HUMIDIFICATION SYSTEM AND POSITIVE AIRWAY PRESSURE APPARATUS INCORPORATING SAME
Systems, apparatus, and methods for providing humidity in a positive airway pressure (PAP) device. In one embodiment, a humidifier is configured to periodically provide vapor to a flow of pressurized gas to produce flows of pressurized gas with added humidity. Each of the flows of pressurized gas with added humidity may be timed to reach a user interface primarily during a first portion of a breath cycle (e.g., during inspiration). Portions of the flow of pressurized gas that reach the user interface during a second portion of the breath cycle (e.g., during expiration) may include little or no added humidity.
This application claims the benefit of U.S. Provisional Application No. 61/916,959, filed Dec. 17, 2013, which is incorporated herein by reference in its entirety.
Embodiments described herein relate generally to positive airway pressure apparatus and systems, and, more particularly, to systems and methods adapted to humidify a gas (such as air) delivered by the positive airway pressure apparatus.
BACKGROUNDPositive airway pressure (PAP) therapies are frequently used in the treatment of, among other ailments, obstructive sleep apnea, asthma, bronchitis, chronic obstructive pulmonary disease, snoring, and congestive heart failure. These therapies typically provide a flow of fluid (e.g., typically a gas such as air, but may be most any gas or gas-vapor mixture that may or may not include therapeutic agents such as oxygen, water, or medicinal vapors) to pressurize the airway of a user to a pressure in the range of 4-30 centimeters (cm) of water (e.g., often about 4-20 cm water) or more.
Depending upon the particular therapy, a variable or a constant pressure may be administered to the user to reduce or eliminate airway occlusions (or to otherwise treat acute or chronic respiratory failure) that necessitated the use of the therapy. For instance, continuous positive airway pressure (CPAP) may provide a generally continuous pressure throughout the user's breathing cycle. Bi-level positive airway pressure (Bi-PAP) may provide at least two different pressures in coordination with the user's inhalation and exhalation efforts. In more advanced systems, auto-titration positive airway pressure (Auto-PAP) systems may regulate the therapy pressure based on the level of breathing assistance the user may require at any given point during a breath.
Regardless of the particular therapy, these positive airway pressure (PAP) systems typically include at least a blower unit and a user interface or mask. A delivery hose may connect the blower unit to the mask, wherein the hose and mask together define a gas delivery conduit between the blower unit and the user.
The mask may be configured to secure relative to the user's head in such a way as to form a generally air-tight seal with the user's airway (e.g., seal about the face, nares, and/or mouth). As a result, the blower unit may generate a flow of pressurized gas that is delivered to the airway via the delivery conduit.
A humidifier for humidifying the gas provided by the blower unit may also be provided. PAP humidifiers typically include a heated water reservoir containing a volume of water with a relatively large surface area. The reservoir is positioned between the blower unit and the mask. Gas from the blower unit may pass over the reservoir, where the gas collects evaporating water. The gas with the now-entrained moisture is then, via the delivery conduit, provided to the user.
SUMMARYIn one embodiment, a positive airway pressure apparatus is provided that includes: a flow generator comprising a housing containing a blower, the blower adapted to produce a flow of pressurized gas; a user interface adapted to communicate the flow of pressurized gas to an airway during a breath cycle; and an elongate delivery tube positioned between the flow generator and the user interface, the delivery tube adapted to communicate the flow of pressurized gas from the blower to the user interface. The apparatus may also include a humidifier defining an outlet that is in communication with the flow of pressurized gas, wherein the humidifier has a vaporizing device and a water source, the outlet located between the blower and the delivery tube. An electrical power source may be provided and adapted to provide electrical power to the humidifier. A controller in communication with both the vaporizing device and the power source is also provided. The controller is adapted to automatically modulate the electrical power provided to the humidifier during the breath cycle, wherein the electrical power is modulated in proportion to a flow rate of the flow of pressurized gas such that the humidifier adds water vapor at a rate that maintains a near constant humidity level in the flow of pressurized gas during the breath cycle.
In another embodiment, a positive airway pressure apparatus is provided that includes: a flow generator having a housing containing a blower, the blower adapted to produce a flow of pressurized gas at a variable flow rate; a user interface adapted to communicate the flow of pressurized gas to an airway during a target breath cycle; and an elongate delivery tube positioned between the flow generator and the user interface, the delivery tube adapted to communicate the flow of pressurized gas from the blower to the user interface. A humidifier may also be provided and includes a vaporizing device having an outlet in communication with the flow of pressurized gas, wherein the outlet is located upstream from the user interface. An electrical power source is adapted to provide electrical power to the vaporizing device. A controller in communication with both the power source and the vaporizing device is also provided. The controller is adapted to provide the electrical power to the vaporizing device during a power interval such that the vaporizing device introduces water vapor into an inspiration portion of the flow of pressurized gas, during the power interval, to produce a flow of pressurized gas with added humidity. A start time and duration of the power interval are selected or calculated such that the flow of pressurized gas with added humidity arrives at the user interface beginning at or near an onset of an inspiratory phase of the target breath cycle and lasts for most or all of the inspiratory phase of the target breath cycle.
In yet another embodiment, a method for adding humidity to gas delivered by a positive airway pressure apparatus is provided. The method includes: producing, with a blower, a flow of pressurized gas at a variable flow rate; transporting the flow of pressurized gas from the blower to a user interface via a delivery tube positioned between the blower and the user interface; and detecting, with a controller, one or both of an inspiratory phase and an expiratory phase of one or more breath cycles. The method further includes introducing, during a power interval, humidity into a portion of the flow of pressurized gas to produce a discrete flow of pressurized gas with added humidity. The humidity is introduced by a vaporizing device having an outlet proximate the blower and in communication with the flow of pressurized gas. The method also includes determining, automatically with the controller, a start time and duration of the power interval so that the flow of pressurized gas with added humidity reaches the user interface at or near an onset of an inspiratory phase of a current or future breath cycle and ends at or near an end of the inspiratory phase, or at or near an onset of an expiratory phase, of the current or future breath cycle.
In still yet another embodiment, a method for adding humidity to gas provided by a positive airway pressure (PAP) apparatus is provided. The method includes: producing a continuous and variable flow of pressurized gas with a blower; transporting the flow of pressurized gas from the blower to a user interface via a delivery tube positioned between the blower and the user interface; and predicting, automatically with a PAP controller, a start time and duration of an inspiratory phase of a target breath cycle based upon an analysis of a current or a preceding breath cycle. The method also includes calculating or selecting, automatically with a humidification controller, a delay time and duration of a power interval, and providing power, under control of the humidification controller, to a vaporizing device after expiration of the power interval delay time, wherein the power lasts for the power interval duration. The vaporizing device is located proximate an outlet of the blower and is in communication with the flow of pressurized gas. The method also includes introducing humidity with the vaporizing device into the flow of pressurized gas during the power interval duration to produce a flow of pressurized gas with added humidity that reaches the user interface at or near an onset of the inspiratory phase of the target breath cycle and terminates at or near a beginning of an expiratory phase of the target breath cycle.
The above summary is not intended to describe each embodiment or every implementation. Rather, a more complete understanding of illustrative embodiments will become apparent and appreciated by reference to the following Detailed Description of Exemplary Embodiments and claims in view of the accompanying figures of the drawing.
Exemplary embodiments will be further described with reference to the figures of the drawing, wherein:
The figures are rendered primarily for clarity and, as a result, are not necessarily drawn to scale. Moreover, various structure/components, including but not limited to fasteners, electrical components (wiring, cables, etc.), and the like may be shown diagrammatically or removed from some or all of the views to better illustrate aspects of the depicted embodiments, or where inclusion of such structure/components is not necessary to an understanding of the various exemplary embodiments described herein. The lack of illustration/description of such structure/components in a particular figure is, however, not to be interpreted as limiting the scope of the various embodiments in any way.
DETAILED DESCRIPTION OF EXEMPLARY EMBODIMENTSIn the following detailed description of illustrative embodiments, reference is made to the accompanying figures of the drawing which form a part hereof. It is to be understood that other embodiments, which may not be specifically described and/or illustrated herein, are also contemplated.
All headings provided herein are for the convenience of the reader and should not be used to limit the meaning of any text that follows the heading, unless so specified. Moreover, unless otherwise indicated, all numbers expressing quantities, and all terms expressing direction/orientation (e.g., vertical, horizontal, parallel, perpendicular, etc.) in the specification and claims are to be understood as being modified in all instances by the term “about.”
Embodiments described herein are directed to positive airway pressure (PAP) apparatus and systems incorporating a humidifier, and to methods of adding humidity to gas provided by a PAP apparatus. Exemplary PAP systems, like those described herein, are adapted to modulate delivery of humidity in proportion to a rate of flow of pressurized gas produced by the PAP apparatus so that a generally constant level of humidity is provided to the user during an inspiration portion of each breath cycle. In other embodiments, the PAP apparatus may deliver added humidity to a portion of the flow of pressurized gas that reaches a user interface (attached to the user) during a portion of the breath cycle (e.g., during inspiration), and potentially reduce or even suspend providing the added humidity to another portion of the flow of pressurized gas that reaches the user interface during a second portion of the breath cycle (e.g., during expiration). As a result, some embodiments using humidifiers like those described herein may provide the user with a generally constant level of humidity during inspiration, regardless of changes in a rate of the flow of pressurized gas, over the course of the treatment period. Moreover, in some embodiments, the PAP apparatus (e.g., humidifier) may vaporize only a volume of water needed to provide a desired target humidity level at the user interface primarily during inspiration. In still other embodiments, the introduction of added humidity to the flow of pressurized gas may occur remotely from the user interface, but be timed to reach the user interface at the expected or predicted time of inspiration.
