The present invention relates generally to medical care for acutely injured and/or ill persons, and particularly to determining and providing proper ventilation for such critical-care patients.
In the critical-care environment, minutes count when caring for an acutely injured or ill patient, for example during transport in an ambulance or medevac. For such acutely injured/ill patients, providing and maintaining the patient's needed oxygen inhalation and carbon dioxide exhalation is critical. So the vast majority of these critical-care patients are intubated with an endotracheal tube connected to a mechanical ventilator to provide them their needed breathing ventilation. Critical-care providers (e.g., paramedics, nurses, doctors, respiratory therapists, and other clinicians) are responsible for providing and maintaining the patient's needed respiration and ventilation through settings on the ventilator. Current best practices in medicine call for the critical-care provider to estimate the patient's height, calculate or look up the corresponding ideal weight for that height, and then calculate or look up the corresponding ventilator setting for that weight. But sometimes the critical-care provider overestimates or underestimates the patient's height, which results in an improper tidal volume provided to the patient.
Accordingly, it can be seen that there exists a need for a better way to quickly, easily, and accurately determine settings for ventilators for critical-care patients. It is to the provision of solutions to this and other problems that the present invention is primarily directed.
Generally described, the present invention relates to an indexing tape and method of use for determining respiration tidal volume settings of a ventilator for a human patient. The tape includes an elongate body, a reference element of the tape body configured for positioning at a first end (e.g., foot) of the patient, a series of length-indicating elements of the tape body spaced from the reference element and configured so that an aligned one at a second end (e.g., head) of the patient indicates the patient's approximate height, and a plurality of ventilator-setting elements of the tape body correlated to the length-indicating elements and including tidal volume settings for the ventilator. The method of determining ventilator settings includes positioning the tape along the patient with the reference element adjacent the patient first end (e.g., foot) and with one of the length-indicating elements adjacent and aligned with the patient second end (e.g., head), and reading the respective ventilator-setting element corresponding to the aligned length-indicating element to identify an appropriate tidal-volume setting for the ventilator.
The specific techniques and structures employed to improve over the drawbacks of the prior devices and accomplish the advantages described herein will become apparent from the following detailed description of example embodiments and the appended drawings and claims.
The present invention relates to an indexing tape for quickly and easily determining an appropriate respiration tidal-volume setting for a mechanical ventilator for patient. The indexing tape can be used with ventilators of a conventional type that can be connected to tubes and used for providing oxygen inhalation and carbon dioxide exhalation to patients in critical-care and other healthcare situations. Aspects of the invention include various embodiments of indexing tapes as well as methods of using the tapes for determining ventilator settings.
The tape 10 includes an elongate body 12 with a length (extending between first and second ends 13 and 15 of the tape body) selected for use to measure adult humans and with a width (along all or at least portions of the length) selected for providing a display area for markings or other indicia. The tape body 12 is typically in the form of a conventional piece of ribbon or narrow strip of material, that is, relatively long and flat. And the tape body 12 has a width selected for displaying markings that are large enough to be legible and easily read by the naked human eye in normal daytime or illuminated-indoor lighting conditions (e.g., in an ambulance with the interior lights on). In the depicted embodiment, for example, the tape body 12 is about 90 inches long and about 2½ inches wide, with a thickness and flexibility providing for easily collapsing (e.g., rolling or folding) it into a compact configuration for storage and transport. The tape body 12 can be made for example of a sheet of a plastic, fabric, metal, vinyl, or other material selected to provide the desired flexibility and durability. In other embodiments, the tape body has other dimensions (e.g., longer or shorter, wider or narrower), has another shape (e.g., an oval or otherwise curved cross-section), and/or has other features for permitting collapsing into a compact configuration (e.g., a folding design with rigid segments hinged together, or a spring-biased automatic retracting design).
The tape body 12 includes a reference element 14, a plurality of length-indicating elements 16 serially arranged and spaced at increasing distances from the reference element, and a plurality of ventilator-setting elements 18 correlated to the length-indicating elements. The reference element 14 can be located distally offset from the first end 13 the tape body 12, as depicted in
The reference element 14 can be formed by a marking on the tape body 12, as depicted in
The length-indicating elements 16 can be formed by markings on the tape body 12, as depicted in
As such, with the reference element 14 in position at one end (e.g., sole of foot) of the patient and with the tape body 12 in its extended/elongated use configuration positioned alongside and/or underneath the patient, the other end (e.g., top of head) of the patient will generally align with one of the length-indicating elements 16. That aligned length-indicating element 16 thus correlates to the approximate height of the patient and can be quickly and easily identified and read by a critical-care provider to correctly and reliably determine the patient's approximate height in tense and pressure-packed emergency situations.
