US20050085869A1 - System and method for mapping diaphragm electrode sites - Google Patents
System and method for mapping diaphragm electrode sites Download PDFInfo
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- US20050085869A1 US20050085869A1 US10/966,484 US96648404A US2005085869A1 US 20050085869 A1 US20050085869 A1 US 20050085869A1 US 96648404 A US96648404 A US 96648404A US 2005085869 A1 US2005085869 A1 US 2005085869A1
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Classifications
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- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/3605—Implantable neurostimulators for stimulating central or peripheral nerve system
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- A—HUMAN NECESSITIES
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- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/3601—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation of respiratory organs
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- A—HUMAN NECESSITIES
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
- A61B5/316—Modalities, i.e. specific diagnostic methods
- A61B5/389—Electromyography [EMG]
- A61B5/395—Details of stimulation, e.g. nerve stimulation to elicit EMG response
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- A61B5/08—Detecting, measuring or recording devices for evaluating the respiratory organs
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
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- A—HUMAN NECESSITIES
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- A61B5/72—Signal processing specially adapted for physiological signals or for diagnostic purposes
- A61B5/7235—Details of waveform analysis
- A61B5/7264—Classification of physiological signals or data, e.g. using neural networks, statistical classifiers, expert systems or fuzzy systems
Definitions
- the present invention relates to devices, systems, and methods useful for determining locations for therapeutic electrode placement on the diaphragm.
- Electrical stimulation of the diaphragm has been performed by delivering a stimulus to the diaphragm through one or more electrodes.
- the location of the stimulation electrodes greatly affects the ability to obtain a desired response with a given stimulus and candidate electrode sites may be mapped in order to aid in selecting a location for electrode placement.
- Diaphragm mapping is the process of correlating electrical stimuli applied at a set of points in the vicinity of the diaphragm muscle with the associated responses of the diaphragm muscle. When an electrical stimulus is applied, the diaphragm may respond directly or indirectly.
- the diaphragm In a direct response, the diaphragm is activated by a signal that is received by muscle fibers without conduction along a nerve. In an indirect response, the muscle fibers respond to a signal that is conducted through a nerve. In general, activation of the diaphragm muscle involves both direct and indirect responses. The relative intensity of direct and indirect response will vary with electrode location.
- the threshold for action potential initiation of nerves and muscle fibers is approximately the same.
- direct stimulation is more localized with respect to an electrode than the response muscle tissue that is stimulated through nerve recruitment.
- changes in electrode location will typically affect the indirect and direct response differently.
- a motor point mapping system is described in “Laparoscopic Placement of Electrodes for Diaphragm Pacing Using Stimulation to Locate the Phrenic Nerve Motor Points,” B. D. Schmit, T. A. Stellato, M. E. Miller, and J. T. Mortimer, IEEE Trans. Rehab. Eng., vol. 6, pp. 382-390, 1998. Mapping was done with the goal of finding a functional motor point on the surface of the diaphragm at which full hemidiaphragm activation could be achieved with a minimum stimulus current. Full activation of the diaphragm was correlated with a tidal volume or peak pressure value. Also, the anatomical motor point was determined to be substantially in the geometric center of a group of nerve branches.
- electrode placement for obtaining full activation may be achieved by mapping a motor point, there are situations in which full activation may not be desirable, e.g., in the treatment of sleep apnea, because it may disturb the sleep of the subject.
- U.S. Pat. No. 4,827,935 describes a demand electroventilator using a plurality of electrodes adapted for placement on the skin. It describes mapping locations on the skin for optimum electrode location. It also uses the tidal volume to determine the optimal placement. The optimum inspiratory points were located as the sites where the maximum volume of air was inspired per milliampere of current.
- an activation level is characterized in each of these references by a peak or integrated value, a given activation level may be produced by many breathing patterns.
- Such peak or integrated value is not believed to be sufficient to determine proper placement of electrodes to achieve a desired breathing morphology because placement of electrodes influences the coordinated activation of various nerve and muscle fibers.
- Motor point mapping as performed in the prior art, for example, does not provide the information necessary for optimal placement of therapeutic electrodes intended to stimulate breathing patterns similar to those associated with certain activity levels such as, e.g., sleep.
- Such natural breathing patterns may be characterized by pressure or flow as a function of time.
- tidal volume is not believed to provide sufficient information for optimal placement of electrodes to provide other desired inspiration morphologies that are characterized by flow properties.
- mapping techniques have been done where the breathing of the subject is controlled by a ventilator, or by inducing a particular state (e.g., apnea induced by hyperventilation) and thus under artificial conditions. Threshold and full activation mapping have been done under these conditions, but it is not believed to be well suited for mapping that is directed to identifying optimal electrode placement for replicating intrinsic breathing patterns or for controlling or manipulating specific aspects of breathing morphology and related physiology.
- mapping has been done using a single electrode that is moved from one location to the next, with stimuli being applied and responses measured at each location. In this scheme there may be some placement error when the mapping electrode is removed and replaced with a permanent implanted electrode.
- the present invention provides a signal source for eliciting a desired respiration response that is coupled to one or more electrodes in the vicinity of the diaphragm.
- a stimulus signal from the source may be applied to the one or more electrodes to produce activation of the diaphragm.
- Respiration response is sensed to provide information that may be correlated with the stimulus signal. The correlated information may be used to identify a therapeutic locus for a therapeutic electrode.
- Sensed respiration response may include, for example, parameters indicating diaphragm activation such as diaphragm movement or diaphragm EMG.
- Sensed respiration response may include parameters such as flow, tidal volume, intraabdominal, intrathoracic and airway pressure. Each of these parameters may be observed over time where they create a respiration or inspiration morphology.
- an electrode is placed in the vicinity of the diaphragm and an electrical stimulus is applied between intrinsic breathing cycles, or regulated breathing cycles.
- an electrical stimulus comprising a series or burst of pulses is applied through one or more electrodes to the diaphragm to elicit a natural breathing response.
- the series of pulses may be varied in either or both amplitude and frequency.
- a support structure supporting one or more electrodes is configured to be placed on the surface of the diaphragm.
- the support structure may be, e.g., a mesh or other flexible thin substrate.
- the support structure may comprise a variety of materials such as, e.g., silicone, PTFE, polyurethane, latex, polyester.
- the support structure may be a substrate with electrodes positioned on, attached to, or formed with the substrate.
- the substrate may be configured to be positioned on the diaphragm, e.g., by aiding proper locating, positioning and placement of the electrodes and/or by accommodating the movement of the diaphragm.
- the substrate may also be shaped to fit on the diaphragm and may also be keyed with anatomical structures to aid in ideal positioning. Electrical stimuli are applied sequentially and/or in combination through the electrodes to the diaphragm to elicit a natural breathing response from the diaphragm.
- Another feature provides an array of electrodes configured to be laparoscopically delivered and to be positioned on the diaphragm.
- the substrate is foldable, deflatable and/or contractible so that it can be delivered through a small opening or cannula, and unfoldable, inflatable or expandable to be positioned on the diaphragm.
- a hierarchy of stimuli are applied to a set of electrodes. At each level in the hierarchy the stimuli are more complex with a greater number of adjustable parameters.
- the set of electrodes may be reduced in number as each level in the hierarchy is reached.
- FIG. 1 shows a diagram of a system for mapping electrode sites on a diaphragm in accordance with an embodiment of the present invention.
- FIG. 2A shows a guide grid on a diaphragm in accordance with an embodiment of the present invention.
- FIG. 2B shows electrode arrays placed with respect to an anatomical feature in accordance with an embodiment of the present invention.
- FIG. 2C shows a template corresponding to each of electrode arrays of FIG. 2B
- FIG. 3A shows a top view of an array of electrodes on a single substrate in accordance with an embodiment of the present invention.
- FIG. 3B shows a cross-section view of the electrode array of FIG. 3A in accordance with an embodiment of the present invention.
- FIG. 4A shows an electrode array arranged on an inflatable member in accordance with an embodiment of the present invention.
- FIG. 4B shows a diagram of an in situ electrode substrate in accordance with an embodiment of the present invention.
- FIG. 5 shows a perspective view of an electrode array with a suction field surrounding the electrodes in accordance with an embodiment of the present invention.
- FIG. 6A shows a view of the active surface of an electrode array with an inflatable member in accordance with an embodiment of the present invention.
- FIG. 6B shows a side view of the electrode array of FIG. 6A .
- FIG. 6C shows the electrode array of FIG. 6A in a folded configuration in accordance with an embodiment of the present invention.
- FIG. 7A shows a perspective view of an electrode array with an inflatable member and suction field in accordance with an embodiment of the present invention.
- FIG. 7B shows a side view of the electrode array of FIG. 7A .
- FIG. 7C shows the electrode array of FIG. 7A in a folded configuration in accordance with an embodiment of the present invention.
- FIG. 8 shows a stimulus waveform in accordance with an embodiment of the present invention.
- FIG. 9A shows a natural breathing response waveform in accordance with an embodiment of the present invention.
- FIGS. 9 B 1 - 9 B 4 shows target, acceptable and unacceptable breathing response waveforms in response to stimulation in accordance with an embodiment of the present invention.
- FIGS. 9 C 1 - 9 C 4 shows target, acceptable and unacceptable breathing response waveforms in response to stimulation in accordance with an embodiment of the present invention.
- FIGS. 9 D 1 - 9 D 4 shows target, acceptable and unacceptable breathing response waveforms in response to stimulation in accordance with an embodiment of the present invention.
- FIGS. 9 E 1 - 9 E 4 shows target, acceptable and unacceptable breathing response waveforms in response to stimulation in accordance with an embodiment of the present invention.
- FIGS. 10A and 10B show timing diagrams for a stimulus applied during intrinsic breathing in accordance with embodiments of the present invention.
- FIG. 11 shows an electrode array and sensors placed on the diaphragm in accordance with an embodiment of the present invention.
- FIG. 12 shows a flow chart of a coarse mapping method in accordance with an embodiment of the present invention.
- FIG. 13A shows a flow chart of a method for intrinsic breathing evaluation in accordance with an embodiment of the present invention.
- FIG. 13B shows a flow chart of a method for baseline acquisition for mapping performed on a subject with regulated breathing in accordance with an embodiment of the present invention.
- FIG. 14A shows a flow chart of a preliminary array mapping method in accordance with an embodiment of the present invention.
- FIG. 14B shows a flow chart of a preliminary array mapping method in accordance with an embodiment of the present invention.
- FIG. 15A shows a flow chart of a single parameter mapping method in accordance with an embodiment of the present invention.
- FIG. 15B shows a flow chart of a single parameter mapping method in accordance with an embodiment of the present invention.
- FIG. 16A shows a flow chart of a multi-parameter mapping method in accordance with an embodiment of the present invention.
- FIG. 16B shows a flow chart of a multi-parameter mapping method in accordance with an embodiment of the present invention.
- FIG. 1 shows a system 100 for mapping electrode sites on a diaphragm 155 of a subject 135 .
- a laparoscopic imaging unit 130 is coupled to a laparoscope 145 for observing the surface of the diaphragm 155 .
- the imaging unit 130 is coupled to a diaphragm mapping control module 105 .
- the imaging unit 130 may provide analog or digital images to the control module 105 .
- the control module 105 includes a monitor 110 , processing unit 115 and an I/O module 120 .
- the monitor 110 may be used displaying a graphical user interface and may also be used for displaying images.
- Displayed images may be either real-time images from the imaging unit 130 or stored images. Stored images may be overlaid with real-time images to provide visual references for electrode placement.
- the processing unit 115 includes a data processor, memory, and program storage for data and image acquisition and manipulation.
- the processing unit 115 is coupled to an input/output (I/O) module 120 , and may be used to control the timing of stimuli delivered to mapping electrodes.
- I/O input/output
- the I/O module 120 is coupled to the imaging unit 130 , and to one or more electrodes 151 on the mapping electrode substrate 150 .
- the electrodes 151 on the mapping electrode substrate are configured for electrical stimulation and/or sensing of the diaphragm.
- the I/O module may also be coupled to other sensing devices coupled to the subject 135 , such as a respiratory sensor 125 (e.g., pneumotachometer) or electrical/mechanical sensors 140 and/or 152 .
- Sensor 152 is shown positioned for sensing abdominal movement, whereas sensor 140 is positioned for sensing movement in the thoracic region 160 .
- Sensors 140 , 152 may also be used to sense movement of the subject which can provide information, such as, activity level of the subject.
- other sensors may positioned or coupled to the body and in communication with the I/O module.
- the I/O module may also have a keyboard, mouse, or other device for operator input.
- Respiratory sensor 125 may be, e.g., a flow meter, pneumotachometer, or pressure sensor used to measure tidal volume, respiratory flow, and/or respiratory pressure.
- Sensor 140 may be, e.g., a piezo-film sensor, multi-axis accelerometer, strain gauge, pressure sensor, and may be used to measure abdominal movement, diaphragmatic movement, other subject movement or activity, intrathoracic pressure, or intraabdominal pressure.
- the system 100 may be used to develop a coordinate system on a per subject basis by capturing an image of the surface of the diaphragm 155 , upon which the mapping electrode substrate 150 is attached.
- the image obtained by the imaging unit 130 is transferred to the control module 105 .
- the control unit may use the images acquired during the mapping process to provide guidance for placement of a permanent electrode, e.g. through real-time visual aid (video feed, laser grid), audible proximity indicator beeps, or haptic feedback.
- FIG. 2A shows an abdominal view of a diaphragm 205 with a reference grid 210 applied to the right hemidiaphragm 215 and a reference grid 220 applied to the left hemidiaphragm 225 .
- the reference grid may be applied with an ink or dye, or it may be an optical projection.
- the grids 210 and 220 may be used as a reference for electrode placement.
- FIG. 2B shows an abdominal view of a diaphragm 205 with attached electrode substrates 230 and 235 .