As further described below, exemplary humidifiers as described herein may humidify gas within the PAP apparatus by utilizing a vaporizing device that vaporizes water when the device is electrically powered (e.g., when electrical power is provided to a moisture transfer or vaporizing element of the vaporizing device) and reduces or terminates vaporization when power is correspondingly reduced or terminated. Moreover, a rate of vaporization and the volume of water per unit of time that is vaporized may be dependent upon the level of power provided to the device such that modulating power to the vaporizing device may proportionally modulate the rate of vapor produced.
By providing added humidity proportional to the flow of pressurized gas during at least a portion of the breath cycle, the volume of liquid (e.g., water) required, as well as the energy necessary to convert the liquid to vapor, may be less than that required for conventional (e.g., heated water surface humidifiers such as system 50 of
As used herein, the terms “PAP,” “PAP system,” “PAP apparatus,” etc. refer to positive airway pressure treatment systems for use in treating a variety of respiratory conditions including but not limited to obstructive sleep apnea (OSA), asthma, bronchitis, chronic obstructive pulmonary disease (COPD), pneumonia, congestive heart failure, and snoring. Such PAP systems may be adapted for use on both stationary and ambulatory users, including applications for non-invasively ventilating patients having restrictive lung disease or hypoventilation syndromes using bi-level positive airway pressure (Bi-PAP) therapy, or adaptive servo-ventilation for the treatment of complex sleep apnea. PAP systems may not include, and may be differentiated from, critical care ventilation, wherein the upper airway is completely bypassed and ventilation occurs via a tracheostomy. In the case of critical care ventilation, relative humidity levels at or near 100% (with air temperatures at or near body temperature) are common, as compared to lower relative humidity (e.g., 70-95%) typically provided during PAP therapy (with air temperatures at, near, or somewhat above room temperature).
As used herein, the terms “breath cycle” (and “breathing cycle”) refer to a respiratory cycle of a user that includes one inspiration (the “inspiratory phase”) followed by one expiration (the “expiratory phase”). The time it takes to complete one breath cycle is referred to herein as a “breath period.” While breath cycles may vary extensively depending on the user and the user's respiratory condition, a flow-versus-time plot of a typical breath cycle may have a generally sinusoidal shape, possibly with different inspiratory and expiratory periods or ratios (“I:E ratios”), the latter which typically range from 1:1 to 1:2. However, significant deviations from this range can occur, e.g., with patients having respiratory diseases.
It is noted that the terms “comprises” and variations thereof do not have a limiting meaning where these terms appear in the accompanying description and claims. Further, “a,” “an,” “the,” “at least one,” and “one or more” are used interchangeably herein. Moreover, relative terms such as “left,” “right,” “front,” “fore,” “forward,” “rear,” “aft,” “rearward,” “top,” “bottom,” “side,” “upper,” “lower,” “above,” “below,” “horizontal,” “vertical,” and the like may be used herein and, if so, are from the perspective observed in the particular figure. These terms are used only to simplify the description, however, and not to limit its scope in any way.
In a configuration like that of
With reference to the figures of the drawing, wherein like reference numerals designate like parts and assemblies throughout the several views, an exemplary embodiment of a PAP apparatus 70 in accordance with one embodiment of this disclosure may be configured as diagrammatically represented in
The apparatus 70 may include a humidifier having a moisture transfer element capable of rapidly initiating and terminating moisture delivery to the flow of pressurized gas (e.g., delivering moisture during a first portion of a breath cycle and reducing or suspending delivery of moisture during a second portion of the same breath cycle). In the embodiments described and illustrated herein, the moisture transfer element may be configured as a capillary force vaporizer (CFV) 73. The CFV 73 may be configured to introduce/add humidity to a flow of pressurized gas 80 produced by the blower 74 to create a flow of pressurized gas with added humidity 82 for delivery to the mask 76. The CFV 73 may be part of a humidification subsystem 71 of the apparatus 70 that also includes a reservoir 72 and a water conveying device 75 (e.g., a wick or small tube (with or without a water pump)) operable to transport water from the reservoir to the CFV.
In one embodiment, some or all of the humidification subsystem 71 may be physically separate from the blower 74/housing 84 as shown in
With this general introduction,
The PAP apparatus 100 may include a flow generator or blower 102 having an outlet 104 that may be in communication with a first or proximal end of an elongate delivery hose or tube 106 positioned between the flow generator (e.g., blower 102) and a user interface or mask 108. In the illustrated embodiment, a T-shaped connector 301 (in cross-hatched section) may be located between the outlet 104 and the delivery tube 106 for reasons that will become apparent.
A second or distal end of the delivery tube 106 may be connected to an inlet of the user interface 108. The user interface 108 is illustrated generically, but is understood to include most any interface that seals effectively to a user 110 (e.g., about the user's face (nose and/or mouth) or within the user's nares) in such a way that a flow of pressurized gas delivered to the user interface may be communicated to an airway 112 of the user during treatment (e.g., during one or more breath cycles). For example, the user interface could be a face mask that covers one or both of the user's mouth and nose; a nares pillow seal; or any similar device or combination of such devices. For simplicity, the user interface may be referred to hereinafter as a “mask” without limitation.
As used herein, the term “gas” is understood to include most any gas or gas-vapor combination. For example, the gas provided by the blower 102 may include air, oxygen, water vapor or droplets, medicinal vapor or droplets, and combinations thereof. For simplicity of description, the terms “air,” “fluid,” and “gas” may be used interchangeably herein. “Pressurized gas,” as used herein, refers to gas at a positive pressure relative to ambient pressure. “Blower,” as used herein, refers to most any device or source capable of producing a flow of pressurized gas.
The delivery tube 106 and user interface (mask) 108 may together define a delivery conduit 107 forming a passage that transports or otherwise communicates the flow of pressurized gas from the outlet 104 of the blower 102 to the inlet of the mask and then to the airway 112 of the user 110. The delivery conduit, e.g., delivery tube 106 or mask 108, may include one or more exhaust vents 114. Such vents are known to provide what is referred to an “intentional leak.” Intentional leak is provided to assist in purging carbon dioxide from the delivery conduit 107 during the expiration phase of each breath cycle. In one embodiment, one or more vents 114 may be included and provide the equivalent of a single, four millimeter (mm) opening (although other leak sized are certainly possible). In practice, the vent leak may vary widely (e.g., up to six mm opening) depending on mask type.
To provide the desired flow of pressurized gas within the delivery conduit 107, the blower 102 may be part of a flow generator having a flow generator or blower housing 103 forming a volute containing an impeller or fan 116. An electric motor 118, such as a brushless DC motor, may rotate the fan during use. As the fan rotates, it draws gas (e.g., ambient air) in via an inlet 120 of the blower 102/housing 103, where the gas is then compressed by the fan and expelled through the outlet 104. By controlling the rotational speed of the fan 116, the pressure of the gas within the delivery conduit 107 may be controlled to provide the desired treatment pressure to the user 110.
The apparatus 100 may further include a gas flow or PAP controller 200 that, among other tasks, may modulate or otherwise control a speed of the motor 118 (and, accordingly, a speed of the fan 116) to, for example, produce a variable flow rate at a constant pressure. The PAP controller 200 may, in one embodiment, include a microprocessor-based motor controller 206. All electrical components may be powered by either an onboard electrical power source or supply (e.g., a battery 202) or a remote power supply (AC or DC source) via an electric cord 204. The PAP controller 200 may electrically interconnect other components of the system 100 as further described herein.
The PAP controller 200 may be contained within the blower housing 103 as shown in
The PAP apparatus 100 may further include a pressure transducer 128. In one embodiment, the pressure transducer 128 is located within the housing 103. For example, in the illustrated embodiment, the pressure transducer 128 is located within the housing 103 and is connected at or near the outlet 104 (or, alternatively, connected at most any other point along the delivery conduit 107) via a pressure line or conduit 130. The pressure transducer 128 may produce an electrical signal proportional to the actual, measured pressure within the delivery conduit 107. The pressure signal may then be transmitted to the PAP controller 200 via an electrical signal line 132 as illustrated in
In other embodiments, additional sensors, e.g., a pneumotachometer 134 (e.g., a differential pressure transducer placed across a known restriction), may also be provided as shown in
While described as a pneumotachometer, other devices and/or methods for measuring or estimating air flow may also be used. For example, other embodiments may analyze a speed of the motor 118 or the voltage, current, or power draw of the motor.