For example, the depicted embodiment includes a first length-indicating element 16a positioned at a first distance (4.0 feet) from the reference element 14 (
In other embodiments, more or fewer of the length-indicating elements 16 are provided, for example in adult-only designs (e.g., with a first of the length-indicating elements 16 being positioned 5.0 feet from the reference element 14) or pediatric-only designs (e.g., with a last of the length-indicating elements 16 being positioned 5.0 feet from the reference element). Also, while the depicted embodiment includes the length-indicating elements 16 in half-foot increments, in other embodiments the increments can be longer (e.g., one-foot increments) or shorter (e.g., one-inch or two-inch increments), as may be desired.
Furthermore, the area on the tape body 12 between adjacent ones of the length-indicating elements 16 defines a segment or panel 19 corresponding to one of the adjacent length-indicating elements (e.g., the lower value/height, as depicted). For example, the depicted embodiment includes a first length-indicating segment 19a spanning a first distance range (3.5 feet to 4.0 feet) from the reference element 14 (
Furthermore, indicia 20 corresponding to the distances/measured heights can be marked on the tape body 12 at a location adjacent to each of the corresponding length-indicating elements 16, at a location within the corresponding length-indicating segment 19 but distal from the corresponding length-indicating element (e.g., adjacent the next-higher length-indicating element, as depicted), or both with at least two of the indicia for each length-indicating element (as depicted). For example, the indicia 20 can be made by printing, embossing, etching, or other conventional marking techniques. The indicia 20 include literal expressions of the corresponding length-indicating elements 16 (e.g., numerals and units) and thus enable the user to conduct a quick visual check confirming the indicated indicia against a quick visual estimation of the patient's height for any obvious errors in the event the tape 10 has slipped. For example, the depicted embodiment includes first indicia 20a (“4 FT”) positioned adjacent the corresponding length-indicating element 16a and also positioned within the corresponding length-indicating segment 19a (but distal from the corresponding length-indicating element), second indicia 20b (“4.5 FT”) positioned adjacent the corresponding length-indicating element 16b and also positioned within the corresponding length-indicating segment 19b (but distal from the corresponding length-indicating element), third indicia 20c (“5 FT”) positioned adjacent the corresponding length-indicating element 16c and also positioned within the corresponding length-indicating segment 19c (but distal from the corresponding length-indicating element), fourth indicia 20d (“5.5 FT”) positioned adjacent the corresponding length-indicating element 16d and also positioned within the corresponding length-indicating segment 19d (but distal from the corresponding length-indicating element), fifth indicia 20e (“6 FT”) positioned adjacent the corresponding length-indicating element 16e and also positioned within the corresponding length-indicating segment 19e (but distal from the corresponding length-indicating element), sixth indicia 20f (“6.5 FT”) positioned adjacent the corresponding length-indicating element 16f and also positioned within the corresponding length-indicating segment 19f (but distal from the corresponding length-indicating element), and seventh indicia 20g (“7 FT”) positioned adjacent the corresponding length-indicating element 16g and also positioned within the corresponding length-indicating segment 19g (but distal from the corresponding length-indicating element). (These indicia 20a-g are collectively referred to herein as the indicia 20.)
In other embodiments, the length-indicating elements include and are defined at least in part by such indicia and/or such segments, in addition to or instead of scale lines or the like. And in still other embodiments, the length-indicating elements and the ventilator-setting elements are combined into single elements for example with the ventilator-setting elements positioned on the tape body at locations that correspond to the correlated length/height of the patient in order to thus also function as the length-indicating elements.