- the electrode substrates are configured to be positioned on the diaphragm.
- the electrode substrates 230 , 235 include electrodes 233 located on the substrates in a predetermined configuration.
- Electrode substrate 230 has a keyed or curved portion 231 on its perimeter that matches the depression 245 on the central tendon 240 .
- electrode substrate 235 has a keyed or curved portion 232 on its perimeter that matches the depression 250 on the central tendon 240 .
- the keyed configuration of the electrode substrate 235 allows a more precise locating, positioning and placement of the substrates on the diaphragm.
- the substrates 230 , 235 further include template openings 234 for marking the position of the substrates 230 , 235 after electrode selection has been made.
- the electrode substrates 230 and 235 may be attached to the diaphragm 205 in a number of ways with laparoscopic instruments, for example with sutures, staples or clips, temporary adhesive (bio-adhesive), and suction.
- a template 236 as illustrated in FIG. 2C includes matching template openings 237 that match the orientation of the template openings 234 of the substrates 230 , 235 . Electrode openings 238 in the template 236 also match the orientation of the electrodes 233 on the substrates 230 , 235 .
- the template is positioned with openings 237 over the marks. The electrode opening that corresponds to the selected electrode on the array may then be used to mark the correct location for a subsequently implanted electrode. Permanently implanted electrodes may then be placed in position of the selected optimal mapping electrode or electrodes as they were positioned with the mapping substrate.
- the electrode substrate may also include an adhesive dye (which can be radio-opaque) in a pattern where once the substrate is removed, the adhesive sticks to the diaphragm indicating key locations so that mapped positions may be visually or radiographically identified.
- the locations of the mapping substrate and electrodes may also be identified with a photo taken of the substrate in position on the diaphragm.
- Electrodes assemblies and/or substrates described herein may be temporarily implanted or permanently implanted and used for stimulation once the assembly or substrate has been optimally positioned.
- FIG. 3A shows a top view of an array of electrodes ( 310 , 315 ) on a single substrate 305 in accordance with an embodiment of the present invention.
- Electrode 310 is a subsurface electrode that is intended to penetrate the peritoneum on the diaphragm
- electrode 315 is a surface electrode that is intended for contact with the surface of the peritoneum on the diaphragm.
- a subsurface electrode 310 will generally provide a greater electrical efficiency, whereas a surface electrode 315 will more easily couple to a larger region.
- a surface electrode may 315 be combined with a subsurface electrode 310 to form a single composite electrode. These electrodes may also be selected to elicit a desired observed response.
- the substrate 305 is preferably fabricated from a flexible material such as silicone, and may or may not be reinforced (e.g., with a mesh).
- the substrate is configured to fit on the diaphragm.
- the perimeter of the substrate 305 may be round, elliptical, or a more complex shape that conforms to a specific feature on the diaphragm surface.
- a complex perimeter shape may be used to facilitate placement of the substrate 305 at a particular location on the surface of the diaphragm, such as one of the depressions separating the three leaflets of the diaphragm, or characteristics of the central tendon.
- the electrode array on the substrate 305 may contain only surface or subsurface electrodes or a combination of surface and subsurface electrodes.
- the electrodes may be arranged in a regular array using polar or rectangular coordinates, or they may be arranged as an irregularly spaced array, e.g., that is correlated with nerve structure that innervates the diaphragm.
- the electrodes may be attached to the substrate a number of ways, e.g., glued, welded, etched on, or encased with the substrate material.
- FIG. 3B shows a cross-section view A-A of the electrode array of FIG. 3A .
- the substrate is thicker in the central region and tapers at the perimeter.
- a reinforcement 325 is also shown.
- the taper at the perimeter 321 reduces the dynamic interfacial forces that are produced between substrate and diaphragm during activation of the diaphragm.
- the enhanced peripheral flexibility reduces mechanical loading of the diaphragm and reduces the stress on the attachment (e.g., sutures or suction).
- the substrate surface 320 upon which the electrodes reside may be flat, or it may be curved to accommodate the surface of the diaphragm.
- Electrodes 310 and 315 may be used individually as monopolar electrodes for sensing and/or stimulation, or any two electrodes may be select as a pair for bipolar sensing and/or stimulation.
- the electrode assembly may also be in the form of a flexible wire member such as a flexible loop.
- the flexibility of the loops permits the ability to form the loops in the shape most ideally suited for a particular patient.
- Other shapes may be used as well, e.g. a loop with a branch that extends to the region adjacent the anterior branches of the phrenic nerve.
- the control unit may be programmed to activate the electrodes in a sequence that is determined to elicit the desired response from the diaphragm.
- the electrodes of the electrode assemblies once implanted may be selected to form bipolar or multipolar electrode pairs or groups that optimize the stimulation response.
- FIG. 4A shows an electrode array 400 coupled to an inflatable member 405 defining an inflation chamber 406 .
- the inflatable member 405 may be inflated to contact a surface opposite the diaphragm to provide the force necessary to hold the electrode array 400 against the surface of the diaphragm.
- the electrodes may be coupled to an external I/O device with lead wires extending inside of, outside of or within the walls of the inflation tube.
- the inflation chamber 406 is coupled to a tube 420 that delivers an inflation medium to or from the chamber 407 .
- the tube 420 may also serve to couple the pressure within the inflation chamber 407 to an external pressure transducer.
- pressure within the inflation chamber 407 may be sensed by a local pressure transducer 425 which is coupled to an I/O port with a lead or in a similar manner as the electrodes.
- the inflation chamber 407 may be evacuated in order to reduce the volume of the inflation member 405 and electrode array 400 during an insertion or removal procedure.
- FIG. 4B shows a diagram of an in situ electrode substrate 406 .
- the electrode substrate 406 is coupled to a flexible tube 435 that penetrates the abdominal wall 440 .
- a switching network 450 couples lines 441 and 442 from the control unit 430 to an array of nine electrodes.
- the switching network 450 allows any one or two of the nine electrodes to be selected, and reduces the number of leads that must be connected directly to the control unit 430 . Electrode selection may be done either for monopolar/bipolar sensing, or stimulus delivery.
- the electrode substrate 406 may support one or more sensors 445 for sensing electrical or mechanical activity of the diaphragm. Sensor 445 is coupled to the control unit 430 by lead 443 .
- electrical sensors are monopolar and bipolar electrodes for electromyogram (EMG) sensing.
- EMG electromyogram
- mechanical activity sensors are: strain gauges, pressure sensors, piezo-electric devices, accelerometers, and position sensors.
- FIG. 5 shows a perspective view of an electrode array structure 505 with a suction field surrounding the electrodes 515 in accordance with an embodiment of the present invention.
- the electrodes 515 are supported on a mesh 510 that is circumferentially enclosed by a seal surface 520 that interfaces with the diaphragm surface.
- a port 525 is used to connect a vacuum source to the electrode array structure 505 . Vacuum is applied after the seal surface is placed on or mated to the surface of the diaphragm.
- FIG. 6A shows a view of the active surface of an electrode array structure 605 with an inflation member 620 having an inflation chamber 621 in accordance with an embodiment of the present invention.
- Individual suction cups 615 are used to provide the attaching force to the diaphragm.
- Electrodes 610 are distributed on the surface between the suction cups 615 .
- FIG. 6B shows a side view 601 of the electrode array structure of FIG. 6A .
- Vacuum ports 625 are shown connected to the suction cups 615
- a fill/evacuation port 630 is shown coupled to the inflation chamber 621 .
- FIG. 6C shows the electrode array of FIG. 6A in a folded configuration that is produced in conjunction with deflation of the inflation member 620 .
- the deflation of the inflation chamber 621 of the inflation member 620 produces a reduction in volume and an elongated shape that facilitates the introduction and removal of the electrode array structure 605 through a cannula or a narrow opening.
- FIG. 7A shows a perspective view of an electrode array 705 on an inflation member 740 with an inflation chamber 741 and a suction field mesh 710 in accordance with an embodiment of the present invention. Electrodes 715 are supported on the mesh 710 . The mesh 710 is surrounded by a seal surface 720 . The inflation chamber 741 is coupled to a fill/evacuation port 730 . An evacuation port 725 is used provide to provide vacuum to the electrode array 705 . Having the mesh 710 with electrodes 715 inside the suction field allows stabilization of the tissue via vacuum and provides intimate contact between the tissue and the electrodes 715 during contraction of the diaphragm. FIG. 7B shows a side view of the electrode array of FIG. 7A . The inflation member 740 has a radial symmetry (e.g., toroidal) with respect to the evacuation port 725 .
- a radial symmetry e.g., toroidal
- FIG. 7C shows the electrode array of FIG. 7A in a folded configuration that is produced in conjunction with deflation of the inflation member 740 .
- the deflation of the inflation member 740 produces a reduction in volume and an elongated shape that facilitates the introduction and removal of the electrode array structure 705 through a cannula or a narrow opening.
- the electrode arrays described herein may be configured to be laparoscopically delivered to the diaphragm. They may be compressed to a smaller configuration and then expanded to be positioned on the diaphragm. They may also be delivered as individual components and assembled at the diaphragm. They may also be delivered as individual components and assembled at the diaphragm.
- FIG. 8 shows an example of a stimulus waveform 800 that may be applied to the diaphragm through an electrode.
- Waveform 800 is a biphasic pulse train; however, in other embodiments a monophasic or other multiphasic pulse train may be used.
- the individual pulses within the pulse train 800 may have variable amplitudes.
- pulse 805 has an amplitude A 1 that is smaller than the amplitude A 2 of pulse 810 .
- the pulse train 800 may also have a variable frequency, with the period P 1 between pulses 813 and 815 being greater than the period P 2 between succeeding pulses 820 and 825 .
- the first pulse amplitude A 1 may be selected to on the basis of an observed or measured threshold value associated with the response of the diaphragm to an applied stimulus (e.g., an observed muscle twitch).
- the stimulus waveform or pulse train 800 may incorporate a delay D between positive and negative pulses, as shown between positive pulse 810 and negative pulse 811 .
- FIG. 9A shows an example of a natural breathing flow response waveform 905 associated with a stimulation waveform 910 delivered to a therapeutic locus on the diaphragm.
- intrinsic breathing refers to breathing that is not induced by an applied stimulus
- natural breathing refers to breathing that is similar or identical to intrinsic breathing, but is induced by an applied stimulus.
- the natural breathing flow response waveform 905 is similar to intrinsic respiration waveforms observed in humans. Flow increases gradually during most of the inspiration phase to a peak value, followed by a relatively sharp decline in flow to the onset of the expiration phase.
- the first pulse in the stimulation waveform 910 has an amplitude A t , that is equal to a measured or observed threshold value for the therapeutic locus.
- FIG. 9A similarly illustrates a natural breathing EMG response waveform 906 and envelope 907 associated with the stimulation waveform 910 .
- FIG. 9B 1 illustrates a stimulation waveform 925 delivered to candidate therapeutic loci on the diaphragm.
- the various loci of stimulation correspond to resulting response waveforms 926 , 927 , 928 illustrated in FIGS. 9 B 2 , 9 B 3 , 9 B 4 respectively and each corresponding to a response resulting from stimulation at a different locus.
- Different waveforms may also result from variations in the stimulation pulses such as, e.g., in frequency pulse duration and amplitudes as well as by using different electrode firing sequences as described for example in parent application Ser. No. 10/686,891.
- the waveform responses illustrated in FIGS. 9 B 1 - 9 B 2 are measured in airflow but may also be determined, from other respiration parameters, e.g. EMG or diaphragm movement.
- “Morphology” refers to the shape or form of the respiration waveform or waveform envelope and may include various aspects of the waveform including, e.g., length of various portions of the waveform, amplitude, frequency or slope.
- a desired response may be natural breathing as illustrated in FIG. 9A or another desired response.
- FIG. 9B 2 illustrates a waveform response 926 in an ideal, preferred or target range.
- a sustained inhalation period or portion of time is an inhalation period in which there is a positive airflow.
- the target range may be expressed as a portion, fraction or percentage of time of the inspiration cycle in which there is a positive or sustained inhalation. While this effect may be expressed in these terms, a percentage or fraction calculation is not required to achieve the effect of the invention or its equivalent.
- the target range is from about 75% to 100% sustained inhalation.
- the waveform illustrated in FIG. 9B 2 shows an inspiration cycle where 95% or 0.95 of the inspiration cycle is sustained positive inhalation.
- FIG. 9B 3 illustrates a waveform response 927 in an acceptable range.
- the acceptable range is between about 50% and 100% sustained inhalation.
- the illustrated waveform is at 60% sustained positive inhalation.
- FIG. 9B 4 illustrates a waveform 928 response in an unacceptable range.
- the unacceptable range is below about 50% sustained inhalation.
- the illustrated waveform is at 20% sustained positive inhalation. Less than about 50% suggests poor efficiency of the delivered stimulation pulse.
- FIG. 9C 1 illustrates a stimulation waveform 935 delivered to candidate therapeutic loci on the diaphragm.
- the various loci of stimulation correspond to resulting response waveforms 936 , 937 , 938 illustrated in FIGS. 9 C 2 , 9 C 3 , 9 C 4 respectively and each corresponding to a response resulting from stimulation at a different locus (or alternatively by varying stimulation parameters).
- the waveform responses illustrated in FIGS. 9 C 1 - 9 C 2 are measured in airflow but may also be determined, from other respiration parameters, e.g. EMG or diaphragm movement.
- FIG. 9C 2 illustrates a waveform response 936 in an ideal, preferred or target range.
- the ratio of peak flow over stimulation time for a given portion of the inspiration cycle is less than about 3.5.
- the ratio may also be expressed as a ratio of percentage of peak flow over a percentage of pacing time. While the effects herein may be expressed as a certain value, a specific calculation of the value is not required to achieve the invention or its equivalent.