The exemplary apparatus 100 may, in one embodiment, further include a humidifier subsystem (“humidifier 300”) as diagrammatically illustrated in
When configured as described above, the apparatus 100 places the vaporizing device in communication with the flow of pressurized gas and at or near the outlet 104 of the blower 102/housing 103. Such a configuration may simplify the apparatus 100 by shortening fluid connections between the water reservoir 304 and the vaporizing device. For example, the water source 304 may be located adjacent the blower housing 103 as indicated in
In one embodiment, water 305 contained within the water reservoir 304 may be conveyed, via wicking or capillary action, to the vaporizing device (e.g., CFV 302) by the water conveying device 306. While so illustrated, other embodiments may utilize a pump (fixed or variable displacement, peristaltic, etc.) connected to the water reservoir 304 and the vaporizing device to convey water from the former to the latter. In such a configuration, the pump may be activated (e.g., by a humidification controller 303) to deliver water, via a water line, to the vaporizing device. In some cases, the water conveying device 306 may simply be a short, small diameter capillary tube (without a pump). Water may then be conveyed by the tube via capillary force created by the vaporizing device, as well as capillary forces created by walls of the tube, or by gravity (depending on the position of the reservoir).
Conventional heated humidifiers (see, e.g.,
Unlike these conventional PAP humidifiers, the humidifier 300 (e.g., the vaporizing device) may, in one embodiment, be a CFV 302 such as the humidifier element used in the MyPUREMIST model CFV 100 personal humidification unit distributed by Vapore, LLC. of Concord, Calif., USA. Such CFV devices may convert water into vapor by providing a heating or vaporizing element (e.g., heated surface area) that converts liquid to vapor via both capillary force and phase transition. The effect is that vapor may be forcefully emitted from the outlet 318 of the vaporizing device 302 upon electrically energizing (heating of) the vaporizing device. As a result, the PAP apparatus 100 may be able to rapidly and reliably control the vapor output of the CFV throughout the breath cycle to provide the flow of pressurized gas with the desired target humidity level. That is, because of the responsive nature of the CFV 302, humidification of the flow of pressurized gas (to produce a flow of pressurized gas with added humidity) may be precisely controlled during individual breath cycles to ensure a constant (or near constant) level of humidity is provided to the user during inspiration (over the entire treatment period), even when parameters such as breath rate, breath flow, leak magnitude (intentional or unintentional), tidal volume, and/or pressure changes. Thus, the CFV 302 may require heating only the amount of water that is needed to provide a constant (or near constant) target humidity level to the flow of pressurized gas delivered to the user interface. In other embodiments, the CFV 302 may add humidity (to reach the desired target humidity level) to only those portions of the flow of pressurized gas that reach the user interface primarily during the inspiratory phase of each breath cycle. Accordingly, disadvantages associated with conventional humidifiers (e.g., heating of a large reservoir of water, delivering humidified gas to the user interface during the expiratory phase) may be avoided.
In the embodiment illustrated in
The humidification controller 303 and/or the PAP controller 200 may analyze data to determine various parameters associated with PAP operation. For example, breath rate, tidal volume, intentional leak flow, gas flow, mask leak flow, inspiratory/expiratory transitions, predictions regarding onset and/or duration of inspiratory phases of subsequent (future) breath cycles, algorithm functional constants and/or lookup tables, vaporizing device operating parameters (some of which are described in more detail below), among others, may all be analyzed and/or determined by the humidification controller 303 and/or the PAP controller 200. Still yet other parameters regarding operation of the PAP apparatus 100 (or PAP apparatus 70), e.g., volume (e.g., length and diameter) of the delivery tube 106, mask intentional leak, mask dead space, and desired humidification level may be user-provided, e.g., via a control panel or the like located on the housing 103 and/or the humidifier housing 311. Some of these parameters may be explicitly entered, while others may be selected from component classifications. For example, instead of entering explicit dimensions for the hose 106 and/or mask 108, the user may only be required to select a hose or mask part number or descriptor (e.g., “A,”, “B,” or “C”). The controller 200 (or 303) may then automatically determine intentional leak, hose volume, and other parameters.
The CFV 302 may respond quickly to commands from the controller 303 (or the controller 200). As a result, exemplary vaporizing devices (e.g., CFV 302) may be able to modulate vapor delivery to the flow of pressurized gas to provide, in one embodiment, the flow of pressurized gas with a generally constant level of humidity (e.g., a continuous modulation humidification mode) regardless of changes in rate of the flow of the pressurized gas. Moreover, in other embodiments, the apparatus (e.g., vaporizing device) may be able to reduce or even suspend vapor delivery (e.g., a discontinuous humidification mode) to a portion of the flow of pressurized gas (e.g., the portion that is present at the user interface during the expiratory phase of the breath cycle) by reducing or suspending electrical power to the vaporizing device, and then resume vapor delivery to another portion of the flow of pressurized gas (the portion that is present at the user interface during the inspiratory phase).
In either the continuous or discontinuous humidification mode, the total water and power required over the treatment period to provide the desired humidity level to the user during the inspiratory phase of each breath cycle (the “target humidity level”) could be reduced as compared to conventional PAP humidification. In fact, it is contemplated that some embodiments of the PAP systems described herein (e.g., apparatus 70, 100, and 400) could provide the target humidity level to the user (at least during the inspiratory phase of each breath cycle) over the course of a typical treatment period (e.g., 8-10 hours) while using a smaller water reservoir and less power (as compared to conventional PAP humidifiers).
As an example, a conventional water surface humidifier may have a reservoir size of 300-500 cubic centimeters (cc) and require 60-500 watts (on average) to adequately deliver a desired humidity level (e.g., up to 95% relative humidity) over a treatment period of 8 hours. It is believed that a PAP apparatus like the apparatus 100 of
While identified herein as a CFV 302, humidifiers having other types of moisture transfer elements now known or later developed that may provide similar performance/response are also contemplated.
As shown in
By delivering power (i.e., electrical current) to the heating/ejecting layer 316, the temperature of the CFV 302 may be elevated rapidly, permitting vapor to be almost instantaneously produced and forcefully emitted by the heating/ejecting layer 316 (via the opening 318) into the flow of pressurized gas. Moreover, assuming that adequate liquid is available to the vaporizing element 312, the volume of water vapor produced by the CFV 302 may be directly proportional to the power delivered to the CFV. As a result, output of the CFV 302 may be modulated (by modulating electrical power to the CFV) to accommodate variations in flow during the breath cycle.
In some embodiments, the controller (e.g., controller 303 or controller 200) may be configured to simply monitor a rate of the flow of pressurized gas and automatically modulate the electrical power to the CFV 302 during the breath cycle. This process may modulate the amount of water vapor added in proportion to the flow of pressurized gas to maintain a generally constant target humidity level in the flow of pressurized gas (even as the flow of pressurized gas changes) during the breath cycle and over the treatment period. In other embodiments, the controller (303 and/or 200) may further analyze current or previous breath cycles to predict future breath/humidification needs, and command the CFV to provide added humidity primarily to those portions (the “inspiration portions”) of the flow of pressurized gas that will reach the user interface 108 at or near the onset of the inspiratory phase of each breath cycle. In the case of this pulsed or discontinuous humidification mode of the CFV 302, the system may again provide a generally constant level of humidity to the patient during the inspiratory phases even as the flow of the pressurized gas changes over the course of inspiration.
Power to the CFV 302 may be reduced substantially or suspended altogether (in some embodiments) during a portion of the breath cycle to effectively reduce or even terminate the introduction of additional humidity into the flow of pressurized gas 136. As a result, the flow of pressurized gas may include the pulses or flows of the pressurized gas with added humidity 140 separated by periods of the flow of pressurized gas 142 that are non-humidified or “dry” as represented in
By applying principles in accordance with embodiments as described herein, the pulses or flows of pressurized gas with added humidity 140 may be timed to be delivered to the user interface 108 primarily during the inspiratory phase of each breath cycle. That is to say, water vapor may be provided by the CFV 302 to the inspiration portions of the flow of pressurized gas (to produce the flows of pressurized gas with added humidity) that are timed to reach the user interface during the inspiratory phase of each breath cycle. Conversely, the flows of non-humidified gas 142 may reach the user interface primarily during the expiratory phase of each breath cycle, or during pauses in breathing. Stated another way, the timing of the interval that produces the flow of pressurized gas with added humidity may be selected to ensure that the flow of pressurized gas with added humidity reaches the user interface 108 generally at or near an onset of the inspiratory phase of a current or subsequent (e.g., future) breath cycle and lasts for a duration of that inspiratory phase. Thus, added humidity to the flow of pressurized gas reaching the user during the expiratory phase may be reduced, minimized, or even avoided, thereby reducing the total volume of water required over the treatment period as well as reducing the power needed to provide the desired target humidity level to the user.
The timing of the delivery of the flows of pressurized gas with added humidity 140 may be complicated in some embodiments by the remote location of the humidifier (e.g., the vaporizing device (CFV) 302). That is, when the CFV 302 is positioned upstream of the user interface 108 by a distance 320, the flow of pressurized gas with added humidity 140 produced by the vaporizing device is delayed, after introduction, in reaching the user interface 108 (e.g., it lags behind the introduction of the added humidity). This delay is dependent on several factors including: the distance 320, the pressure of the flow of pressurized gas 136, tidal volume, and breath rate, as well as tube 106/mask 108 volume and intentional and unintentional leak flow. This delay could be at least partially alleviated by locating the CFV 302 closer to the user interface. However, moving the CFV 302 away from the housing 103 could result in a less compact design, e.g., power and water would need to extend to the CFV location.
