximetric measurements.

16. The method of claim 15 wherein said measuring and adjusting includes measuring one or more of central venous hemoglobin saturation, central venous pressure, oxygen extraction ratio, pulse oximetry, transcutaneous CO 2 end-tidal CO 2 skin temperature flux, galvanic skin response, transcutaneous PO 2 variations of Heart Rate Variability, cardiac output, stroke volume variation, pulse volume variation, central venous pressure, tissue hemoglobin oxygen saturation, cerebral hemoglobin oxygen saturation, EEG, transcranial Doppler, somatosensory evoked potential, breathing rate, auditory evoked potentials, actigraphy, and eye movement.

17. The method of claim 15 wherein the measured and adjusted variables are correlated to a state of precision and optimized physiologic endpoints including at least one of a group comprising metabolism, cardiovascular function, and at least one neurologic state.

18. The method of claim 12 further comprising the step of controlling one or more of a skin heating pad or a skin cooling pad.

19. The method of claim 12 wherein said measuring and adjusting includes measuring and adjusting one or more of central venous hemoglobin saturation, central venous pressure, oxygen extraction ratio, pulse oximetry, transcutaneous CO 2 end-tidal CO 2 skin temperature flux, galvanic skin response, transcutaneous PO 2 variations of Heart Rate Variability, cardiac output, stroke volume variation, pulse volume variation, central venous pressure, tissue hemoglobin oxygen saturation, cerebral hemoglobin oxygen saturation, EEG, and transcranial Doppler.

Assignees

• Alam Hasan
• Ward Kevin
• Gunnerson Kyle
• Najarian Kayvan
• Univ Michigan Regents

Inventors

• Ward Kevin
• Gunnerson Kyle
• Najarian Kayvan

Classifications

• A61F2007/126

  for invasive application, e.g. for introducing into blood vessels · CPC title

• A61F2007/0096

  with a thermometer · CPC title

• A61B2505/01

  Emergency care · CPC title

• A61B5/7267

  involving training the classification device · CPC title

• A61B5/412

  Detecting or monitoring sepsis · CPC title