The ventilator-setting elements 18 listed on the tape body 12 are ventilator settings that are widely accepted in medicine and can be readily verified through a number of websites and medical references. The ventilator-setting elements 18 are correlated to the length-indicating elements 16 and enable the user to identify a proper ventilator setting based on the aligned length-indicating element corresponding to the patient's height. The ventilator-setting elements 18 can be formed by markings on the tape body 12, as depicted in
As mentioned, the ventilator-setting elements 18 correspond to the length-indicating elements 16. So in the depicted embodiment with seven length-indicating elements 16a-g, there are at least seven corresponding ventilator-setting elements 18a-g (collectively referred to herein as the ventilator-setting elements 18). For each length-indicating element 16, the corresponding ventilator-setting element 18 can include a plurality of ventilator settings. For example, in the depicted embodiment the pediatric ventilator-setting elements 18a-b each include lists (e.g., an array) of optional ventilator settings broken out by different patient weights (24/26/28 kg or 30/32/34 kg) and by different tidal volumes, and the adult ventilator-setting elements 18c-g each include a list of optional ventilator settings broken out by patient gender (male or female) and by tidal volumes (6 mL/kg for below-normal oxygen needs, 8 mL/kg for normal, and 10 mL/kg for above-normal needs).
The ventilator-setting elements 18 literally express the appropriate respiration tidal volumes corresponding to the ideal body weight corresponding to the patient's measured height. These tidal volumes thus represent approximations that are sufficient and close-enough for use in urgent-care situations and that are readily identifiable by using the tape 10 in such urgent-care situations, not exact tidal volumes as can be more-accurately determined in non-emergency situations when time is not so critical. In other embodiments, the ventilator-setting elements are visual representations of control positions of the ventilator, for example for use with ventilators having control positions indentified by numbers, letters, icons, or the like.
These listed tidal volumes are determined by identifying the ideal weight given the patient's height and age, and then determining the appropriate tidal volume for that weight (given the patient's gender and condition, for adults), based on the following height-to-weight and weight-to-tidal-volume formulas:
In typical embodiments such as that depicted, the ventilator-setting elements 18 each include multiple ventilator settings, as noted above. For example, referring to
As another example, referring to
The tidal volumes of the ventilator-setting elements 18 displayed on the tape 10 as depicted are determined based on the formulas/criteria set forth above. It will be understood that additional tidal volumes of additional ventilator-setting elements for patient heights falling between the length-indicating elements 16 can be determined and included on the tape 10 based on these same formulas/criteria. In addition, it will be understood that variations of these formulas/criteria can be used, for example by using a different starting height and corresponding ideal body weight (instead of 5.0 feet and 50.0/45.5 kg M/F) and/or using average body weight for a given height (instead of ideal body weight) then making additions based on the height and/or weight of the patient as determined using the tape, or by not using a starting height and doing a calculation for the total measured height (and corresponding ideal body weight) of the patient.
The portion of the tape 10 between the reference element 14 and the first of the length-indicating elements 16 provides the needed length and is thus included for physical extension and connection purposes. This intermediate/extension portion of the tape 10 can be significant, typically having a length that is generally comparable to the length of the length-indicating segments 19 and thus about half the overall length of the tape 10, for example with each about 3.5 feet in the depicted embodiment (in shorter pediatric-only embodiments the extension portion is typically more than half the total tape length). In addition, this intermediate/extension portion of the tape 10 can be divided into segments and used to display additional relevant information. In the depicted embodiment, for example, this intermediate/extension portion of the tape 10 is divided into serial segments that display:
Referring back to
In addition, the corresponding first end 13 of the tape body 12 can be secured in place to prevent the tape 10 from slipping when it is extended along the patient. In typical embodiments such as that depicted, the first end 13 of the tape body 12 can be secured in place by applying a strip of conventional medical adhesive tape 11 to it and to the patient's foot (or alternatively to the support surface, provided that the patient doesn't move longitudinally). In other embodiments, the reference element 14 or tape first end 13 includes a mechanical feature (e.g., an adhesive portion with a removable backing, a rigid transverse/perpendicular tab, or a transverse loop or hook) for engagement by a body part of the patient (e.g., sole or toe of foot, or crown or ear of head), and the mechanical feature is positioned in engagement with the patient to secure the tape 10 in place during use to prevent slippage and thus prevent a patient-height misreading. Furthermore, for embodiments with the reference element 14 located distally offset from the first end 13 the tape body 12 (
Then the indexing tape 10 is positioned in an extended/elongated configuration at least coextensive with the height of the patient (i.e., lying-down length). The tape 10 can be slipped entirely under the patient if the patient's condition permits, or if not then it can be extended alongside the patient with at least portions of it laterally offset from the patient as shown. With the tape 10 now extending foot-to-head along the patient, the opposite end of the patient (in this case the top of the patient's head) and a location on the tape 10 are now adjacent and in alignment (i.e., along a line perpendicular to the tape). That aligned location of the patient's head and the tape 10 is then identified by the clinician to determine the corresponding generally aligned length-indicating element 16 for the particular patient, for example the closest one of the length-indicating elements (whether in the shorter or longer direction) or the last one that has been exceeded by the patient's height.