Illustrative apparatus and methods like those described and illustrated herein may address this problem by accurately predicting when the onset of the next inspiratory phase will begin, and timing a start and duration of a power interval to the vaporizing device 302 to produce the pulses or flows of pressurized gas with added humidity 140. By accurately predicting inspiration and timing the power interval based upon that prediction, the apparatus 100 (or apparatus 70 and 400) may deliver the flows of pressurized gas with added humidity 140 to the user interface 108 beginning at the onset of the inspiratory phases and lasting for the duration of the inspiratory phases.
In one embodiment, injecting the humidity into the flow of pressurized gas may include injecting humidity into the flow of pressurized gas before the inspiratory phase of the target breath cycle, e.g., injecting the humidity during at least a portion of a breath cycle preceding the target breath cycle (e.g., the breath cycle for which the humidity is to be added). Moreover, each injection of humidity may be provided for the power interval duration (which is estimated or otherwise determined by the controller 303 or controller 200) to ensure that the added humidity is provided for most or all of the inspiratory phase of each breath cycle. Still further, the power delivered during the power interval may be modulated by the controller 303 to ensure delivery of a generally continuous level of humidity regardless of the flow of gas (i.e., the vapor emitted by the vaporizing device may be proportional to the flow within the conduit 107).
While not wishing to be limited to any specific embodiment, the power interval start time (also referred to herein as a power interval delay time) and duration, as well as how electrical power to the CFV will be modulated, may be determined based on one or more of: a pressure of the pressurized gas; total hose flow (which may include flow attributable to each of: intentional leak; unintentional leak; and breath cycle flow); a breath rate of the user; inspiratory tidal volume; expiratory volume; I:E ratio; inspiratory and expiratory flow dynamics (e.g., shape and amplitude of the flow curves); start and end times of both inspiration and expiration; time of peak flow during inspiration and expiration; power available to the vaporizing device, a volume of the delivery tube and the user interface between the outlet of the humidifier and the airway (which is a function of the distance 320); and a power-to-vaporization transfer function of the vaporizing device.
PAP apparatus and methods incorporating CFVs (e.g., apparatus 70, 100, and 400) may offer numerous benefits. For instance, by delivering vapor in proportion to the electrical power or current supplied to the CFV 302, humidity added by the CFV may be dynamically adjusted to meet the needs of a particular user, e.g., based upon actual breath needs. Moreover, as stated elsewhere herein, due to the responsiveness of the CFV 302, power to the CFV may be modulated during vaporization to minimize power and water usage while maintaining a relatively constant target humidity level based upon gas flow. In still other embodiments, power to the CFV may be entirely terminated during at least a portion of one or more breath cycles. As further described below, in embodiments that provide this discontinuous humidification, power delivery to and modulation of the CFV 302 may be initiated based upon a detected parameter of a breath (e.g., the onset of inspiration or expiration of a previous breath cycle, a peak inspiratory or expiratory flow, etc.).
As further shown in
The housing 400 may further define an Input/Output (I/O) or control interface 410 to permit user input and system feedback regarding operation of the apparatus 400. In one embodiment, the control interface includes an input device, e.g., directional joystick 412, and an output device, e.g., LCD screen 414. During operation, various operational parameters may be presented on the LCD screen, whereby the user may select and/or alter such parameters by manipulation of the input device. Of course, while shown as a joystick and LCD screen, such a configuration is not limiting. For example, a series of discrete knobs or switches, indicator lights, touchscreen interfaces, and the like could be used alternatively, or in addition, to the joystick and LCD screen shown. In yet other embodiments, the control interface 410 may be configured as a remote computer (e.g., smartphone) that communicates (via wired or wireless protocols) with the housing 403.
Within the housing 403, a blower assembly or blower 430 may be provided. The blower 430 may include an impeller 431 or fan powered by an electric motor 433 (see
Various electronics may also be included to provide real time control of the blower 430 and other aspects of the apparatus 400. In one embodiment, these electronics may be incorporated onto a printed circuit board (PCB) 434. The PCB may include a microprocessor 436, a PAP controller 437 (e.g., to control the blower 430), a humidity or humidification controller 630 (described in more detail below), and a memory unit 438.
The housing 403 may further contain an I/O board 440 that receives input from the joystick 412 and outputs information to the LCD screen 414. The I/O board 440 is in communication with the PCB 434 to permit bidirectional communication with the components of the PCB 434 and other components of the apparatus. The control interface 410 may allow various inputs including, for example, the target humidity level desired during operation. Such a humidity level may be referred to in relative terms, e.g., the control interface may provide settings 1-10, each corresponding to a successively higher target humidity level.
The housing 403 (e.g., the body 402) may also include various seals or covers to protect system components (e.g., a transparent cover may be provided over the LCD screen 414). The housing 403 may provide other seals to ensure that flow through the apparatus is contained. For example, an air filter cartridge seal 442 may be provided to ensure ambient air flows into the blower 430 and not to unintended areas of the housing 403.
A gasket 444 may be located at or near the blower outlet 432 between the blower 430 and a humidifier housing 446, the latter adapted to removably receive the humidifier 600 as further described below. The humidifier housing 446 may include an inlet 448 that communicates with the outlet 432 of the blower 430, and an outlet 450 that communicates with the outlet 408 of the housing 403. In one embodiment, a seal 449 may be provided between the outlet 450 and the outlet 408 to prevent pressurized gas from leaking into the housing 403.
The humidifier housing 446 may also include a pressure port 452 adapted to communicate with a conduit 453 on the blower 430. The conduit 453 may connect to a pressure sensor or transducer 454, e.g., located on the PCB 434.
As will be further described below, the humidifier 600 may include a CFV 602 that vaporizes water 435 drawn from the reservoir 406 and emits the vapor into a humidification chamber 456 formed by the humidifier housing 446. In some embodiments, a sensor, e.g., a temperature and humidity sensor 458, may be provided. While the sensor 458 may be located most anywhere, it is, in one embodiment, located in the humidification chamber 456. The sensor 458 may provide a signal representative of the temperature and/or humidity level of ambient air at system startup. By providing the sensor 458 within the humidification chamber 456, the sensor may be used to monitor temperature and humidity during operation as well.
The humidifier 600 may further include a mounting sleeve 612 to hold the CFV 602. In one embodiment, the mounting sleeve 612 includes a groove 614 to hold a seal (e.g., O-ring 616), the latter adapted to seal the mounting sleeve relative to the humidifier housing 446/housing 403.
The mounting sleeve 612 may further include a receiver 618 for receiving and securing a PCB 620. Two contact members 622 may electrically couple contacts on the PCB to electrical leads 624 on the heating/ejection layer 606 of the CFV 602 when the humidifier 600 is fully assembled. A lower cap 626 may attach (e.g., via a screw thread) to the mounting sleeve 612. The lower cap 626 may protect elements of the humidifier 600, while also securing the water conveying device 610 within the humidifier. When correctly installed, the humidifier 600 may make electrical connection with the housing 403 (e.g., with the humidity controller 630 on the PCB 434) via an electrical connector 628 of the housing that engages associated contacts on the PCB 620.
To generate vapor output, the humidity controller 630 may command a current to pass to the electrical leads 624 (see
As the vaporizing device vaporizes the water 435, more water is transferred to the vaporizing element 604 (as indicated by arrows 429 in
Both the water level sensor 621 and the water quality sensor 623 may be electrically connected to the humidity controller 630 or flow controller 437, so that appropriate action may be taken in response to unacceptable water level and/or water quality. In some embodiments, both the water level detector 621 and the water quality detector 623 may utilize the same sensor (e.g., sensor contacts 621). For instance, water level and water quality may be assessed by monitoring the impedance between two exposed contacts 621 formed on the PCB 620. An intermittent current or voltage may be passed across the contacts (e.g., a 10 kHz symmetrical square wave), wherein a measured current or voltage may be detected when the contacts 621 are submerged. When water level drops below the contacts 621, continuity between the contacts breaks, indicating to the controller 630 (or 437) an out-of-water condition. In such an instance, the controller may sound an alarm or terminate power to the humidifier.
In addition to water level detection, the contacts 621 may also distinguish whether the water in the reservoir is distilled or whether it contains minerals that may potentially damage the CFV. For example, since distilled water has a very high but measureable impedance, and tap water has ions and/or minerals that provide a lower impedance, the controller 630 (or controller 437) may distinguish between distilled water and potentially damaging mineralized water. Based upon the determination that the water is not distilled, the controller 630 (or 437) may sound an alarm, provide an alert message on the display 414 (see
The water level sensor 621 and water quality sensor 623 may be positioned in locations other than those shown in the figures. For example, the sensors could be in contact with the water in the water conveying device 610 or at some other location within the reservoir 406. Moreover, other methods for detecting water level and quality may be utilized. For instance, piezo-electric sensors could be used. Such sensors may be located at positions similar to the sensors 621 and 623. Alternatively, water level and/or quality sensors may be configured as non-contacting sensors located above the water in the reservoir 604. For example, the water level sensor could be an ultrasonic sensor that emits an ultrasonic sound wave and measures transit time of pulses reflected from the water surface.
During operation, the apparatus (e.g., apparatus 400) may, upon initialization, determine a relative humidity level of the ambient air. This may be accomplished using the temperature and humidity sensor, e.g., sensor 458. The user may set a desired target humidity level, e.g., via interaction with the control interface 410. Based upon the relative humidity of the ambient air and its temperature and pressure, and upon the user-selected target humidity level of the flow of pressurized gas, the apparatus (e.g., PAP controller 437 or humidification controller 630) may determine how much water vapor should be added (per unit volume of gas) by the humidifier 600.