- FIG. 9C 3 illustrates a waveform response 937 in an acceptable range.
- the acceptable range ratio of peak flow over pacing time is about less than or equal to about 10.
- FIG. 9C 4 illustrates a waveform response 938 in an unacceptable range.
- the unacceptable range ratio of peak flow over pacing time is above about 10.
- a ratio above 10 suggests an abrupt flow which may cause airway collapse, stretch receptor inhibition reflex, or pain for patients.
- FIG. 9D 1 illustrates a stimulation waveform 945 delivered to candidate therapeutic loci on the diaphragm.
- the various loci of stimulation correspond to resulting response waveforms 946 , 947 , 948 illustrated in FIGS. 9 D 2 , 9 D 3 , 9 D 4 respectively and each corresponding to a response resulting from stimulation at a different locus (or alternatively by varying stimulation parameters).
- the waveform responses illustrated in FIGS. 9 D 1 - 9 D 2 are measured in airflow but may also be determined, from other respiration parameters, e.g. EMG or diaphragm movement.
- FIG. 9D 2 illustrates a waveform response 946 in an ideal, preferred or target range.
- the instantaneous slope of peak flow over stimulation time for a given portion of the inspiration cycle is less than about 0.75.
- the ratio may also be expressed as a ratio of percentage of peak flow per milliseconds. While the effects herein may be expressed as a certain value, a specific calculation of the value is not required to achieve the invention or its equivalent.
- FIG. 9D 3 illustrates a waveform response 947 in an acceptable range.
- the acceptable range of instantaneous peak flow over time is about less than or equal to about 2.
- FIG. 9D 4 illustrates a waveform response 948 in an unacceptable range.
- the unacceptable range of instantaneous peak flow over time is above about 2.
- a ratio above 2 suggests an abrupt flow which may cause airway collapse, stretch receptor inhibition reflex, or pain for patients.
- FIG. 9E 1 illustrates a stimulation waveform 955 delivered to candidate therapeutic loci on the diaphragm.
- the various loci of stimulation correspond to resulting response waveforms 956 , 957 , 958 illustrated in FIGS. 9 E 2 , 9 E 3 , 9 E 4 respectively and each corresponding to a response resulting from stimulation at a different locus (or alternatively by varying stimulation parameters).
- the waveform responses illustrated in FIGS. 9 E 1 - 9 E 2 are measured in airflow but may also be determined, from other respiration parameters, e.g. EMG or diaphragm movement.
- FIG. 9E 2 illustrates a waveform response 956 in an ideal, preferred or target range. According to this target morphology, the minimum time elapsed before peak flow is achieved is greater than or equal to about 300 milliseconds or more.
- FIG. 9E 3 illustrates a waveform response 957 in an acceptable range.
- the acceptable range of minimum time to reach peak flow is greater than or equal to about 100 milliseconds and more preferably between about 100 milliseconds and 300 milliseconds.
- FIG. 9E 4 illustrates a waveform response 958 in an unacceptable range.
- the unacceptable range minimum time to reach peak flow is less than about 100 milliseconds.
- a time below about 100 ms suggests an abrupt flow which may cause airway collapse, stretch receptor inhibition reflex, or pain for patients.
- Minute ventilation may be increased or decreased with respect to a baseline minute ventilation. This may be done by manipulation of one or more parameters affecting minute ventilation. Some of the parameters may include, for example, tidal volume, respiration rate, flow morphology, flow rate, inspiration duration, slope of the inspiration curve, and diaphragm created or intrathoracic pressure gradients. Increasing minute ventilation generally increases the partial pressure of O 2 compared to a reference minute ventilation. Decreasing minute ventilation generally increases the partial pressure of CO 2 compared to a reference minute ventilation.
- stimulation parameters may be used to elicit different responses and therefore may also be used to determine optimal electrode location as well as optimal stimulus parameters. This stimulation may also be done with multiple electrodes simultaneously or in a sequence.
- the system may adjust the pace, pulse, frequency and amplitude within a series of pulses to induce or control various portions of a respiratory cycle, inspiration, exhalation, tidal volume (area under waveform curve) slope of inspiration, fast exhalation and other parameters of the respiratory cycle.
- the system may also adjust the rate of the respiratory cycle.
- the stimulation optimization may be used not only for mapping to identify electrode sites but may also be used to determine stimulation parameters for the ultimately implanted device.
- the ideal, preferred, target and acceptable waveform morphologies are not only for mapping but are also ideal, preferred, target and acceptable stimulation responses in the implanted device.
- a breathing response depends upon both the electrode location and the applied stimulus waveform. Not all electrode locations may be capable of producing a desired response. Also, different stimulus waveforms may be required at those locations that are shown to be capable of producing a desired response.
- FIG. 10A shows a timing diagram for a fixed stimulus 1000 applied during a rest period associated with intrinsic (or regulated) breathing.
- Regulated breathing refers to a predominantly regular breathing pattern that is produced by external assistance (e.g., a ventilator).
- Fixed stimulation may also be done during absence of breathing (e.g., in apnea) where stimulation is applied a certain period of time after apnea has begun.
- the fixed stimulus may be applied after a percentage (e.g., 30%) of the observed rest period has elapsed, or it may be applied after a fixed period of time has elapsed.
- the fixed period of time may be referenced to the beginning of inhalation 1005 , end of inhalation 1010 , or end of exhalation 1015 .
- the fixed time period may also be referenced to a period of time after EMG waveform 1006 has stopped or after the EMG envelope 1007 has fallen off.
- Fixed stimulation is not necessarily in phase with intrinsic respiration, and rather,
- FIG. 10B shows a timing diagram for a dynamically synchronized stimulus 1020 applied during a rest period associated with intrinsic (or regulated) breathing.
- the dynamically synchronized stimulus is applied after a delay equal to the length of the inspiration phase, expiration phase, or the total respiratory cycle.
- the delay is indexed to the end of the respiration cycle 1035 .
- the delay at 1035 is approximately equal to or less than the total respiratory cycle.
- the delay may also be equal to the length of the EMG signal 1036 or to the length of the EGM envelope 1037 .
- the delay may also be indexed to the end of the EMG envelope 1038 .
- Dynamic synchronization may occur or be adjusted breath to breath.
- the stimulation may be fixed or dynamically synchronized, it may also switch between fixed and dynamically synchronized, for example depending on the rate of respiration. If a subject is hyperventilating, hypoventilating or apneaic, the stimulation may revert to a fixed stimulation mode.
- FIG. 11 shows an abdominal view of a diaphragm 1105 with attached electrode substrates 1110 and 1120 .
- Electrode substrates 1110 , 1120 have keyed portions 1111 , 1121 respectively for positioning the substrate 1110 , 1120 on a conforming portions or surfaces of the central tendon 1106 .
- Electrode substrate 1110 located on the right hemidiaphragm 1115 has a pair of extensions 1126 a - b .
- Electrode substrate 1120 located on the left hemidiaphragm 1125 has a single extension 1126 c .
- Each extension 1126 a - c supports a peripheral device 1130 that may be either an electrode (e.g., stimulation or sensing electrode) or a sensor (e.g., movement sensor).
- the extensions 1126 a - c are located adjacent specific portions of the diaphragm apart from the stimulation electrodes.
- the peripheral device or devices 1130 sense movement or EMG at a distal or radial location from the stimulation electrodes on the electrode substrates 1110 , 1120 . This sensed movement or EMG may be used to confirm activation or degree of activation of the diaphragm from stimulation by one or more electrodes on the substrates 1110 , 1120 .
- FIGS. 12 through 16 show a series of flow charts for process sequences that may be combined to provide a hierarchical method for mapping diaphragm electrode sites.
- coarse mapping is done as described with reference to FIG. 12 .
- Coarse mapping entails testing a wide area on the diaphragm which is typically greater than the are of the electrode assembly used in testing. Once an area for electrode array positioning is determined, specific electrode position testing is performed and then stimulation optimization as described in FIGS. 13A-16B . These process sequences may be performed using all or part of the system shown in FIG. 1 .
- FIGS. 13A, 14A , 15 A and 16 A are directed to patients who are breathing on their own.
- FIGS. 13B, 14B , 15 B and 16 B are directed to patients in artificial respiratory states (i.e.—ventilator dependent.
- FIG. 12 shows a flow chart of a coarse mapping method in accordance with an embodiment of the present invention. This method may be used as a preliminary mapping process to determine the initial placement of an electrode array. Coarse mapping may be useful since physical land marks provided by the diaphragm might not be enough to identify an optimal positioning of the electrode array. In order to determine sections of the diaphragm that is more responsive to electrical stimulation course mapping may be performed. In step 1210 a coordinate system is established in a selected area. The selected area is typically larger than the foot print of the electrode array being placed. Selection of the area may be based upon visually observable features of the diaphragm, or may use information regarding the nerve structure of the diaphragm obtained by computer aided tomography (CAT), or other imaging technologies.
- CAT computer aided tomography
- a single electrode probe is used to probe a series of points distributed across the area selected in step 1210 .
- the locations may be marked, e.g. with ink, a laser grid, or on a monitor.
- the system depicted in FIG. 1 may be used, with the single electrode probe being substituted for the electrode substrate 150 .
- a fixed waveform may be applied at each location and a response sensed, e.g., by one of the previously mentioned techniques.
- step 1220 the pattern of test locations obtained in step 1215 is evaluated to determine where within the selected area the electrode array should be placed. For example, the electrode array may be placed in the region of the selected area for which the underlying test points have the highest average response value.
- step 1225 the process is done.
- FIG. 13A shows a flow chart 1300 of a method for intrinsic breathing evaluation in accordance with an embodiment of the present invention. This process is typically used prior to applying mapping stimuli in order to establish a target response that may be subsequently updated during mapping.
- the mapping electrode array is placed on the diaphragm.
- the mapping electrode array may be placed using the results of the coarse mapping procedure shown in FIG. 12 , or may be placed using physical features of the diaphragm.
- step 1315 the intrinsic breathing pattern is sensed and recorded using respiratory flow sensors to determine time dependent characteristics such as flow rate, pressure and tidal volume.
- step 1320 the intrinsic breathing diaphragm movement and activity are sensed and recorded using electrical (e.g., EMG) and/or mechanical (e.g., accelerometer or strain gauge) sensors.
- electrical e.g., EMG
- mechanical e.g., accelerometer or strain gauge
- the intrinsic breathing parameters associated with the observed intrinsic breathing pattern are calculated to provide reference values for subsequent comparison to those calculated from observed responses to mapping stimuli.
- Examples of intrinsic (or desired) breathing parameters are inspiration length, exhalation length, rate, amplitude, rest length and cycle length, slope of the inspiration cycle, slope of the expiration cycle, peak flow per time, percent peak flow per percent of inspiration time, and sustaining positive flow as a time value or as a percent of inspiration cycle.
- step 1330 the optimum stimulation timing is determined. As previously discussed, the stimulation may be dynamically synchronized or fixed.
- the process is done.
- FIG. 13B shows a flow chart of a method for baseline acquisition for mapping performed on a subject with regulated breathing in accordance with an embodiment of the present invention.
- Subjects with regulated breathing such as those on a ventilator may lack the diaphragm activity associated with intrinsic breathing.
- a baseline is developed during monitored intrinsic breathing prior to regulation.
- the baseline reference is a target response that is not updated during mapping.
- a respiratory flow monitor e.g., a pneumotachometer
- the intrinsic breathing pattern is recorded.
- step 1350 the intrinsic breathing parameters are calculated. In contrast to the process of FIG. 13A , information regarding diaphragm activity is not used.
- step 1355 the baseline reference is stored. Since intrinsic breathing is absent during mapping performed on a subject with regulated breathing, the baseline reference will not change during mapping.
- step 1360 the process is done.
- FIG. 14A shows a flow chart of a preliminary array mapping method for intrinsic breathing (or desired breathing) in accordance with an embodiment of the present invention.
- an electrode is selected from the array.
- a locator wave is applied to the selected electrode (e.g., fixed or dynamically synchronized).
- a locator wave typically has fixed parameters and a low current and is a wave that will evoke an observable response for area close to the desired permanent electrode implantation site(or desired).
- step 1420 the response to the locator wave is sensed and stored.
- a desired or acceptable response may be with respect to any of the parameters set forth with respect to FIG. 13A .
- the response may be a particular parameter such as, e.g., the amplitude of the response.
- step 1425 the intrinsic breathing pattern is sensed and recorded.
- step 1430 the intrinsic breathing parameters are recalculated.
- step 1435 the stored response is compared to the intrinsic breathing parameters, and an accuracy score or figure of merit is determined for the response.
- step 1440 a check is made to see if all of the electrodes in the array have been evaluated. If not, steps 1410 through 1435 are repeated. If all electrodes have been evaluated, the process is done at step 1445 .
- FIG. 14B shows a flow chart of a preliminary array mapping method for regulated breathing in accordance with an embodiment of the present invention.
- an electrode is selected from the array.
- a locator wave is applied to the selected electrode (e.g., in a dynamic or fixed synchronized manner).
- a locator wave typically has fixed parameters and a low current.
- step 1460 the response to the locator wave is sensed and stored.
- step 1465 the stored response is compared to a baseline reference (e.g., as obtained from the process of FIG. 13B ), and an accuracy score or figure of merit is determined for the response.
- step 1470 a check is made to see if all of the electrodes in the array have been evaluated. If not, steps 1450 through 1465 are repeated. If all electrodes have been evaluated, the process is done at step 1475 .
- FIG. 15A shows a flow chart of a single parameter mapping method for intrinsic breathing in accordance with an embodiment of the present invention.
- a set of candidate electrodes is selected, i.e., electrodes that have given the best response. This set may be selected on the basis of accuracy scores determined by the process shown in FIG. 14A .