The length-indicating elements (i.e., height markings) 16 are correlated to body weight (e.g., ideal), which are in turn correlated to appropriate ventilator-setting elements (i.e., tidal volumes) 18, which are displayed on the tape in positions corresponding to the associated length-indicating elements. So the clinician simply reads the ventilator-setting element 18 on the tape 10 that corresponds to the length-indicating element 16 (or segment 19) adjacent and aligned with the top of the patient's head to obtain an appropriate tidal volume for setting the ventilator, without having to estimate any body characteristic (e.g., height or weight) of the patient, without having to look up any conversion factors, and without having to perform any calculation.
To illustrate this one-step read-and-set method, its use will be described for a 6-foot, 1-inch male adult. With the tape 10 in its extended/elongated configuration and positioned alongside the supine patient, and with the reference element 14 at the patient's heel, the top of the patient's head would be a little beyond the fifth length-indicating element 16e. So the clinician could quickly and easily select, from the corresponding fifth ventilator-setting element 18e, a tidal volume of 465.6 mL, 620.8 mL, or 776 mL, depending on the tidal rate (6 mL/kg, 8 mL/kg, or 10 mL/kg, respectively) selected as appropriate given the patient's condition at the time. In this way, the clinician can quickly and reliably ensure that the patient receives the proper respiratory ventilation, without worry of significant overestimation or underestimation, and then move on to meeting other urgent-care needs.
This one-step read-and-set method provides for reading an appropriate tidal volume directly from the tape 10 based on the ideal body weight for the measured height of the patient, without any calculations or conversions (e.g., accounting for ideal body weight). For situations such as this example in which the patient's height is between two of the length-indicating elements 16, this provides a general approximation of appropriate tidal volumes, which is typically sufficient because the differences over only a few inches of height are not significant (i.e., the general estimation is sufficient for proper patient care).
However, if the patient's height is between length-indicating elements 16 and more precision is desired, then a more-precise tidal volume can be readily determined using the tape 10. Using this same scenario, the above-listed formulas for a male adult can be applied to a 6-foot, 1-inch height as follows: 50 kg+2.3 kg/inch (21 inches)=50 kg+48.3 kg=98.3 kg of ideal body weight (IDW). The clinician would then take that weight and multiple it by the selected oxygen tidal rate (e.g., standard/convention is 6-10 mL/kg). Therefore, this patient's more-precise initial ventilator settings for tidal volume would be 590 mL (at 6 mL/kg), 786 mL (at 8 mL/kg), or 983 mL (at 10 mL/kg).
It is to be understood that this invention is not limited to the specific devices, methods, conditions, or parameters described and/or shown herein, and that the terminology used herein is for the purpose of describing particular example embodiments by way of example only. Thus, the terminology is intended to be broadly construed and is not intended to be unnecessarily limiting of the claimed invention. For example, as used in the specification including the appended claims, the singular forms “a,” “an,” and “one” include the plural, the term “or” means “and/or,” and reference to a particular numerical value includes at least that particular value, unless the context clearly dictates otherwise. In addition, any methods described herein are not intended to be limited to the sequence of steps described but can be carried out in other sequences, unless expressly stated otherwise herein.
While the invention has been shown and described in example forms, it will be apparent to those skilled in the art that many modifications, additions, and deletions can be made therein without departing from the spirit and scope of the invention as defined by the following claims.
This application claims the priority benefit of U.S. Provisional Patent Application Ser. No. 62/375,517, filed Aug. 16, 2016, which is hereby incorporated herein by reference.
Number | Date | Country | |
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62375517 | Aug 2016 | US |