For example, if the apparatus determines that the ambient relative humidity is 40% and the ambient temperature is 23 degrees Celsius (° C.), the absolute humidity can be determined from known relationships (see, e.g., www.humidity-calculator.com) to be approximately 8.3 milligrams of water/liter of gas (mg water/L gas) for a given pressure. If the user wishes to achieve a target relative humidity of 80%, this would require an absolute humidity at the same temperature of 16.5 mg water/L gas. As a result, the apparatus (e.g., the controller 437 or controller 630) can determine that the humidifier 600 would need to add about 8.2 mg water/liter gas to achieve the desired target humidity level.
In one embodiment, the relationship between relative humidity and absolute humidity may be provided in a lookup table contained in memory (e.g., memory 438 of the PCB 434, see
AH=(0.0583*e(0.0548*T))*RH (Equation 1))
wherein AH is the absolute humidity in mg water/L gas; T is the temperature in degrees Celsius (° C.); and RH is relative humidity at temperature T expressed as a percentage. Based upon this equation, the apparatus 400 (e.g., the humidity controller 600 and/or the PAP controller 437) may calculate the vapor content need to achieve the target humidity level. As is evident from Equation 1 above, the relationship between AH and RH, for a given temperature, may be expressed linearly.
Accordingly, apparatus in accordance with embodiments as described herein (e.g., apparatus 70, 100, and 400) may calculate how much water vapor needs to be added per unit volume of gas flow to achieve the desired target humidity level. As stated above, the apparatus may subtract from these calculated humidity levels the moisture content already present in the ambient gas and provide only the difference as added humidity to the flow of pressurized gas.
The apparatus (e.g., apparatus 70, 100, 400) may provide, at any given time during operation, a signal representative of a rate of flow of the pressurized gas. Such a flow rate may be directly measured, e.g., with a pneumotachometer (see pneumotachometer 134 of apparatus 100 of
With this information, power to the CFV (e.g., 302, 602) may be modulated to achieve the constant target humidity level regardless of changes in the rate of flow of the pressurized gas. As an example, in some embodiments, the CFV (e.g., 302, 602) may be based upon a model MyPUREMIST CFV 100 personal humidification unit.
P=(45.3*F)+0.6 (Equation 2)
Wherein P is the power in watts provided to the CFV and F is the volumetric flow of water vaporized (in cc/min). The actual power calculated by Equation 2 may include a power efficiency loss factor that may be added as a multiplier (linear or nonlinear), or as an offset factor, to accommodate performance characteristics of any particular CFV or system construction.
Accordingly, in its simplest implementation, apparatus as described herein (e.g., apparatus 70, 100, and 400) may, based upon the instantaneous rate of flow of the pressurized gas detected in the system, energize and modulate the humidifier (e.g., 73, 300, 600) to provide the target humidity level to the user in a continuous modulation humidification mode.
While the vapor produced by the CFV may be proportional to the electrical power provided to the vaporizing device, such a configuration is not limiting. Rather, in other embodiments, most any transfer function, or combination of transfer functions, could define the relationship between electrical power to the CFV and the resulting water vaporized based upon a given CFV design and based upon an apparatus in which the CFV is used. Using the CFV from the model MyPUREMIST CFV 100, power losses may be present and the slope of the curve in Equation 2 may increase with a partial multiplier of this equation.
During or before the initialization period, the user may select a desired target humidity level (e.g., using the control interface 410). The apparatus may then compare vapor content of the ambient gas to the target humidity level at 638 and then calculate the difference as the amount of vapor to be added to the flow of pressurized gas at 640. Once this is determined, the controller (e.g., humidification controller 630) may begin modulating power to the humidifier (e.g., to the CFV) to correspondingly modulate humidity added to the flow of pressurized gas in proportion to the rate of flow of the pressurized gas at 642. The rate of flow of the pressurized gas may be provided, in one embodiment, to the humidification controller 630 by the PAP controller (e.g., controller 437). This operation may continue unless a system fault or system termination is detected at 643, at which point the apparatus may initiate a humidifier shutdown sequence at 644.
As stated above, while the continuous modulation humidification mode is effective, humidity of a particular level is of benefit to the user primarily during inspiratory portions of the user's breathing cycles. That is, maintaining a desired target humidity level at the user interface may provide little benefit to the user during expiration. As a result, if the humidity added to the flow of pressurized gas reaching the user interface during expiration were reduced or terminated (e.g., added humidity from the CFV were discontinuous or pulsed), water and power conservation may be realized without negatively impacting the user.
The CFV is positioned remotely from the user interface in the exemplary PAP apparatus 70, 100, and 400. As a result, in order to provide the target humidity level to the user primarily when the user is inspiring requires the PAP apparatus to predict when the added humidity should be injected into the flow of pressurized gas to account for the delay between adding the humidity to the flow of pressurized gas and the flow of pressurized gas with the added humidity reaching the user interface.
In general, the process illustrated in
Based upon this prediction, the controller (e.g., controller 437 or 630) may automatically select or calculate a power interval start time or delay (e.g., a period of time measured from an indexing event after which power will be provided to the CFV) and power interval duration at 647. “Power interval” or “power interval duration” as used herein refers to the time period in which the controller (e.g., humidification controller) provides electrical power to the humidifier (e.g., to the CFV) at a level that causes the CFV to add humidity (as water vapor) to the flow of pressurized gas. The power interval start time (based upon the power interval delay) and power interval duration are selected or calculated in an attempt to ensure that the flow of pressurized gas with added humidity 140 (see, e.g.,
In some embodiments, the power interval delay time is triggered from a start of inspiration. That is, the controller (e.g., controller 437 or 630) may detect when the inspiratory phase of a preceding first breath cycle begins and then initiate the power interval delay and duration for the subsequent target breath cycle based thereon. While described as indexed from the start of inspiration, the power interval delay time could be based upon most any event trigger that occurs during each breath cycle (e.g., start of expiration, peak expiratory or peak inspiratory flow).
After the specified power interval delay elapses at 649, power to the CFV may be initiated (e.g., the power interval may start) and modulated in proportion to the flow of pressurized gas at 651 to achieve the target humidity level. This may continue until the power interval expires at 653, at which point control is passed to 655. At 655, power to the CFV is: reduced to a point where little or no vapor is added to the flow of pressurized gas; or terminated altogether. The process may then determine whether treatment is complete or the PAP apparatus has encountered a fault (e.g., low water reservoir level, CFV fault, low battery (where used) power remaining, etc.) at 657. If not, control may return to 645. Otherwise, a shutdown sequence may be initiated at 659. The shutdown sequence may disable power to the humidifier (e.g., humidifier 600) and may take other steps, e.g., provide a visual or audible alarm.
While these methodologies describe generally how a PAP apparatus may provide continuous or discontinuous humidification modes, the following examples describe more specific implementations.
ExamplesIn one example, a computer model was built to simulate different PAP breathing scenarios. For each of these PAP breathing scenarios, humidifier power interval delay (e.g., indexed from a start of inspiration) and power interval duration (e.g., for discontinuous humidification) were then iteratively input into the computer model and the results analyzed. Based upon this analysis, specific values for power interval delay and duration were selected (for each scenario) that yielded the desired target humidity level at the user interface during the inspiratory portion of each breath cycle, and reduced or terminated added humidity to the user interface during the expiratory phase of each breath cycle.
A substantial number of breathing scenarios that might be encountered during typical PAP operation were investigated using the computer model simulation, and corresponding values for power interval delay and duration were iteratively determined for each scenario. These values, could, in one embodiment, be stored, e.g., as a lookup table, within (or otherwise accessible by) the PAP apparatus (e.g., apparatus 70, 100, and 400). Based upon actual sensor measurements and system inputs (e.g., flow, pressure, etc.), the PAP apparatus could then identify the simulation scenario within the lookup table that most closely matches the actual breath cycle and then select the power interval delay and duration values associated with that lookup table entry. Of course, such a system could constantly update the set of parameters being used (and therefore update the power interval delay and duration) to closely follow the user's instantaneous breath cycle.
The exemplary computer model allows for manual input of pertinent system and breath parameters including: hose volume (e.g., hose length and diameter); user interface (mask dead space) volume; intentional leak; PAP pressure; user breath rate; I/E ratio; tidal volume; inspiratory and expiratory flow dynamics/patterns; unintentional leak; ambient humidity and temperature; and target humidity and temperature, among others. With these parameters fixed each scenario, values for power interval delay and duration were manually iterated until the most appropriate humidification values were determined.
With reference to
The process starts at 701. Initial parameters regarding the PAP apparatus may first be provided. For example, hose (e.g., hose 106) information may be input at 702. Hose information may be input as a length and diameter, or directly as a hose volume. Of course, when implemented on an actual PAP apparatus, the hose information could be input into the PAP apparatus as a part number or other hose identifier, from which the PAP apparatus could, e.g., via a lookup table, determine the actual hose volume. Similarly, information regarding the mask (e.g., mask dead space) may be input at 704. Once again, the mask dead space may be provided directly to the PAP apparatus, or the apparatus could determine (e.g., via a lookup table) the dead space based upon a mask part number or other inputted identifier.