- a response parameter is selected for qualification. Examples of response parameters are: inspiration length, exhalation length, rate, amplitude, rest length and cycle length, slope of the inspiration cycle, slope of the expiration cycle, peak flow per time, percent peak flow per percent of inspiration time, and sustaining positive flow as a time value or as a percent of inspiration cycle.
- a test wave is adjusted to match the intrinsic breath duration.
- Other parameters may subsequently be adjusted, for example: by lowering maximum current or lowering maximum frequency if peak flow/movement/EMG/volume/etc. are achieved too quickly; by increasing initial current amplitude or initial frequency if flow/EMG/pressure/etc initiation is delayed from delivery of initial pulse; or by changing (e.g., increasing) the ramp slope if flow/movement/EMG/volume/etc. has had more than one peak during an inspiration period.
- Other parameters that may also be adjusted are amplitude, frequency, shape, and timing.
- the test wave may also be adjusted to achieve a desired response, e.g., a percent of sustained positive airflow with respect to an inspiration cycle or other response.
- step 1525 an individual electrode is selected from the set of candidate electrodes selected in step 1510 .
- step 1530 the test wave constructed in step 1520 is delivered to the electrode (e.g., fixed or dynamically synchronized).
- step 1535 the response to the test wave is sensed and stored.
- step 1540 the intrinsic breathing pattern is sensed and recorded.
- step 1545 the intrinsic breathing parameters are recalculated.
- step 1550 the stored response is compared to the intrinsic breathing parameters, and an accuracy score or figure of merit is determined for the response.
- step 1555 a check is made to see if all of the electrodes in the array have been evaluated. If not, steps 1510 through 1550 are repeated. If all electrodes have been evaluated, the process is done at step 1560 .
- FIG. 15B shows a flow chart of a single parameter mapping method for regulated breathing in accordance with an embodiment of the present invention.
- a set of candidate electrodes is selected. This set may be selected on the basis of accuracy scores determined by the process shown in FIG. 14B .
- a response parameter is selected for qualification. Examples of response parameters are: EMG, flow, tidal volume, movement and pressure.
- a test wave is adjusted to match the intrinsic breath duration. Other parameters that may also be adjusted as well.
- an individual electrode is selected from the set of candidate electrodes selected in step 1570 .
- the test wave constructed in step 1574 is delivered to the electrode (e.g., fixed or dynamically synchronized).
- the response to the test wave is sensed and stored.
- step 1582 the stored response is compared to a baseline reference, and an accuracy score or figure of merit is determined for the response.
- step 1584 a check is made to see if all of the electrodes in the array have been evaluated. If not, steps 1570 through 1582 are repeated. If all electrodes have been evaluated, the process is done at step 1586 .
- FIG. 16A shows a flow chart of a multi-parameter mapping method for intrinsic breathing in accordance with an embodiment of the present invention.
- an electrode is selected.
- the electrode may be selected on the basis of the accuracy score determined in the process shown in FIG. 14A or FIG. 15A .
- a plurality of response parameters are selected for qualification. This may be done to refine the elelctorde choice or if a single parameter has not resulted in an electrode selection. Adjustments may be made where necessary in a manner similar as described with reference to FIG. 15A .
- Examples of response parameters are: EMG, flow, tidal volume, movement and pressure.
- An example of a pair of parameters are tidal volume and the measured parameter associated with diaphragm activation that shows the greatest dynamic range.
- a therapy wave is adjusted to match the intrinsic breath duration.
- Other parameters may also be adjusted as described with reference to FIG. 15A .
- the therapy wave may be adjusted to elicit an inspiration slope, a percentage peak value in a minimum percentage of the inspiration cycle, or a percentage of the peak inspiriaton in a minimum amount of time.
- the therapy wave constructed in step 1620 is delivered to the electrode (e.g., fixed or dynamically synchronized).
- the response to the therapy wave is sensed and stored.
- step 1635 the intrinsic breathing pattern is sensed and recorded.
- step 1640 the intrinsic breathing parameters are recalculated.
- step 1645 the stored response is compared to the intrinsic breathing parameters, and an accuracy score or figure of merit is determined for the response.
- step 1650 a check is made to see if the accuracy score or figure of merit determined in step 1645 is greater than a predetermined value. If not, steps 1610 through 1645 are repeated. If yes, the electrode location is qualified as a therapeutic locus and the process is done at step 1655 .
- FIG. 16B shows a flow chart of a multi-parameter mapping method for regulated breathing in accordance with an embodiment of the present invention.
- an electrode is selected.
- the electrode may be selected on the basis of the accuracy score determined in the process shown in FIG. 14B or FIG. 15B .
- step 1665 at least two response parameters are selected for qualification.
- response parameters are: EMG, flow, tidal volume, movement and pressure.
- An example of a pair of parameters are tidal volume and the measured parameter associated with diaphragm activation that shows the greatest dynamic range.
- step 1670 a therapy wave is adjusted to match the intrinsic breath duration. Other parameters may also be adjusted.
- step 1675 the therapy wave constructed in step 1670 is delivered to the electrode (e.g., fixed or dynamically synchronized).
- step 1680 the response to the therapy wave is sensed and stored.
- step 1685 the stored response is compared to a baseline reference, and an accuracy score or figure of merit is determined for the response.
- step 1690 a check is made to see if the accuracy score or figure of merit determined in step 1685 is greater than a predetermined value. If not, steps 1660 through 1685 are repeated. If yes, the electrode location is qualified as a therapeutic locus and the process is done at step 1695 .
- a desired breathing pattern for example, to manipulate physiological responses or to treat disorders, may be selected or programmed into the device.
- the electrodes may the be selected as set forth with reference to FIGS. 14-16 using the desired breathing pattern instead of the natural breathing pattern for comparison.
- the stimulation device may be used, for example in subjects with breathing disorders, heart failure patients and patients who cannot otherwise breathe on their own such as spinal cord injury patients.
- Safety mechanisms may be incorporated into any stimulation device in accordance with the invention.
- the safety feature disables the device under certain conditions.
- Such safety features may include a patient or provider operated switch, e.g. a magnetic switch.
- a safety mechanism may be included that determines when patient intervention is being provided. For example, the device will turn off if there is diaphragm movement sensed without an EMG as the case would be where a ventilator is being used.
Abstract
A signal source coupled to one or more electrodes in the vicinity of the diaphragm for mapping therapeutic electrode sites. A stimulus signal from the signal source may be applied to the one or more electrodes to produce activation of the diaphragm. Activation of the diaphragm is sensed to provide information that may be correlated with the stimulus signal. The correlated information may be used to identify a therapeutic locus for a therapeutic electrode. An electrical stimulus comprising a series of pulses may be applied to the one or more electrodes to elicit a desired breathing response. The electrical stimulus may be applied between intrinsic breathing cycles, or between regulated breathing cycles. More than one electrode may be supported on a single substrate. The substrate may configured to be positioned on the diaphragm. A hierarchy of stimuli may be applied to a set of electrodes.
Description
- This application is a continuation-in-part to U.S. patent application Ser. No. 10/686,891, “BREATHING DISORDER DETECTION AND THERAPY DELIVERY DEVICE AND METHOD”, by Tehrani filed Oct. 15, 2003, and incorporated herein by reference.
- The present invention relates to devices, systems, and methods useful for determining locations for therapeutic electrode placement on the diaphragm.
- Electrical stimulation of the diaphragm has been performed by delivering a stimulus to the diaphragm through one or more electrodes. The location of the stimulation electrodes greatly affects the ability to obtain a desired response with a given stimulus and candidate electrode sites may be mapped in order to aid in selecting a location for electrode placement.
- Diaphragm mapping is the process of correlating electrical stimuli applied at a set of points in the vicinity of the diaphragm muscle with the associated responses of the diaphragm muscle. When an electrical stimulus is applied, the diaphragm may respond directly or indirectly.
- In a direct response, the diaphragm is activated by a signal that is received by muscle fibers without conduction along a nerve. In an indirect response, the muscle fibers respond to a signal that is conducted through a nerve. In general, activation of the diaphragm muscle involves both direct and indirect responses. The relative intensity of direct and indirect response will vary with electrode location.
- The threshold for action potential initiation of nerves and muscle fibers is approximately the same. However, due to the signal attenuation of muscle tissue, direct stimulation is more localized with respect to an electrode than the response muscle tissue that is stimulated through nerve recruitment. Thus, changes in electrode location will typically affect the indirect and direct response differently.
- A motor point mapping system is described in “Laparoscopic Placement of Electrodes for Diaphragm Pacing Using Stimulation to Locate the Phrenic Nerve Motor Points,” B. D. Schmit, T. A. Stellato, M. E. Miller, and J. T. Mortimer, IEEE Trans. Rehab. Eng., vol. 6, pp. 382-390, 1998. Mapping was done with the goal of finding a functional motor point on the surface of the diaphragm at which full hemidiaphragm activation could be achieved with a minimum stimulus current. Full activation of the diaphragm was correlated with a tidal volume or peak pressure value. Also, the anatomical motor point was determined to be substantially in the geometric center of a group of nerve branches.
- Although electrode placement for obtaining full activation may be achieved by mapping a motor point, there are situations in which full activation may not be desirable, e.g., in the treatment of sleep apnea, because it may disturb the sleep of the subject.
- U.S. Pat. No. 4,827,935 describes a demand electroventilator using a plurality of electrodes adapted for placement on the skin. It describes mapping locations on the skin for optimum electrode location. It also uses the tidal volume to determine the optimal placement. The optimum inspiratory points were located as the sites where the maximum volume of air was inspired per milliampere of current.
- Since an activation level is characterized in each of these references by a peak or integrated value, a given activation level may be produced by many breathing patterns. Such peak or integrated value is not believed to be sufficient to determine proper placement of electrodes to achieve a desired breathing morphology because placement of electrodes influences the coordinated activation of various nerve and muscle fibers. Motor point mapping as performed in the prior art, for example, does not provide the information necessary for optimal placement of therapeutic electrodes intended to stimulate breathing patterns similar to those associated with certain activity levels such as, e.g., sleep. Such natural breathing patterns may be characterized by pressure or flow as a function of time. Also, tidal volume is not believed to provide sufficient information for optimal placement of electrodes to provide other desired inspiration morphologies that are characterized by flow properties.
- Additionally, known mapping techniques have been done where the breathing of the subject is controlled by a ventilator, or by inducing a particular state (e.g., apnea induced by hyperventilation) and thus under artificial conditions. Threshold and full activation mapping have been done under these conditions, but it is not believed to be well suited for mapping that is directed to identifying optimal electrode placement for replicating intrinsic breathing patterns or for controlling or manipulating specific aspects of breathing morphology and related physiology.
- Mapping has been done using a single electrode that is moved from one location to the next, with stimuli being applied and responses measured at each location. In this scheme there may be some placement error when the mapping electrode is removed and replaced with a permanent implanted electrode.
- Thus, a need exists for a system and method of mapping sites on the diaphragm for therapeutic electrode placement that is more suitable to create intrinsic breathing or to control or manipulate specific aspects of breathing morphology and related physiology. A need also exists for a system and method that provides increased accuracy of electrode placement.
- The present invention provides a signal source for eliciting a desired respiration response that is coupled to one or more electrodes in the vicinity of the diaphragm. A stimulus signal from the source may be applied to the one or more electrodes to produce activation of the diaphragm. Respiration response is sensed to provide information that may be correlated with the stimulus signal. The correlated information may be used to identify a therapeutic locus for a therapeutic electrode.
- Sensed respiration response may include, for example, parameters indicating diaphragm activation such as diaphragm movement or diaphragm EMG. Sensed respiration response may include parameters such as flow, tidal volume, intraabdominal, intrathoracic and airway pressure. Each of these parameters may be observed over time where they create a respiration or inspiration morphology.
- In one embodiment of the invention an electrode is placed in the vicinity of the diaphragm and an electrical stimulus is applied between intrinsic breathing cycles, or regulated breathing cycles.
- In a further embodiment an electrical stimulus comprising a series or burst of pulses is applied through one or more electrodes to the diaphragm to elicit a natural breathing response. The series of pulses may be varied in either or both amplitude and frequency.
- In another embodiment a support structure supporting one or more electrodes is configured to be placed on the surface of the diaphragm. The support structure may be, e.g., a mesh or other flexible thin substrate. The support structure may comprise a variety of materials such as, e.g., silicone, PTFE, polyurethane, latex, polyester. The support structure may be a substrate with electrodes positioned on, attached to, or formed with the substrate. The substrate may be configured to be positioned on the diaphragm, e.g., by aiding proper locating, positioning and placement of the electrodes and/or by accommodating the movement of the diaphragm. The substrate may also be shaped to fit on the diaphragm and may also be keyed with anatomical structures to aid in ideal positioning. Electrical stimuli are applied sequentially and/or in combination through the electrodes to the diaphragm to elicit a natural breathing response from the diaphragm.
- Another feature provides an array of electrodes configured to be laparoscopically delivered and to be positioned on the diaphragm. In addition to features that allow the device to be positioned on the diaphragm for stimulation, the substrate is foldable, deflatable and/or contractible so that it can be delivered through a small opening or cannula, and unfoldable, inflatable or expandable to be positioned on the diaphragm.
- In yet another embodiment a hierarchy of stimuli are applied to a set of electrodes. At each level in the hierarchy the stimuli are more complex with a greater number of adjustable parameters. The set of electrodes may be reduced in number as each level in the hierarchy is reached.
-
FIG. 1 shows a diagram of a system for mapping electrode sites on a diaphragm in accordance with an embodiment of the present invention. -
FIG. 2A shows a guide grid on a diaphragm in accordance with an embodiment of the present invention. -
FIG. 2B shows electrode arrays placed with respect to an anatomical feature in accordance with an embodiment of the present invention. -
FIG. 2C shows a template corresponding to each of electrode arrays ofFIG. 2B -
FIG. 3A shows a top view of an array of electrodes on a single substrate in accordance with an embodiment of the present invention. -
FIG. 3B shows a cross-section view of the electrode array ofFIG. 3A in accordance with an embodiment of the present invention. -
FIG. 4A shows an electrode array arranged on an inflatable member in accordance with an embodiment of the present invention. -
FIG. 4B shows a diagram of an in situ electrode substrate in accordance with an embodiment of the present invention. -
FIG. 5 shows a perspective view of an electrode array with a suction field surrounding the electrodes in accordance with an embodiment of the present invention. -
FIG. 6A shows a view of the active surface of an electrode array with an inflatable member in accordance with an embodiment of the present invention. -
FIG. 6B shows a side view of the electrode array ofFIG. 6A . -
FIG. 6C shows the electrode array ofFIG. 6A in a folded configuration in accordance with an embodiment of the present invention. -
FIG. 7A shows a perspective view of an electrode array with an inflatable member and suction field in accordance with an embodiment of the present invention. -
FIG. 7B shows a side view of the electrode array ofFIG. 7A . -
FIG. 7C shows the electrode array ofFIG. 7A in a folded configuration in accordance with an embodiment of the present invention. -
FIG. 8 shows a stimulus waveform in accordance with an embodiment of the present invention. -
FIG. 9A shows a natural breathing response waveform in accordance with an embodiment of the present invention. - FIGS. 9B1-9B4 shows target, acceptable and unacceptable breathing response waveforms in response to stimulation in accordance with an embodiment of the present invention.
- FIGS. 9C1-9C4 shows target, acceptable and unacceptable breathing response waveforms in response to stimulation in accordance with an embodiment of the present invention.
- FIGS. 9D1-9D4 shows target, acceptable and unacceptable breathing response waveforms in response to stimulation in accordance with an embodiment of the present invention.
- FIGS. 9E1-9E4 shows target, acceptable and unacceptable breathing response waveforms in response to stimulation in accordance with an embodiment of the present invention.
-
FIGS. 10A and 10B show timing diagrams for a stimulus applied during intrinsic breathing in accordance with embodiments of the present invention. -
FIG. 11 shows an electrode array and sensors placed on the diaphragm in accordance with an embodiment of the present invention. -
FIG. 12 shows a flow chart of a coarse mapping method in accordance with an embodiment of the present invention. -
FIG. 13A shows a flow chart of a method for intrinsic breathing evaluation in accordance with an embodiment of the present invention. -
FIG. 13B shows a flow chart of a method for baseline acquisition for mapping performed on a subject with regulated breathing in accordance with an embodiment of the present invention. -
FIG. 14A shows a flow chart of a preliminary array mapping method in accordance with an embodiment of the present invention. -
FIG. 14B shows a flow chart of a preliminary array mapping method in accordance with an embodiment of the present invention. -
FIG. 15A shows a flow chart of a single parameter mapping method in accordance with an embodiment of the present invention. -
FIG. 15B shows a flow chart of a single parameter mapping method in accordance with an embodiment of the present invention. -
FIG. 16A shows a flow chart of a multi-parameter mapping method in accordance with an embodiment of the present invention. -
FIG. 16B shows a flow chart of a multi-parameter mapping method in accordance with an embodiment of the present invention. -
FIG. 1 shows asystem 100 for mapping electrode sites on adiaphragm 155 of a subject 135. Alaparoscopic imaging unit 130 is coupled to alaparoscope 145 for observing the surface of thediaphragm 155. Theimaging unit 130 is coupled to a diaphragmmapping control module 105. Theimaging unit 130 may provide analog or digital images to thecontrol module 105. Thecontrol module 105 includes amonitor 110, processingunit 115 and an I/O module 120. - The
monitor 110 may be used displaying a graphical user interface and may also be used for displaying images. Displayed images may be either real-time images from theimaging unit 130 or stored images. Stored images may be overlaid with real-time images to provide visual references for electrode placement. - The
processing unit 115 includes a data processor, memory, and program storage for data and image acquisition and manipulation. Theprocessing unit 115 is coupled to an input/output (I/O)module 120, and may be used to control the timing of stimuli delivered to mapping electrodes. - The I/
O module 120 is coupled to theimaging unit 130, and to one ormore electrodes 151 on themapping electrode substrate 150. Theelectrodes 151 on the mapping electrode substrate are configured for electrical stimulation and/or sensing of the diaphragm. The I/O module may also be coupled to other sensing devices coupled to the subject 135, such as a respiratory sensor 125 (e.g., pneumotachometer) or electrical/mechanical sensors 140 and/or 152.Sensor 152 is shown positioned for sensing abdominal movement, whereassensor 140 is positioned for sensing movement in thethoracic region 160.Sensors -
Respiratory sensor 125 may be, e.g., a flow meter, pneumotachometer, or pressure sensor used to measure tidal volume, respiratory flow, and/or respiratory pressure.Sensor 140 may be, e.g., a piezo-film sensor, multi-axis accelerometer, strain gauge, pressure sensor, and may be used to measure abdominal movement, diaphragmatic movement, other subject movement or activity, intrathoracic pressure, or intraabdominal pressure. - The
system 100 may be used to develop a coordinate system on a per subject basis by capturing an image of the surface of thediaphragm 155, upon which themapping electrode substrate 150 is attached. The image obtained by theimaging unit 130 is transferred to thecontrol module 105. Each time themapping electrode substrate 150 is moved, a new coordinate system is created. Once a desired therapeutic locus is determined on the surface of thediaphragm 155 as described in more detail below, the control unit may use the images acquired during the mapping process to provide guidance for placement of a permanent electrode, e.g. through real-time visual aid (video feed, laser grid), audible proximity indicator beeps, or haptic feedback. -
FIG. 2A shows an abdominal view of adiaphragm 205 with areference grid 210 applied to theright hemidiaphragm 215 and areference grid 220 applied to theleft hemidiaphragm 225. The reference grid may be applied with an ink or dye, or it may be an optical projection. Thegrids -
FIG. 2B shows an abdominal view of adiaphragm 205 with attachedelectrode substrates electrode substrates electrodes 233 located on the substrates in a predetermined configuration.Electrode substrate 230 has a keyed orcurved portion 231 on its perimeter that matches thedepression 245 on thecentral tendon 240. Similarly,electrode substrate 235 has a keyed orcurved portion 232 on its perimeter that matches thedepression 250 on thecentral tendon 240. The keyed configuration of theelectrode substrate 235 allows a more precise locating, positioning and placement of the substrates on the diaphragm. Thesubstrates template openings 234 for marking the position of thesubstrates - The
electrode substrates diaphragm 205 in a number of ways with laparoscopic instruments, for example with sutures, staples or clips, temporary adhesive (bio-adhesive), and suction. - To identify the precise location of the selected mapping electrode after the
substrates template openings 234. Atemplate 236 as illustrated inFIG. 2C includes matchingtemplate openings 237 that match the orientation of thetemplate openings 234 of thesubstrates Electrode openings 238 in thetemplate 236 also match the orientation of theelectrodes 233 on thesubstrates template openings 234 in thesubstrates openings 237 over the marks. The electrode opening that corresponds to the selected electrode on the array may then be used to mark the correct location for a subsequently implanted electrode. Permanently implanted electrodes may then be placed in position of the selected optimal mapping electrode or electrodes as they were positioned with the mapping substrate. - The electrode substrate may also include an adhesive dye (which can be radio-opaque) in a pattern where once the substrate is removed, the adhesive sticks to the diaphragm indicating key locations so that mapped positions may be visually or radiographically identified. The locations of the mapping substrate and electrodes may also be identified with a photo taken of the substrate in position on the diaphragm.
- This and other electrode assemblies and/or substrates described herein may be temporarily implanted or permanently implanted and used for stimulation once the assembly or substrate has been optimally positioned.
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FIG. 3A shows a top view of an array of electrodes (310,315) on asingle substrate 305 in accordance with an embodiment of the present invention.Electrode 310 is a subsurface electrode that is intended to penetrate the peritoneum on the diaphragm, whereaselectrode 315 is a surface electrode that is intended for contact with the surface of the peritoneum on the diaphragm. Asubsurface electrode 310 will generally provide a greater electrical efficiency, whereas asurface electrode 315 will more easily couple to a larger region. A surface electrode may 315 be combined with asubsurface electrode 310 to form a single composite electrode. These electrodes may also be selected to elicit a desired observed response. - The
substrate 305 is preferably fabricated from a flexible material such as silicone, and may or may not be reinforced (e.g., with a mesh). The substrate is configured to fit on the diaphragm. The perimeter of thesubstrate 305 may be round, elliptical, or a more complex shape that conforms to a specific feature on the diaphragm surface. A complex perimeter shape may be used to facilitate placement of thesubstrate 305 at a particular location on the surface of the diaphragm, such as one of the depressions separating the three leaflets of the diaphragm, or characteristics of the central tendon. - The electrode array on the
substrate 305 may contain only surface or subsurface electrodes or a combination of surface and subsurface electrodes. The electrodes may be arranged in a regular array using polar or rectangular coordinates, or they may be arranged as an irregularly spaced array, e.g., that is correlated with nerve structure that innervates the diaphragm. The electrodes may be attached to the substrate a number of ways, e.g., glued, welded, etched on, or encased with the substrate material. -
FIG. 3B shows a cross-section view A-A of the electrode array ofFIG. 3A . The substrate is thicker in the central region and tapers at the perimeter. Areinforcement 325 is also shown. The taper at theperimeter 321 reduces the dynamic interfacial forces that are produced between substrate and diaphragm during activation of the diaphragm. The enhanced peripheral flexibility reduces mechanical loading of the diaphragm and reduces the stress on the attachment (e.g., sutures or suction). Thesubstrate surface 320 upon which the electrodes reside may be flat, or it may be curved to accommodate the surface of the diaphragm. -
Electrodes - The electrode assembly may also be in the form of a flexible wire member such as a flexible loop. The flexibility of the loops permits the ability to form the loops in the shape most ideally suited for a particular patient. Other shapes may be used as well, e.g. a loop with a branch that extends to the region adjacent the anterior branches of the phrenic nerve. The control unit may be programmed to activate the electrodes in a sequence that is determined to elicit the desired response from the diaphragm.
- The electrodes of the electrode assemblies once implanted, may be selected to form bipolar or multipolar electrode pairs or groups that optimize the stimulation response.
-
FIG. 4A shows anelectrode array 400 coupled to aninflatable member 405 defining aninflation chamber 406. In this embodiment, theinflatable member 405 may be inflated to contact a surface opposite the diaphragm to provide the force necessary to hold theelectrode array 400 against the surface of the diaphragm. The electrodes may be coupled to an external I/O device with lead wires extending inside of, outside of or within the walls of the inflation tube. Theinflation chamber 406 is coupled to atube 420 that delivers an inflation medium to or from thechamber 407. Thetube 420 may also serve to couple the pressure within theinflation chamber 407 to an external pressure transducer. Alternatively pressure within theinflation chamber 407 may be sensed by alocal pressure transducer 425 which is coupled to an I/O port with a lead or in a similar manner as the electrodes. Theinflation chamber 407 may be evacuated in order to reduce the volume of theinflation member 405 andelectrode array 400 during an insertion or removal procedure. -
FIG. 4B shows a diagram of an insitu electrode substrate 406. In this example, theelectrode substrate 406 is coupled to aflexible tube 435 that penetrates theabdominal wall 440. Aswitching network 450couples lines control unit 430 to an array of nine electrodes. Theswitching network 450 allows any one or two of the nine electrodes to be selected, and reduces the number of leads that must be connected directly to thecontrol unit 430. Electrode selection may be done either for monopolar/bipolar sensing, or stimulus delivery. - The
electrode substrate 406 may support one ormore sensors 445 for sensing electrical or mechanical activity of the diaphragm.Sensor 445 is coupled to thecontrol unit 430 bylead 443. Examples of electrical sensors are monopolar and bipolar electrodes for electromyogram (EMG) sensing. Examples of mechanical activity sensors are: strain gauges, pressure sensors, piezo-electric devices, accelerometers, and position sensors. -
FIG. 5 shows a perspective view of anelectrode array structure 505 with a suction field surrounding theelectrodes 515 in accordance with an embodiment of the present invention. Theelectrodes 515 are supported on amesh 510 that is circumferentially enclosed by aseal surface 520 that interfaces with the diaphragm surface. Aport 525 is used to connect a vacuum source to theelectrode array structure 505. Vacuum is applied after the seal surface is placed on or mated to the surface of the diaphragm. -
FIG. 6A shows a view of the active surface of anelectrode array structure 605 with aninflation member 620 having aninflation chamber 621 in accordance with an embodiment of the present invention.Individual suction cups 615 are used to provide the attaching force to the diaphragm.Electrodes 610 are distributed on the surface between thesuction cups 615.FIG. 6B shows a side view 601 of the electrode array structure ofFIG. 6A .Vacuum ports 625 are shown connected to thesuction cups 615, and a fill/evacuation port 630 is shown coupled to theinflation chamber 621. -
FIG. 6C shows the electrode array ofFIG. 6A in a folded configuration that is produced in conjunction with deflation of theinflation member 620. The deflation of theinflation chamber 621 of theinflation member 620 produces a reduction in volume and an elongated shape that facilitates the introduction and removal of theelectrode array structure 605 through a cannula or a narrow opening. -
FIG. 7A shows a perspective view of anelectrode array 705 on aninflation member 740 with aninflation chamber 741 and asuction field mesh 710 in accordance with an embodiment of the present invention.Electrodes 715 are supported on themesh 710. Themesh 710 is surrounded by aseal surface 720. Theinflation chamber 741 is coupled to a fill/evacuation port 730. Anevacuation port 725 is used provide to provide vacuum to theelectrode array 705. Having themesh 710 withelectrodes 715 inside the suction field allows stabilization of the tissue via vacuum and provides intimate contact between the tissue and theelectrodes 715 during contraction of the diaphragm.FIG. 7B shows a side view of the electrode array ofFIG. 7A . Theinflation member 740 has a radial symmetry (e.g., toroidal) with respect to theevacuation port 725. -
FIG. 7C shows the electrode array ofFIG. 7A in a folded configuration that is produced in conjunction with deflation of theinflation member 740. The deflation of theinflation member 740 produces a reduction in volume and an elongated shape that facilitates the introduction and removal of theelectrode array structure 705 through a cannula or a narrow opening. - The electrode arrays described herein may be configured to be laparoscopically delivered to the diaphragm. They may be compressed to a smaller configuration and then expanded to be positioned on the diaphragm. They may also be delivered as individual components and assembled at the diaphragm. They may also be delivered as individual components and assembled at the diaphragm.