The PAP pressure (which is typically determined and set by a clinician) may be input into the model at 706. Based upon the intentional mask leak (which may be part of the mask information inputted at 704), the simulation may determine an appropriate equation or lookup table for mask leak flow versus pressure at 708, and the mask leak flow (Fm) may be calculated at 710.
The model may further have as inputs: an estimated unintentional mask leak flow (Fu) at 712; a breath rate at 714; an inspiratory:expiratory (I:E) ratio at 716; and a tidal volume (Vt) at 718.
The model may also permit the input or selection of one or more breathing types at 720. For example, a sinusoidal breathing pattern may be selected, as well as other predefined shapes. Based upon the breathing type selected for the simulation, an equation may be determined (e.g., selected from a lookup table or otherwise calculated) that represents lung flow (Fl) versus time at 722.
A desired sampling time increment (dt) may be input at 724, and for time (t) set equal to zero, lung flow (Fl) and lung volume (Vl) may be set to zero at 726. Moreover, hose flow (Fh) may be calculated (at time zero) to be equal to the sum of Fl, Fm, and Fu at 728.
The simulation may increment time by dt at 730 and then re-calculate lung flow Fl (at 732), lung volume Vl (at 734), and hose flow Fh (at 736). Assuming that a time period for the simulation has not expired at 738, control will return to 730 as shown and the calculations at 732, 734, and 736 will repeat for each time increment. Once the simulation time period (e.g., a period equal to several breath cycles) has expired at 738, the computer model may end the simulation at 740. The simulation may store the values for lung flow Fl (at 732), lung volume Vl (at 734), and hose flow Fh (at 736) for each time increment dt, along with calculations of: the timing of humidification delivered to the airway relative to the breathing cycle; the power delivered at each time step; and the average power and water consumed over each inspiratory phase, expiratory phase, and complete breathing cycle. By varying the inputs into the computer model and repeating this process, simulation models for dozens, hundreds, or even thousands (or more) of permutations of breathing and system variables (the scenarios) may thus be developed.
Based upon each breath simulation generated, humidification parameters were then evaluated (while the remaining variables for the simulation remain fixed). As shown in
The ambient relative humidity (RHa) and ambient temperature (Ta) may be input at 804. With this information, the ambient absolute humidity (AHa) may be calculated (see, e.g., Equation 1 above) at 806. The target relative humidity (RHt) may be input at 808, and the target absolute humidity (AHt) calculated at 810. The difference between the target and ambient absolute humidity (AHt−AHa) may be calculated at 812 to yield the additional vapor to be provided by the humidifier/CFV.
The computer model may be configured to simulate either continuous (e.g., continuous modulation mode) or discontinuous (e.g., discontinuous mode) humidification. For continuous humidification, a power interval delay time (Pdt) may be set to zero at 814, and a power interval duration time (Pdu) may be set to continuous at 816. On the other hand, for discontinuous humidification, a first iterative value for Pdt (e.g., which may be triggered by the onset of inspiration) may be input at 814, while a first iterative value for Pdu may be input at 816. Once again, as will be evident below, the values of Pdt and Pdu can be iteratively revised and the respective simulation re-run for each identified breathing scenario.
In addition to the power interval parameters, the type of power modulation (transfer function) that will be used (e.g., proportional flow modulation, step function input (e.g., square wave), or combinations thereof) may be input at 818.
The supply voltage available to the humidifier may be input or otherwise determined at 820, while the minimum input power level that will be provided to the CFV during operation (e.g. which may be zero watts or something higher) and the maximum input power level to the CFV may be input at 822 and 824, respectively.
The computer model may also receive the following inputs: tidal volume (Tv) at 826; I:E ratio at 828; system pressure (P) at 830; breath rate (e.g., breaths/minute) at 832; and the time interval step (dt) desired at 834. The simulation/system time (t) may then be set to zero at 836 (some of these parameters may have been input earlier, see, e.g., process of
Control is then routed from 836 to 838. If continuous humidification is selected, the model first determines or detects lung flow Fl and hose flow Fh at 840 (see 732 and 736 in
Next, the computer model may calculate the cumulative hose volume Vch at 850. As used herein, the cumulative hose volume (Vch) is calculated by subtracting from the current cumulative hose volume (Vcch) the sum of: the hose volume (as measured from the outlet 318 of the humidifier); and the mask volume. For instance, in the system shown in
The computer model may then, via a lookup table (or calculation), determine a time entry (tx) associated with the calculated value of Vch at 852. If the time entry tx in the lookup table that is associated with Vch specifies that power to the humidifier is on at 854, then the time t and current cumulative hose volume Vcch are tagged as providing humidity to the mask at 856.
If the answer at 854 is no, then the computer model may check to see if the end of the expiratory phase of the current breath cycle has occurred at 858. If not, the time t may be incremented (e.g., by dt) at 860 and control returned to 840 as shown. If, on the other hand, the end of expiration has occurred, then the model may calculate the peak and average power provided to the humidifier over the just-ended breath cycle at 862, as well as the peak and average power utilized over all the previous breath cycles at 864. Of course, given the known relationship between water vapor added by—and power provided to—the humidifier, the average vapor added to the flow of pressurized gas may also be determined. These values may be stored for subsequent utilization.
The computer model may continue by incrementing time by dt at 868 and returning to 840 until an adequate time period (e.g., at least as great as several breath cycles) has expired at 866, in which case the model may end at 870.
If discontinuous humidification is selected (e.g., at 814 and 816 of
Current cumulative hose volume (Vcch) may be calculated at 908. In some embodiments, Vcch may be calculated by integrating hose flow Fh over the time elapsed. Once again, the model may determine or detect (based upon the flow dynamics) when the inspiratory phase begins at 910. If inspiration is detected at 910, then the time t is tagged as the start of inspiration at 912. The peak and average power used over the just-completed breath cycle, as well as the peak and average power used over all previous breath cycles, may then be calculated at 914 and 916, respectively. The start of inspiration may also result in indexing the breath cycle counter to the next breath cycle (e.g., n+1) as indicated at 918. If the start of inspiration is not detected at 910, then control passes to 920, where the time t is tagged as being within the current breath cycle.
From both 918 and 920, control is passed to 922 to determine the time that has elapsed (te) since the start of inspiration of the current breath cycle was detected at 910. This elapsed time te may be calculated based upon the current time t and the breath rate.
The computer model may then, at 924, determine whether the elapsed time te determined at 922 satisfies two humidifier power conditions: (1) is te greater than or equal to the power interval delay (Pdt; inputted at 814); and (2) is te less than or equal to the sum of the power interval delay (Pdt) and the power interval duration (Pdu; inputted at 816). If so, it is known that the humidifier power is on and control passes to 926. Otherwise, control may pass to 928.
At 926, the computer model may calculate the electrical power needed to provide the flow of pressurized gas with the target ambient humidity (AHt). Based upon the power-to-water vaporization equation and the hose flow Fh (see, e.g., Equation 2), the power to the heating element of the humidifier may then be modulated (e.g., in accordance with the modulation type input at 818) at 930.
The values for time t and current cumulative hose volume Vcch (the latter calculated at 908) may then be saved and marked as being associated with power modulation of the humidifier at 934, after which control may pass to 928. At 928, the cumulative hose volume Vch may be calculated by, as stated above, subtracting from the current cumulative hose volume (Vcch) the sum of: the hose volume (as measured from the outlet 318 of the humidifier); and the mask volume.
Once Vch is determined, a time entry tx (e.g., from a lookup table or calculation) that corresponds to that value of Vch (or the next largest value of Vch) is determined at 932. The lookup table can then determine, for this time entry tx value, whether the humidifier power is on or off at 936. If the answer at 936 is yes, then the time t and Vcch are marked as occurring while humidity is provided to the mask at 938. In either event, control is passed to 940. If the simulation time period has expired, the process may then end at 942. Otherwise, control may return to 904 as shown.
As indicated above, in the illustrated examples, the power interval delay time is indexed from the beginning of the inspiratory phase of each breath cycle (the “indexing event”). However, such a configuration is not limiting. For instance, peak inspiratory flow, inspiratory lung volume, peak expiratory flow, and expiratory lung volume, among others, could each be used as the indexing event.
Once again, for any given set of breathing and physical conditions (i.e., for any one of the scenarios modelled), multiple simulations were run that iteratively covered a range of humidifier conditions (e.g., a range of power interval delays and power interval durations) while all other variables remain constant. These iterations were then evaluated to identify the values of Pdt and Pdu that provided the desired target humidity level at the user interface during most or all of each inspiratory phase of each scenario, but provided less or no added humidity to the flow of pressurized gas at the user interface during each expiratory phase. Once the best solution to each scenario was determined, a lookup table of power interval delay and power interval duration times was constructed and indexed to the respective scenarios. Such a lookup table may be similar to that shown in Table I. below, wherein for each scenario, Pdt and Pdu are tabulated.
In evaluating the iterative results to create each record in the lookup table, various characteristics of the simulations may be analyzed. These include, among others: how much humidity is delivered to the user interface during inspiration; what is the duration of the humidity delivered relative to the duration of the inspiratory phase; how much added humidity is provided at the user interface during expiration; and what is the relative humidity at the user interface compared to the target relative humidity. As discovered, a solution may exist for many breathing scenarios that provides the desired target humidity during inspiration, while reducing or terminating added humidity during expiration.