-
FIG. 8 shows an example of astimulus waveform 800 that may be applied to the diaphragm through an electrode.Waveform 800 is a biphasic pulse train; however, in other embodiments a monophasic or other multiphasic pulse train may be used. The individual pulses within thepulse train 800 may have variable amplitudes. For example,pulse 805 has an amplitude A1 that is smaller than the amplitude A2 ofpulse 810. Thepulse train 800 may also have a variable frequency, with the period P1 betweenpulses pulses - The stimulus waveform or
pulse train 800 may incorporate a delay D between positive and negative pulses, as shown betweenpositive pulse 810 andnegative pulse 811. -
FIG. 9A shows an example of a natural breathingflow response waveform 905 associated with astimulation waveform 910 delivered to a therapeutic locus on the diaphragm. For purposes of this disclosure, “intrinsic breathing” refers to breathing that is not induced by an applied stimulus, and “natural breathing” refers to breathing that is similar or identical to intrinsic breathing, but is induced by an applied stimulus. The natural breathingflow response waveform 905 is similar to intrinsic respiration waveforms observed in humans. Flow increases gradually during most of the inspiration phase to a peak value, followed by a relatively sharp decline in flow to the onset of the expiration phase. In this example, the first pulse in thestimulation waveform 910 has an amplitude At, that is equal to a measured or observed threshold value for the therapeutic locus.FIG. 9A similarly illustrates a natural breathingEMG response waveform 906 andenvelope 907 associated with thestimulation waveform 910. -
FIG. 1 illustrates a9B stimulation waveform 925 delivered to candidate therapeutic loci on the diaphragm. The various loci of stimulation correspond to resultingresponse waveforms - The waveform responses illustrated in FIGS. 9B1-9B2 are measured in airflow but may also be determined, from other respiration parameters, e.g. EMG or diaphragm movement. “Morphology” refers to the shape or form of the respiration waveform or waveform envelope and may include various aspects of the waveform including, e.g., length of various portions of the waveform, amplitude, frequency or slope. A desired response may be natural breathing as illustrated in
FIG. 9A or another desired response. -
FIG. 2 illustrates a9B waveform response 926 in an ideal, preferred or target range. According to this target morphology, for a given portion of the inspiration cycle positive inhalation is sustained. A sustained inhalation period or portion of time is an inhalation period in which there is a positive airflow. The target range may be expressed as a portion, fraction or percentage of time of the inspiration cycle in which there is a positive or sustained inhalation. While this effect may be expressed in these terms, a percentage or fraction calculation is not required to achieve the effect of the invention or its equivalent. The target range is from about 75% to 100% sustained inhalation. The waveform illustrated inFIG. 2 shows an inspiration cycle where 95% or 0.95 of the inspiration cycle is sustained positive inhalation.9B -
FIG. 9B 3 illustrates awaveform response 927 in an acceptable range. The acceptable range is between about 50% and 100% sustained inhalation. The illustrated waveform is at 60% sustained positive inhalation. -
FIG. 9B 4 illustrates awaveform 928 response in an unacceptable range. The unacceptable range is below about 50% sustained inhalation. The illustrated waveform is at 20% sustained positive inhalation. Less than about 50% suggests poor efficiency of the delivered stimulation pulse. - It is believed that long period of isometric diaphragm contraction can lead to diaphragm fatigue and patient discomfort. Staying within the target range suggests increased energy efficiency, likely responses similar to physiologic or natural conditions. Gradual contraction is also less likely to cause airway collapse or stretch receptor inhibition reflex and is likely to provide more comfortable breathing for patients.
-
FIG. 1 illustrates a9C stimulation waveform 935 delivered to candidate therapeutic loci on the diaphragm. The various loci of stimulation correspond to resultingresponse waveforms - The waveform responses illustrated in FIGS. 9C1-9C2 are measured in airflow but may also be determined, from other respiration parameters, e.g. EMG or diaphragm movement.
-
FIG. 2 illustrates a9C waveform response 936 in an ideal, preferred or target range. According to this target morphology, the ratio of peak flow over stimulation time for a given portion of the inspiration cycle is less than about 3.5. The ratio may also be expressed as a ratio of percentage of peak flow over a percentage of pacing time. While the effects herein may be expressed as a certain value, a specific calculation of the value is not required to achieve the invention or its equivalent. -
FIG. 9C 3 illustrates awaveform response 937 in an acceptable range. The acceptable range ratio of peak flow over pacing time is about less than or equal to about 10. -
FIG. 9C 4 illustrates awaveform response 938 in an unacceptable range. The unacceptable range ratio of peak flow over pacing time is above about 10. A ratio above 10 suggests an abrupt flow which may cause airway collapse, stretch receptor inhibition reflex, or pain for patients. -
FIG. 1 illustrates a9D stimulation waveform 945 delivered to candidate therapeutic loci on the diaphragm. The various loci of stimulation correspond to resultingresponse waveforms - The waveform responses illustrated in FIGS. 9D1-9D2 are measured in airflow but may also be determined, from other respiration parameters, e.g. EMG or diaphragm movement.
-
FIG. 2 illustrates a9D waveform response 946 in an ideal, preferred or target range. According to this target morphology, the instantaneous slope of peak flow over stimulation time for a given portion of the inspiration cycle is less than about 0.75. The ratio may also be expressed as a ratio of percentage of peak flow per milliseconds. While the effects herein may be expressed as a certain value, a specific calculation of the value is not required to achieve the invention or its equivalent. -
FIG. 9D 3 illustrates awaveform response 947 in an acceptable range. The acceptable range of instantaneous peak flow over time is about less than or equal to about 2. -
FIG. 9D 4 illustrates awaveform response 948 in an unacceptable range. The unacceptable range of instantaneous peak flow over time is above about 2. A ratio above 2 suggests an abrupt flow which may cause airway collapse, stretch receptor inhibition reflex, or pain for patients. -
FIG. 1 illustrates a9E stimulation waveform 955 delivered to candidate therapeutic loci on the diaphragm. The various loci of stimulation correspond to resultingresponse waveforms - The waveform responses illustrated in FIGS. 9E1-9E2 are measured in airflow but may also be determined, from other respiration parameters, e.g. EMG or diaphragm movement.
-
FIG. 2 illustrates a9E waveform response 956 in an ideal, preferred or target range. According to this target morphology, the minimum time elapsed before peak flow is achieved is greater than or equal to about 300 milliseconds or more. -
FIG. 9E 3 illustrates awaveform response 957 in an acceptable range. The acceptable range of minimum time to reach peak flow is greater than or equal to about 100 milliseconds and more preferably between about 100 milliseconds and 300 milliseconds. -
FIG. 9E 4 illustrates awaveform response 958 in an unacceptable range. The unacceptable range minimum time to reach peak flow is less than about 100 milliseconds. A time below about 100 ms suggests an abrupt flow which may cause airway collapse, stretch receptor inhibition reflex, or pain for patients. - Various desired responses may also include waveforms or morphologies that have a desired physiological outcome or effect such as desired blood oxygen saturation levels or PCO2 levels. Minute ventilation may be increased or decreased with respect to a baseline minute ventilation. This may be done by manipulation of one or more parameters affecting minute ventilation. Some of the parameters may include, for example, tidal volume, respiration rate, flow morphology, flow rate, inspiration duration, slope of the inspiration curve, and diaphragm created or intrathoracic pressure gradients. Increasing minute ventilation generally increases the partial pressure of O2 compared to a reference minute ventilation. Decreasing minute ventilation generally increases the partial pressure of CO2 compared to a reference minute ventilation.
- As noted variations in stimulation parameters may be used to elicit different responses and therefore may also be used to determine optimal electrode location as well as optimal stimulus parameters. This stimulation may also be done with multiple electrodes simultaneously or in a sequence.
- The system may adjust the pace, pulse, frequency and amplitude within a series of pulses to induce or control various portions of a respiratory cycle, inspiration, exhalation, tidal volume (area under waveform curve) slope of inspiration, fast exhalation and other parameters of the respiratory cycle. The system may also adjust the rate of the respiratory cycle.
- The stimulation optimization may be used not only for mapping to identify electrode sites but may also be used to determine stimulation parameters for the ultimately implanted device. As such the ideal, preferred, target and acceptable waveform morphologies are not only for mapping but are also ideal, preferred, target and acceptable stimulation responses in the implanted device.
- A breathing response depends upon both the electrode location and the applied stimulus waveform. Not all electrode locations may be capable of producing a desired response. Also, different stimulus waveforms may be required at those locations that are shown to be capable of producing a desired response.
-
FIG. 10A shows a timing diagram for a fixedstimulus 1000 applied during a rest period associated with intrinsic (or regulated) breathing. Regulated breathing refers to a predominantly regular breathing pattern that is produced by external assistance (e.g., a ventilator). Fixed stimulation may also be done during absence of breathing (e.g., in apnea) where stimulation is applied a certain period of time after apnea has begun. The fixed stimulus may be applied after a percentage (e.g., 30%) of the observed rest period has elapsed, or it may be applied after a fixed period of time has elapsed. The fixed period of time may be referenced to the beginning ofinhalation 1005, end ofinhalation 1010, or end ofexhalation 1015. The fixed time period may also be referenced to a period of time afterEMG waveform 1006 has stopped or after theEMG envelope 1007 has fallen off. Fixed stimulation is not necessarily in phase with intrinsic respiration, and rather, is offset from a previous cycle. -
FIG. 10B shows a timing diagram for a dynamically synchronizedstimulus 1020 applied during a rest period associated with intrinsic (or regulated) breathing. The dynamically synchronized stimulus is applied after a delay equal to the length of the inspiration phase, expiration phase, or the total respiratory cycle. The delay is indexed to the end of therespiration cycle 1035. In this example the delay at 1035 is approximately equal to or less than the total respiratory cycle. The delay may also be equal to the length of theEMG signal 1036 or to the length of theEGM envelope 1037. The delay may also be indexed to the end of theEMG envelope 1038. Dynamic synchronization may occur or be adjusted breath to breath. - While the stimulation may be fixed or dynamically synchronized, it may also switch between fixed and dynamically synchronized, for example depending on the rate of respiration. If a subject is hyperventilating, hypoventilating or apneaic, the stimulation may revert to a fixed stimulation mode.
-
FIG. 11 shows an abdominal view of adiaphragm 1105 with attachedelectrode substrates Electrode substrates substrate central tendon 1106.Electrode substrate 1110 located on theright hemidiaphragm 1115 has a pair ofextensions 1126 a-b.Electrode substrate 1120 located on theleft hemidiaphragm 1125 has asingle extension 1126 c. Eachextension 1126 a-c supports aperipheral device 1130 that may be either an electrode (e.g., stimulation or sensing electrode) or a sensor (e.g., movement sensor). Theextensions 1126 a-c are located adjacent specific portions of the diaphragm apart from the stimulation electrodes. The peripheral device ordevices 1130 sense movement or EMG at a distal or radial location from the stimulation electrodes on theelectrode substrates substrates -
FIGS. 12 through 16 show a series of flow charts for process sequences that may be combined to provide a hierarchical method for mapping diaphragm electrode sites. First, coarse mapping is done as described with reference toFIG. 12 . Coarse mapping entails testing a wide area on the diaphragm which is typically greater than the are of the electrode assembly used in testing. Once an area for electrode array positioning is determined, specific electrode position testing is performed and then stimulation optimization as described inFIGS. 13A-16B . These process sequences may be performed using all or part of the system shown inFIG. 1 . -
FIGS. 13A, 14A , 15A and 16A are directed to patients who are breathing on their own.FIGS. 13B, 14B , 15B and 16B are directed to patients in artificial respiratory states (i.e.—ventilator dependent. -
FIG. 12 shows a flow chart of a coarse mapping method in accordance with an embodiment of the present invention. This method may be used as a preliminary mapping process to determine the initial placement of an electrode array. Coarse mapping may be useful since physical land marks provided by the diaphragm might not be enough to identify an optimal positioning of the electrode array. In order to determine sections of the diaphragm that is more responsive to electrical stimulation course mapping may be performed. In step 1210 a coordinate system is established in a selected area. The selected area is typically larger than the foot print of the electrode array being placed. Selection of the area may be based upon visually observable features of the diaphragm, or may use information regarding the nerve structure of the diaphragm obtained by computer aided tomography (CAT), or other imaging technologies. - In step 1215 a single electrode probe is used to probe a series of points distributed across the area selected in
step 1210. The locations may be marked, e.g. with ink, a laser grid, or on a monitor. The system depicted inFIG. 1 may be used, with the single electrode probe being substituted for theelectrode substrate 150. A fixed waveform may be applied at each location and a response sensed, e.g., by one of the previously mentioned techniques. - In
step 1220 the pattern of test locations obtained instep 1215 is evaluated to determine where within the selected area the electrode array should be placed. For example, the electrode array may be placed in the region of the selected area for which the underlying test points have the highest average response value. Atstep 1225 the process is done. -
FIG. 13A shows a flow chart 1300 of a method for intrinsic breathing evaluation in accordance with an embodiment of the present invention. This process is typically used prior to applying mapping stimuli in order to establish a target response that may be subsequently updated during mapping. - In
step 1310 the mapping electrode array is placed on the diaphragm. The mapping electrode array may be placed using the results of the coarse mapping procedure shown inFIG. 12 , or may be placed using physical features of the diaphragm. - In
step 1315 the intrinsic breathing pattern is sensed and recorded using respiratory flow sensors to determine time dependent characteristics such as flow rate, pressure and tidal volume. - In
step 1320 the intrinsic breathing diaphragm movement and activity are sensed and recorded using electrical (e.g., EMG) and/or mechanical (e.g., accelerometer or strain gauge) sensors. - In
step 1325 the intrinsic breathing parameters associated with the observed intrinsic breathing pattern are calculated to provide reference values for subsequent comparison to those calculated from observed responses to mapping stimuli. Examples of intrinsic (or desired) breathing parameters are inspiration length, exhalation length, rate, amplitude, rest length and cycle length, slope of the inspiration cycle, slope of the expiration cycle, peak flow per time, percent peak flow per percent of inspiration time, and sustaining positive flow as a time value or as a percent of inspiration cycle. - In
step 1330 the optimum stimulation timing is determined. As previously discussed, the stimulation may be dynamically synchronized or fixed. Atstep 1335 the process is done. -
FIG. 13B shows a flow chart of a method for baseline acquisition for mapping performed on a subject with regulated breathing in accordance with an embodiment of the present invention. Subjects with regulated breathing, such as those on a ventilator may lack the diaphragm activity associated with intrinsic breathing. In such cases, a baseline is developed during monitored intrinsic breathing prior to regulation. The baseline reference is a target response that is not updated during mapping. - In step 1340 a respiratory flow monitor (e.g., a pneumotachometer) is placed on the subject. In
step 1345 the intrinsic breathing pattern is recorded. - In
step 1350 the intrinsic breathing parameters are calculated. In contrast to the process ofFIG. 13A , information regarding diaphragm activity is not used. - In
step 1355 the baseline reference is stored. Since intrinsic breathing is absent during mapping performed on a subject with regulated breathing, the baseline reference will not change during mapping. Atstep 1360 the process is done. -
FIG. 14A shows a flow chart of a preliminary array mapping method for intrinsic breathing (or desired breathing) in accordance with an embodiment of the present invention. Instep 1410 an electrode is selected from the array. In step 1415 a locator wave is applied to the selected electrode (e.g., fixed or dynamically synchronized). A locator wave typically has fixed parameters and a low current and is a wave that will evoke an observable response for area close to the desired permanent electrode implantation site(or desired). - In
step 1420 the response to the locator wave is sensed and stored. A desired or acceptable response may be with respect to any of the parameters set forth with respect toFIG. 13A . The response may be a particular parameter such as, e.g., the amplitude of the response. - In
step 1425 the intrinsic breathing pattern is sensed and recorded. Instep 1430 the intrinsic breathing parameters are recalculated. Instep 1435 the stored response is compared to the intrinsic breathing parameters, and an accuracy score or figure of merit is determined for the response. - At step 1440 a check is made to see if all of the electrodes in the array have been evaluated. If not,
steps 1410 through 1435 are repeated. If all electrodes have been evaluated, the process is done atstep 1445. -
FIG. 14B shows a flow chart of a preliminary array mapping method for regulated breathing in accordance with an embodiment of the present invention. Instep 1450 an electrode is selected from the array. In step 1455 a locator wave is applied to the selected electrode (e.g., in a dynamic or fixed synchronized manner). A locator wave typically has fixed parameters and a low current. - In
step 1460 the response to the locator wave is sensed and stored. Instep 1465 the stored response is compared to a baseline reference (e.g., as obtained from the process ofFIG. 13B ), and an accuracy score or figure of merit is determined for the response. - At step 1470 a check is made to see if all of the electrodes in the array have been evaluated. If not,
steps 1450 through 1465 are repeated. If all electrodes have been evaluated, the process is done atstep 1475. -
FIG. 15A shows a flow chart of a single parameter mapping method for intrinsic breathing in accordance with an embodiment of the present invention. In step 1510 a set of candidate electrodes is selected, i.e., electrodes that have given the best response. This set may be selected on the basis of accuracy scores determined by the process shown inFIG. 14A . In step 1515 a response parameter is selected for qualification. Examples of response parameters are: inspiration length, exhalation length, rate, amplitude, rest length and cycle length, slope of the inspiration cycle, slope of the expiration cycle, peak flow per time, percent peak flow per percent of inspiration time, and sustaining positive flow as a time value or as a percent of inspiration cycle. - In step 1520 a test wave is adjusted to match the intrinsic breath duration. Other parameters may subsequently be adjusted, for example: by lowering maximum current or lowering maximum frequency if peak flow/movement/EMG/volume/etc. are achieved too quickly; by increasing initial current amplitude or initial frequency if flow/EMG/pressure/etc initiation is delayed from delivery of initial pulse; or by changing (e.g., increasing) the ramp slope if flow/movement/EMG/volume/etc. has had more than one peak during an inspiration period. Other parameters that may also be adjusted are amplitude, frequency, shape, and timing. The test wave may also be adjusted to achieve a desired response, e.g., a percent of sustained positive airflow with respect to an inspiration cycle or other response.
- In
step 1525 an individual electrode is selected from the set of candidate electrodes selected instep 1510. Instep 1530 the test wave constructed instep 1520 is delivered to the electrode (e.g., fixed or dynamically synchronized). Instep 1535 the response to the test wave is sensed and stored. - In
step 1540 the intrinsic breathing pattern is sensed and recorded. Instep 1545 the intrinsic breathing parameters are recalculated. Instep 1550 the stored response is compared to the intrinsic breathing parameters, and an accuracy score or figure of merit is determined for the response. - At step 1555 a check is made to see if all of the electrodes in the array have been evaluated. If not,
steps 1510 through 1550 are repeated. If all electrodes have been evaluated, the process is done atstep 1560. -
FIG. 15B shows a flow chart of a single parameter mapping method for regulated breathing in accordance with an embodiment of the present invention. In step 1570 a set of candidate electrodes is selected. This set may be selected on the basis of accuracy scores determined by the process shown inFIG. 14B . In step 1572 a response parameter is selected for qualification. Examples of response parameters are: EMG, flow, tidal volume, movement and pressure. - In step 1574 a test wave is adjusted to match the intrinsic breath duration. Other parameters that may also be adjusted as well. In
step 1576 an individual electrode is selected from the set of candidate electrodes selected instep 1570. Instep 1578 the test wave constructed instep 1574 is delivered to the electrode (e.g., fixed or dynamically synchronized). Instep 1580 the response to the test wave is sensed and stored. - In
step 1582 the stored response is compared to a baseline reference, and an accuracy score or figure of merit is determined for the response. - At step 1584 a check is made to see if all of the electrodes in the array have been evaluated. If not,
steps 1570 through 1582 are repeated. If all electrodes have been evaluated, the process is done atstep 1586. -
FIG. 16A shows a flow chart of a multi-parameter mapping method for intrinsic breathing in accordance with an embodiment of the present invention. Instep 1610 an electrode is selected. The electrode may be selected on the basis of the accuracy score determined in the process shown inFIG. 14A orFIG. 15A . - In step 1615 a plurality of response parameters are selected for qualification. This may be done to refine the elelctorde choice or if a single parameter has not resulted in an electrode selection. Adjustments may be made where necessary in a manner similar as described with reference to
FIG. 15A . Examples of response parameters are: EMG, flow, tidal volume, movement and pressure. An example of a pair of parameters are tidal volume and the measured parameter associated with diaphragm activation that shows the greatest dynamic range. - In step 1620 a therapy wave is adjusted to match the intrinsic breath duration. Other parameters may also be adjusted as described with reference to
FIG. 15A . For example, the therapy wave may be adjusted to elicit an inspiration slope, a percentage peak value in a minimum percentage of the inspiration cycle, or a percentage of the peak inspiriaton in a minimum amount of time. Instep 1625 the therapy wave constructed instep 1620 is delivered to the electrode (e.g., fixed or dynamically synchronized). Instep 1630 the response to the therapy wave is sensed and stored. - In
step 1635 the intrinsic breathing pattern is sensed and recorded. Instep 1640 the intrinsic breathing parameters are recalculated. Instep 1645 the stored response is compared to the intrinsic breathing parameters, and an accuracy score or figure of merit is determined for the response. - At step 1650 a check is made to see if the accuracy score or figure of merit determined in
step 1645 is greater than a predetermined value. If not,steps 1610 through 1645 are repeated. If yes, the electrode location is qualified as a therapeutic locus and the process is done atstep 1655. -
FIG. 16B shows a flow chart of a multi-parameter mapping method for regulated breathing in accordance with an embodiment of the present invention. Instep 1660 an electrode is selected. The electrode may be selected on the basis of the accuracy score determined in the process shown inFIG. 14B orFIG. 15B . - In
step 1665 at least two response parameters are selected for qualification. Examples of response parameters are: EMG, flow, tidal volume, movement and pressure. An example of a pair of parameters are tidal volume and the measured parameter associated with diaphragm activation that shows the greatest dynamic range. - In step 1670 a therapy wave is adjusted to match the intrinsic breath duration. Other parameters may also be adjusted. In
step 1675 the therapy wave constructed instep 1670 is delivered to the electrode (e.g., fixed or dynamically synchronized). Instep 1680 the response to the therapy wave is sensed and stored. - In
step 1685 the stored response is compared to a baseline reference, and an accuracy score or figure of merit is determined for the response. - At step 1690 a check is made to see if the accuracy score or figure of merit determined in
step 1685 is greater than a predetermined value. If not,steps 1660 through 1685 are repeated. If yes, the electrode location is qualified as a therapeutic locus and the process is done atstep 1695. - With respect to hierarchical optimization scheme described with reference to
FIGS. 13-16 , if one parameter does not give the user control over enough breathing parameters to match the intrinsic breathing characteristics, then another parameter is hierarchically added and adjusted that parameter until it provides sufficient control. If it does not, then again, another parameter is added until sufficient control over the breathing pattern or morphology is reached. - As an alternative, instead of using a natural breathing pattern as set for the with respect to
FIGS. 12-16B , a desired breathing pattern, for example, to manipulate physiological responses or to treat disorders, may be selected or programmed into the device. The electrodes may the be selected as set forth with reference toFIGS. 14-16 using the desired breathing pattern instead of the natural breathing pattern for comparison. - The stimulation device may be used, for example in subjects with breathing disorders, heart failure patients and patients who cannot otherwise breathe on their own such as spinal cord injury patients.
- Safety mechanisms may be incorporated into any stimulation device in accordance with the invention. The safety feature disables the device under certain conditions. Such safety features may include a patient or provider operated switch, e.g. a magnetic switch. In addition a safety mechanism may be included that determines when patient intervention is being provided. For example, the device will turn off if there is diaphragm movement sensed without an EMG as the case would be where a ventilator is being used.
- While the invention has been described in detail with reference to preferred embodiments thereof, it will be apparent to one skilled in the art that various changes can be made, and equivalents employed, without departing from the scope of the invention.
Claims (54)
1. A system for mapping therapeutic electrode sites on a diaphragm comprising:
a signal source configured to provide a stimulus for eliciting a respiration response comprising an inspiration waveform having a morphology;
one or more implanted electrodes coupled to the signal source and configured to deliver the stimulus to body tissue within the body.
a sensor configured to sense a parameter corresponding to the respiration response; and,
a processor coupled to the sensor, configured to receive a signal from the sensor corresponding to the respiration response, and configured to determine a correlation between the morphology and a desired morphology.
2. The system for mapping therapeutic electrode sites of claim 1 wherein the desired morphology comprises a natural breathing pattern.
3. The system for mapping therapeutic electrode sites of claim 1 wherein the desired morphology is configured to elicit a desired physiological response.
4. The system for mapping therapeutic electrodes sites of claim 3 wherein the desired physiological response is to influence SaO2 levels.
5. The system for mapping therapeutic electrodes sites of claim 3 wherein the desired physiological response is to influence PCO2 levels.
6. The system for mapping therapeutic electrode sites on a diaphragm of claim 1 wherein the electrodes are coupled to a substrate.
7. The system for mapping therapeutic electrode sites on a diaphragm of claim 6 wherein the sensor is coupled to the substrate.
8. The system for mapping therapeutic electrode sites on a diaphragm of claim 1 wherein the waveform comprises information representative of inter-abdominal pressure over time.
9. The system for mapping therapeutic electrode sites on a diaphragm of claim 1 wherein the waveform comprises information representative of thoracic pressure over time.
10. The system for mapping therapeutic electrode sites on a diaphragm of claim 1 wherein the waveform comprises information representative of movement of the diaphragm over time.
11. The system for mapping therapeutic electrode sites on a diaphragm of claim 1 wherein the waveform comprises information representative of at least a portion of a diaphragm EMG over time.
12. The system for mapping therapeutic electrode sites on a diaphragm of claim 1 wherein the waveform comprises information representative of airway flow over time.
13. A system for mapping therapeutic electrode sites on a diaphragm comprising:
a signal source configured to provide a stimulus configured to elicit a respiration response;
one or more electrodes coupled to the signal source and configured to deliver the stimulus to tissue of a body;
a sensor configured to sense a response to the stimulus wherein the sensor is configured to sense at least one parameter corresponding the respiration response; and,
a processor coupled to the sensor and configured to receive a signal corresponding to the at least one parameter, wherein the processor is configured to determine from the at least one parameter, a ratio of a portion of peak volume over a portion of stimulation time.
14. The system of claim 13 wherein the processor is configured to determine whether the percentage of peak volume per percentage of and inspiration cycle corresponds to an acceptable respiration response.