The lookup table (e.g., Table I) could be incorporated into an actual PAP apparatus (e.g., 70, 100, or 400). The PAP apparatus (e.g., its controller(s)) could then continuously monitor parameters such as lung flow and hose flow (among others) and compare them to the breathing scenarios contained in the lookup table to determine which table entry is most appropriately matched to the current (e.g., measured) flow pattern. Once found, the appropriate power interval delay and duration values Pdt and Pdu from that table entry could be used to control the CFV and provide the desired humidification. Of course, the controller(s) may update these parameters in real time, e.g., every calculation cycle, to ensure that the most accurate humidification parameters are being used throughout the treatment period.
In other embodiments, the simulation (or the PAP and/or humidification controller) may include the capability to automatically predict an appropriate power interval delay and power interval duration for a given breathing scenario without requiring the manual iterations described above. For example, the simulation (or controller) may accept any of the input or determined parameters described above with respect to
One embodiment that utilizes a predicted/calculated power interval delay and duration is illustrated generally in
Based upon an analysis of these characteristics of the breath cycle n, ideal values for power interval delay (Pdt) and power interval duration (Pdu) that would have provided effective humidification (e.g., provided power to the CFV in a way that would have produced the desired humidity level at the mask for most or all of the inspiratory phase while providing little or no additional humidity at the mask during the expiratory phase) during the breath cycle n may be calculated at 1006.
These ideal values of Pdt and Pdu calculated at 1006 may then be compared, in one embodiment, to the actual values of Pdt and Pdu that were used during the breath cycle n, and a difference or error calculated at 1008. In some embodiments, similar error calculations may be made comparing the ideal values of Pdt and Pdu calculated at 1006 to average values of Pdt and Pdu for two or more previous breaths. In yet other embodiments, error calculations may be generated based upon: the previous breath, the previous two breaths, and on up to the previous x breaths (where x is greater than or equal to three).
If it is found at 1010 that one or more of the errors calculated at 1008 exceeds a threshold value, control may pass to 1012, wherein a continuous modulation humidification mode is activated, after which the breath count B is indexed at 1016, and control returns to 1002. The continuous modulation humidification mode may remain active until breathing has stabilized, which may be determined by the errors calculated at 1008 dropping below the threshold values at 1010. The threshold value of error may be based upon some predetermined criteria that suggests breathing has become too erratic to permit accurate prediction of Pdt and Pdu.
If, on the other hand, the error determination at 1010 is below the established threshold error level, control may pass to 1014. Based upon the error calculations made at 1008, values of Pdt and Pdu may be selected/predicted for the next (now-current) breath cycle (n+1) at 1014. For instance, the values of Pdt and Pdu for the next breath cycle may be based upon the lowest error calculated at 1008. Alternatively, the various errors calculated at 1008 may be averaged and used to predict Pdt and Pdu for the next breath cycle.
After selecting Pdt and Pdu, the breath cycle counter may be indexed to reflect the actual breath cycle count at 1016, after which control is returned to 1002.
Thus, in some embodiments, the simulation (or the PAP or humidification controller) may at the end of each breath cycle, calculate an optimal or ideal power interval delay and power interval duration for that just-completed breath cycle and compare those values to the predicted values that were actually used during the just-completed breath cycle (and/or to one or more other preceding breath cycles) to generate one or more errors for both Pdt and Pdu. In the event that one or more of those calculated errors exceeds a threshold, the process may resort to continuous power modulation (continuous modulation humidification mode) until the calculated error(s) returns to acceptable levels.
Error calculation (see, e.g., 1008 in
While described as a simple average, other embodiments may calculate error based upon a more sophisticated statistical analysis. For instance, other embodiments may calculate error based upon weighted or moving averages, standard deviations, trend analyses, etc. where such analyses are beneficial to the accurate prediction of Pdt and Pdu.
As the process of
In addition to predicting Pdt and Pdu based upon an analysis of one or more previous breaths, systems/methods like those described above and shown in
Breathing scenarios using predicative humidification concepts and real-time, controller-calculated values for power interval delay and duration (as described above with reference to
The simulations of
Moreover, tidal volume is assumed to be 500 cubic centimeters (cc); the ambient temp is 23 degrees C.; the ambient relative humidity is 40%; the target relative humidity is 90%; the I:E ratio is 1:1; and a power efficiency factor of the CFV is 1.25. The simulations seek to deliver added vapor to achieve the target humidity level during the entire inspiratory portion of each breath cycle. With these assumptions,
As already discussed above, the simulation model measured or calculated several parameters (the “measured or calculated system parameters”). These measured or calculated system parameters may be measured/calculated based upon sampling at some time interval (e.g., every 10-50 milliseconds). Any or all of these calculated parameters may be continuously updated and stored for operational use or subsequent clinician interrogation. These measured or calculated system parameters may include: total hose flow (e.g., intentional leak, unintentional leak, and breath flow); breath rate; inspiratory tidal volume; expiratory volume; I:E ratio; inspiratory and expiratory flow dynamics (e.g., parameters representing the shape of inspiratory or expiratory flow versus time); a start and an end of the inspiratory portion of each breath cycle; a start and an end of the expiratory portion of each breath cycle; the time of peak inspiratory flow; and the time and peak expiratory flow. PAP pressure may also be included as measured or calculated parameter.
A plot of an exemplary simulation model is illustrated in
As described earlier, the simulation model may be capable of determining or calculating a variety of breath parameters. Based on various measurements or inputs of tidal volume and pressure, the controller (e.g., controller 303 of
Moreover, the computer model may simulate the application of power (see, e.g., CFV power curve 516, further described below) to the CFV 302 for a power interval duration or period 514 (Pdu) as illustrated in
In addition to turning power to the CFV 302 on and off (or at least reduced to a minimum threshold power), simulated power to the CFV may be modulated during use as represented by the power curve 516 in
Results similar to that illustrated in
Accordingly, it can be seen from these computer simulations how an exemplary PAP apparatus 100 could accommodate a wide variety of system pressures while still providing the benefit of precise vapor delivery with minimal power required. Moreover, as shown in
While these simulations indicate that an exemplary PAP apparatus (e.g., apparatus 100) may accommodate different breathing scenarios while still providing the desired vapor delivery, certain scenarios may present issues. For example, the ability to deliver vapor to the user during the entire inspiratory phase of each breath cycle could be adversely affected by: low breath rates; high leaks (intentional and unintentional); and low PAP pressures. For example, in the simulation of
As one may appreciate, these simulations illustrate exemplary implementations for predictive PAP humidification. When a sufficient number of these simulations are developed, a lookup table (containing scenario variables and their corresponding values for power interval delay and power interval duration) may be generated and stored in an actual PAP apparatus. During operation, the PAP apparatus controllers may match the actual breath parameters to the lookup table to find appropriate values for power interval delay and duration. Alternatively, the methods described with respect to
While exemplary transfer function relationships between CFV power and vapor produced are referenced above (see, e.g., Equation 2), such functional relationships may change to address the influence of various factors. For instance, it was discovered that the CFV is very responsive when the heater is maintained at a temperature just below its vaporization temperature. Therefore, in order to maximize response time, it may be preferred to maintain power at a minimum threshold power level (e.g., hold power at 5 watts rather than terminating power altogether) and modulate power proportional to flow above that level during the power interval. In other embodiments, the transfer function may deviate from strict modulation based upon the flow rate of the gas. For example, at the beginning of the power interval, it may be beneficial to momentarily spike the power to a high level to introduce water vapor more quickly. The power level may then return to levels dictated by the flow modulation relationship.
In practice, accuracy of the simulation models could be confirmed and corrected by including a humidity and temperature sensor in the mask to provide a specific measurement of the humidity and temperature during the inspiratory portion of each breath cycle. By relaying this information to the PAP controller and/or the humidification controller, humidification parameters may be tuned during PAP operation.
While described herein above in the context of a CPAP device, it is contemplated that the same or similar algorithms utilized to time the delivery of the humidified gas to the user interface could also be adapted to function with other PAP devices such as Bi-Level and Auto-titrating systems. At a minimum, computer algorithms may be modified to utilize pressure as a variable rather than a constant in these Bi-PAP and Auto-PAP systems.
U.S. Pat. No. 8,074,645 is incorporated herein by reference in its entirety. Moreover, the complete disclosure of other patents, patent documents, and publications cited in the Background, the Detailed Description of Exemplary Embodiments, and elsewhere herein are incorporated by reference in their entirety as if each were individually incorporated.
Illustrative embodiments are described and reference has been made to possible variations of the same. These and other variations, combinations, and modifications will be apparent to those skilled in the art, and it should be understood that this invention is not limited to the illustrative embodiments set forth herein.
Claims
1. A positive airway pressure apparatus comprising:
- a flow generator comprising a housing containing a blower, the blower adapted to produce a flow of pressurized gas;
- a user interface adapted to communicate the flow of pressurized gas to an airway during a breath cycle;
- an elongate delivery tube positioned between the flow generator and the user interface, the delivery tube adapted to communicate the flow of pressurized gas from the blower to the user interface;
- a humidifier defining an outlet that is in communication with the flow of pressurized gas, the humidifier comprising a vaporizing device and a water source, the outlet located between the blower and the delivery tube;
- an electrical power source adapted to provide electrical power to the humidifier; and
- a controller in communication with both the vaporizing device and the power source, the controller adapted to automatically modulate the electrical power provided to the humidifier during the breath cycle, wherein the electrical power is modulated in proportion to a flow rate of the flow of pressurized gas such that the humidifier adds water vapor at a rate that maintains a near constant humidity level in the flow of pressurized gas during the breath cycle.
2. The apparatus of claim 1, wherein the controller is adapted to modulate the electrical power provided to the humidifier based upon one or more of: a pressure of the flow of pressurized gas; an intentional leak; an unintentional leak; a breathing flow; a breath rate; an inspiratory tidal volume; an expiratory volume; an I:E ratio; inspiratory and expiratory flow dynamics; start and end of inspiration; start and end of expiration; time of peak flow during inspiration; time of peak flow during expiration; ambient temperature; ambient humidity; an output power of the power source; a power-to-vaporization transfer function of the vaporizing device; a volume of the delivery tube and the user interface between the outlet of the vaporizing device and the airway; and a distance between the outlet of the vaporizing device and the user interface.
3. The apparatus of claim 1, wherein the humidifier is located within the housing of the flow generator.
4. The apparatus of claim 1, wherein the controller is adapted to automatically modulate the electrical power provided to the humidifier between: a minimum power level; and a maximum power level.
5. The apparatus of claim 4, wherein the minimum power level is greater than zero watts.
6. A positive airway pressure apparatus comprising:
- a flow generator comprising a housing containing a blower, the blower adapted to produce a flow of pressurized gas at a variable flow rate;
- a user interface adapted to communicate the flow of pressurized gas to an airway during a target breath cycle;
- an elongate delivery tube positioned between the flow generator and the user interface, the delivery tube adapted to communicate the flow of pressurized gas from the blower to the user interface;
- a humidifier comprising a vaporizing device having an outlet in communication with the flow of pressurized gas, the outlet located upstream from the user interface;
- an electrical power source adapted to provide electrical power to the vaporizing device; and
- a controller in communication with both the power source and the vaporizing device, the controller adapted to provide the electrical power to the vaporizing device during a power interval such that the vaporizing device introduces water vapor into an inspiration portion of the flow of pressurized gas, during the power interval, to produce a flow of pressurized gas with added humidity, and wherein a start time and duration of the power interval are selected or calculated such that the flow of pressurized gas with added humidity arrives at the user interface beginning at or near an onset of an inspiratory phase of the target breath cycle and lasts for most or all of the inspiratory phase of the target breath cycle.
7. The apparatus of claim 6, wherein the duration of the power interval is selected or calculated by the controller to terminate the introduction of the water vapor by the vaporizing device such that the flow of pressurized gas with added humidity that reaches the user interface ends at or near an end of the inspiratory phase or at or near an onset of an expiratory phase of the target breath cycle.
8. The apparatus of claim 6, wherein the controller modulates power to the vaporizing device during the power interval to maintain a constant level of humidity within the flow of pressurized gas with added humidity.
9. The apparatus of claim 6, wherein the controller reduces the electrical power provided to the vaporizing device to a minimum level after the power interval expires.
10. The apparatus of claim 6, wherein the outlet of the vaporizing device is located in the housing of the flow generator.
11. The apparatus of claim 6, wherein the controller is adapted to automatically predict when the onset of the inspiratory phase of the target breath cycle will begin based upon an analysis of one or more prior breath cycles.
12. The apparatus of claim 8, wherein the controller is adapted to modulate the electrical power provided to the vaporizing device based upon one or more of: a pressure of the flow of pressurized gas; an intentional leak; an unintentional leak; a breathing flow; a breath rate; an inspiratory tidal volume; an expiratory volume; an I:E ratio; inspiratory and expiratory flow dynamics; start and end of inspiration; start and end of expiration; time of peak flow during inspiration; time of peak flow during expiration; ambient temperature; ambient humidity; an output power of the power source; a power-to-vaporization transfer function of the vaporizing device; and a distance between the outlet of the vaporizing device and the user interface.
13. The apparatus of claim 11, wherein the controller is adapted to predict when the inspiratory portion of the flow of pressurized gas will reach the user interface by analyzing one or more of: a pressure of the flow of pressurized gas; an intentional leak; an unintentional leak; a breathing flow; a breath rate; an inspiratory tidal volume; an expiratory volume; an I:E ratio; inspiratory and expiratory flow dynamics; start and end of inspiration; start and end of expiration; time of peak flow during inspiration; time of peak flow during expiration; and a distance between the outlet of the vaporizing device and the user interface.
14. A method for adding humidity to gas delivered by a positive airway pressure apparatus, the method comprising:
- producing, with a blower, a flow of pressurized gas at a variable flow rate;
- transporting the flow of pressurized gas from the blower to a user interface via a delivery tube positioned between the blower and the user interface;
- detecting, with a controller, one or both of an inspiratory phase and an expiratory phase of one or more breath cycles;
- introducing, during a power interval, humidity into a portion of the flow of pressurized gas to produce a discrete flow of pressurized gas with added humidity, the humidity introduced by a vaporizing device having an outlet proximate the blower and in communication with the flow of pressurized gas; and
- determining, automatically with the controller, a start time and duration of the power interval so that the flow of pressurized gas with added humidity reaches the user interface at or near an onset of an inspiratory phase of a current or future breath cycle and ends at or near an end of the inspiratory phase, or at or near an onset of an expiratory phase, of the current or future breath cycle.
15. The method of claim 14, further comprising introducing the humidity periodically into the flow of pressurized gas to produce periodic flows of pressurized gas with added humidity, wherein each of the periodic flows of pressurized gas with added humidity is timed to reach the user interface at or near the onset of an inspiratory phase of one of the breath cycles.
16. The method of claim 14, introducing the humidity into the flow of pressurized gas for the power interval comprises providing electrical power to the vaporizing device during the power interval.
17. The method of claim 16, wherein providing the electrical power to the vaporizing device during the power interval comprises modulating the electrical power to the vaporizing device during the power interval.
18. The method of claim 14, wherein determining the start time and duration of the power interval comprises analyzing one or more characteristics of the one or more breath cycles preceding the current or future breath cycle.
19. The method of claim 14, wherein introducing the humidity into the portion of the flow of pressurized gas comprises introducing water vapor into the flow of pressurized gas at a variable rate proportional to a flow rate of the flow of pressurized gas.
20. The method of claim 14, wherein determining the start time and duration of the power interval comprises selecting the start time and duration from a lookup table accessible by the controller.
21. The method of claim 14, wherein determining the start time and duration of the power interval comprises calculating the start time and duration with the controller.
22. The method of claim 21, wherein calculating the start time and duration of the power interval comprises:
- measuring one or more characteristics of a previous breath cycle;
- determining ideal values of the start time and duration of the power interval for the previous breath cycle;
- comparing the ideal values of the start time and duration of the power interval for the previous breath cycle to actual values of the start time and duration used;
- calculating an error between the ideal values and the actual values of the start time and duration of the power interval for the previous breath cycle; and
- predicting the start time and duration of the power interval for the current or future breath cycle based at least in part upon the error calculated.
23. A method for adding humidity to gas provided by a positive airway pressure (PAP) apparatus, the method comprising:
- producing a continuous and variable flow of pressurized gas with a blower;
- transporting the flow of pressurized gas from the blower to a user interface via a delivery tube positioned between the blower and the user interface;
- predicting, automatically with a PAP controller, a start time and duration of an inspiratory phase of a target breath cycle based upon an analysis of a current or a preceding breath cycle;
- calculating or selecting, automatically with a humidification controller, a delay time and duration of a power interval;
- providing power, under control of the humidification controller, to a vaporizing device after expiration of the power interval delay time, the power lasting for the power interval duration, wherein the vaporizing device is located proximate an outlet of the blower and is in communication with the flow of pressurized gas;
- introducing humidity with the vaporizing device into the flow of pressurized gas during the power interval duration to produce a flow of pressurized gas with added humidity that reaches the user interface at or near an onset of the inspiratory phase of the target breath cycle and terminates at or near a beginning of an expiratory phase of the target breath cycle.
24. The method of claim 23, further comprising modulating the power provided to the vaporizing device in proportion to a flow rate of the flow of pressurized gas during the power interval duration such that a near constant humidity level is maintained in the flow of pressurized gas with added humidity.
25. The method of claim 23, wherein one or both of the delay time and duration of the power interval are selected based, at least in part, upon one or more of: a pressure of the flow of pressurized gas; an intentional leak; an unintentional leak; a breathing flow; a breath rate; an inspiratory tidal volume; an expiratory volume; an I:E ratio; inspiratory and expiratory flow dynamics; start and end of inspiration; start and end of expiration; time of peak flow during inspiration; time of peak flow during expiration; ambient temperature; ambient humidity; an output power available to the vaporizing device; a power-to-vaporization transfer function of the vaporizing device; and a distance between the outlet of the vaporizing device and the user interface.
Type: Application
Filed: Dec 16, 2014
Publication Date: Jun 18, 2015
Inventors: Bruce Bowman (Eden Prairie, MN), Matthew T. Olson (Maple Grove, MN)
Application Number: 14/571,479