15. The system of claim 14 wherein the acceptable response is a ratio of less than or equal to about 10.
16. The system of claim 15 wherein the acceptable response is a ratio of less than or equal to about 3.5.
17. A system for mapping therapeutic electrode sites on a diaphragm comprising:
a signal source configured to provide a stimulus configured to elicit a respiration response;
one or more electrodes coupled to the signal source and configured to deliver the stimulus to tissue of a body;
a sensor configured to sense a response to the stimulus wherein the sensor is configured to sense at least one parameter corresponding the respiration response; and,
a processor coupled to the sensor and configured to receive a signal corresponding to the at least one parameter, wherein the processor is configured to determine from the at least one parameter whether a sustained inspiration portion of a stimulation duration for a cycle is at an acceptable level.
18. The system of claim 17 wherein an acceptable level is about 0.5 of the stimulation duration or more.
19. The system of claim 17 wherein an acceptable level is about 0.75 of the stimulation duration or more.
20. A system for mapping therapeutic electrode sites on a diaphragm comprising:
a signal source configured to provide a stimulus configured to elicit a respiration response;
one or more electrodes coupled to the signal source and configured to deliver the stimulus to tissue of a body;
a sensor configured to sense a response to the stimulus wherein the sensor is configured to sense at least one parameter corresponding the respiration response; and,
a processor coupled to the sensor and configured to receive a signal corresponding to the at least one parameter, wherein the processor is configured to determine from the at least one parameter whether an instantaneous slope of peak flow over stimulation time is at an acceptable level.
21. The system of claim 20 wherein an acceptable level of instantaneous slope of peak flow over stimulation time is about 2 or less.
22. The system of claim 20 wherein an acceptable level of the instantaneous slope of peak flow over stimulation time is about 0.75 or less.
23. A system for mapping therapeutic electrode sites on a diaphragm comprising:
a signal source configured to provide a stimulus configured to elicit a respiration response;
one or more electrodes coupled to the signal source and configured to deliver the stimulus to tissue of a body;
a sensor configured to sense a response to the stimulus wherein the sensor is configured to sense at least one parameter corresponding the respiration response; and,
a processor coupled to the sensor and configured to receive a signal corresponding to the at least one parameter, wherein the processor is configured to determine from the at least one parameter whether an instantaneous slope of peak flow over stimulation time is at an acceptable level.
24. The system of claim 23 wherein an acceptable level of minimum time to reach peak flow between about 100 milliseconds and 300 milliseconds.
25. The system of claim 23 wherein an acceptable level of minimum time to reach peak flow is greater than or equal to about 300 milliseconds.
26. An electrode assembly comprising:
an inflatable member comprising a substrate and an inflation chamber configured to receive an inflation medium; and
one or more electrodes configured to deliver or sense an electrical signal, coupled to the substrate.
27. The electrode assembly of claim 26 wherein the assembly is configured to be positioned on a diaphragm.
28. The electrode assembly of claim 26 further comprising a manipulation member coupled to the inflatable member, wherein the manipulation member is configured to position the inflatable member in a desired location adjacent a portion of a body.
29. An electrode assembly for stimulating sites on a diaphragm comprising:
a member configured to be positioned on a diaphragm during electrical stimulation of the diaphragm; and,
a plurality of electrodes coupled to the member and configured to deliver electrical stimulation to the diaphragm.
30. The electrode assembly of claim 29 wherein the member comprises a keyed portion configured to be positioned adjacent an anatomical structure of the diaphragm to aid in positioning of the member.
31. The electrode assembly of claim 29 wherein the member comprises a flexible portion configured to accommodate movement of the diaphragm during electrical stimulation.
32. The electrode assembly of claim 29 wherein the member comprises a perimeter having a shape that conforms to a specific feature on a surface of a diaphragm.
33. The electrode assembly of claim 29 wherein the member comprises an active surface configured to interface with a diaphragm surface, wherein the plurality of electrodes is coupled to the active surface of the member, and wherein the active surface is curved.
34. The electrode assembly of claim 29 wherein at least one of the plurality of electrodes comprises a subsurface electrode.
35. The electrode assembly of claim 29 wherein at least one of the plurality of electrodes comprises a composite electrode.
36. The electrode assembly of claim 29 further comprising a switching network coupled to the plurality of electrodes.
37. The electrode assembly of claim 29 wherein the member comprises a mesh.
38. A method for delivering an electrode array to a diaphragm comprising the steps of:
providing an electrode array configured to be compressed to a first configuration and to expand to a second configuration;
compressing the electrode array to the first configuration;
positioning the electrode array adjacent a diaphragm within a subject's body; and
expanding the electrode array to the second configuration.
39. The method of claim 38 wherein the step of compressing the electrode array comprises folding the electrode array; and wherein the step of expanding the electrode array comprises unfolding the electrode array.
40. The method of claim 38 wherein the step of expanding the electrode array comprises inflating the electrode array.
40. A method for mapping electrode sites on a diaphragm, the method comprising:
placing a mapping electrode array on a surface of the diaphragm;
sensing and recording an intrinsic breathing pattern;
selecting an electrode of the mapping electrode array;
delivering a stimulus wave to the electrode; and,
sensing and recording a response to the stimulus wave.
41. The method of claim 40 further comprising calculating intrinsic breathing parameters and establishing a target response.
42. The method of claim 41 further comprising comparing the response to the target response.
43. The method of claim 42 further comprising the step of determining whether the response sufficiently correlates with the target response.
44. The method of claim 40 wherein the stimulus is applied asynchronously.
45. The method of claim 40 wherein the stimulus is applied synchronously.
46. The method of claim 40 wherein the stimulus is applied between intrinsic breathing cycles.
47. A method for mapping electrode sites on a diaphragm, the method comprising:
placing a mapping electrode array on a surface of the diaphragm;
selecting an electrode of the mapping electrode array;
delivering a stimulus to the selected electrode; and,
sensing and recording a response to the stimulus.
48. The method of claim 47 further comprising the step of:
defining an acceptable breathing response morphology.
49. The method of claim 48 further comprising the step of comparing the recorded response to the acceptable breathing response morphology.
50. The method of claim 49 further comprising the step of determining whether the response is sufficiently close to the desired breathing response morphology.
51. A system for electrically stimulating a diaphragm comprising:
an implantable electrode configured to be positioned on the diaphragm;
a signal source configured to provide a stimulation signal to the diaphragm through the electrodes, wherein the stimulation signal comprises a series of pulses that vary in amplitude.
52. The system of claim 51 wherein the pulses vary in frequency.
53. A system for electrically stimulating a diaphragm comprising:
an implantable electrode configured to be positioned on the diaphragm;
a signal source configured to provide a stimulation signal to the diaphragm through the electrodes, wherein the stimulation signal comprises a series of pulses that vary in frequency.
Priority Applications (25)
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US10/966,484 US20050085869A1 (en) | 2003-10-15 | 2004-10-15 | System and method for mapping diaphragm electrode sites |
US11/272,353 US20060167523A1 (en) | 2003-10-15 | 2005-11-10 | Device and method for improving upper airway functionality |
US11/271,315 US8244358B2 (en) | 2003-10-15 | 2005-11-10 | Device and method for treating obstructive sleep apnea |
US11/271,726 US7970475B2 (en) | 2003-10-15 | 2005-11-10 | Device and method for biasing lung volume |
US11/271,554 US9259573B2 (en) | 2003-10-15 | 2005-11-10 | Device and method for manipulating exhalation |
US11/271,264 US7979128B2 (en) | 2003-10-15 | 2005-11-10 | Device and method for gradually controlling breathing |
US11/480,074 US8160711B2 (en) | 2003-10-15 | 2006-06-29 | Multimode device and method for controlling breathing |
US11/981,800 US8116872B2 (en) | 2003-10-15 | 2007-10-31 | Device and method for biasing and stimulating respiration |
US11/981,342 US8140164B2 (en) | 2003-10-15 | 2007-10-31 | Therapeutic diaphragm stimulation device and method |
US12/004,932 US20080177347A1 (en) | 2003-10-15 | 2007-12-21 | Method for treating a subject having neuromuscular impairment of the diaphragm |
US12/005,198 US20080161878A1 (en) | 2003-10-15 | 2007-12-26 | Device and method to for independently stimulating hemidiaphragms |
US12/069,823 US20080215106A1 (en) | 2003-10-15 | 2008-02-13 | Thoracoscopically implantable diaphragm stimulator |
US12/080,133 US20080188903A1 (en) | 2003-10-15 | 2008-04-01 | Device and method for biasing and stimulating respiration |
US12/082,057 US8265759B2 (en) | 2003-10-15 | 2008-04-08 | Device and method for treating disorders of the cardiovascular system or heart |
US12/150,052 US20080288015A1 (en) | 2003-10-15 | 2008-04-23 | Diaphragm stimulation device and method for use with cardiovascular or heart patients |
US12/150,045 US20080288010A1 (en) | 2003-10-15 | 2008-04-23 | Subcutaneous diaphragm stimulation device and method for use |
US13/015,302 US20110288609A1 (en) | 2003-10-15 | 2011-01-27 | Therapeutic diaphragm stimulation device and method |
US13/118,802 US20110230932A1 (en) | 2003-10-15 | 2011-05-31 | Device and method for independently stimulating hemidiaphragms |
US13/170,076 US9370657B2 (en) | 2003-10-15 | 2011-06-27 | Device for manipulating tidal volume and breathing entrainment |
US13/347,474 US8335567B2 (en) | 2003-10-15 | 2012-01-10 | Multimode device and method for controlling breathing |
US13/371,153 US20120158091A1 (en) | 2003-10-15 | 2012-02-10 | Therapeutic diaphragm stimulation device and method |
US13/598,284 US20120323293A1 (en) | 2003-10-15 | 2012-08-29 | Device and method for treating disorders of the cardiovascular system or heart |
US13/740,041 US20130197601A1 (en) | 2003-10-15 | 2013-01-11 | Device and method for independently stimulating hemidiaphragms |
US14/494,244 US20150034081A1 (en) | 2003-10-15 | 2014-09-23 | Therapeutic diaphragm stimulation device and method |
US15/181,973 US20170036017A1 (en) | 2003-10-15 | 2016-06-14 | Device and method for biasing lung volume |
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US11/526,949 Expired - Fee Related US8509901B2 (en) | 2003-10-15 | 2006-09-25 | Device and method for adding to breathing |
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Cited By (90)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20050021102A1 (en) * | 2003-07-23 | 2005-01-27 | Ignagni Anthony R. | System and method for conditioning a diaphragm of a patient |
US20050085867A1 (en) * | 2003-10-15 | 2005-04-21 | Tehrani Amir J. | System and method for diaphragm stimulation |
US20060122661A1 (en) * | 2004-12-03 | 2006-06-08 | Mandell Lee J | Diaphragmatic pacing with activity monitor adjustment |
US20060122662A1 (en) * | 2003-10-15 | 2006-06-08 | Tehrani Amir J | Device and method for increasing functional residual capacity |
US20060149334A1 (en) * | 2003-10-15 | 2006-07-06 | Tehrani Amir J | Device and method for controlling breathing |
US20060155341A1 (en) * | 2003-10-15 | 2006-07-13 | Tehrani Amir J | Device and method for biasing lung volume |
US20060247729A1 (en) * | 2003-10-15 | 2006-11-02 | Tehrani Amir J | Multimode device and method for controlling breathing |
US20070044669A1 (en) * | 2005-08-24 | 2007-03-01 | Geise Gregory D | Aluminum can compacting mechanism with improved actuation handle assembly |
US20070049793A1 (en) * | 2005-08-25 | 2007-03-01 | Ignagni Anthony R | Method And Apparatus For Transgastric Neurostimulation |
US20070118183A1 (en) * | 2005-11-18 | 2007-05-24 | Mark Gelfand | System and method to modulate phrenic nerve to prevent sleep apnea |
US20070150023A1 (en) * | 2005-12-02 | 2007-06-28 | Ignagni Anthony R | Transvisceral neurostimulation mapping device and method |
US20070265611A1 (en) * | 2004-07-23 | 2007-11-15 | Ignagni Anthony R | Ventilatory assist system and methods to improve respiratory function |
US20070272242A1 (en) * | 2006-04-21 | 2007-11-29 | Sanborn Warren G | Work of breathing display for a ventilation system |
US20080072902A1 (en) * | 2006-09-27 | 2008-03-27 | Nellcor Puritan Bennett Incorporated | Preset breath delivery therapies for a breathing assistance system |
US20080103407A1 (en) * | 2006-10-13 | 2008-05-01 | Apnex Medical, Inc. | Obstructive sleep apnea treatment devices, systems and methods |
US20080109047A1 (en) * | 2006-10-26 | 2008-05-08 | Pless Benjamin D | Apnea treatment device |
US20080154330A1 (en) * | 2006-12-22 | 2008-06-26 | Tehrani Amir J | Device and method to treat flow limitations |
US20080167695A1 (en) * | 2003-10-15 | 2008-07-10 | Tehrani Amir J | Therapeutic diaphragm stimulation device and method |
US20080188867A1 (en) * | 2007-02-05 | 2008-08-07 | Ignagni Anthony R | Removable intramuscular electrode |
US20080188904A1 (en) * | 2003-10-15 | 2008-08-07 | Tehrani Amir J | Device and method for treating disorders of the cardiovascular system or heart |
US20080208282A1 (en) * | 2007-01-22 | 2008-08-28 | Mark Gelfand | Device and method for the treatment of breathing disorders and cardiac disorders |
US20080287820A1 (en) * | 2007-05-17 | 2008-11-20 | Synapse Biomedical, Inc. | Devices and methods for assessing motor point electromyogram as a biomarker |
US20090024176A1 (en) * | 2007-07-17 | 2009-01-22 | Joonkyoo Anthony Yun | Methods and devices for producing respiratory sinus arrhythmia |
US20090062882A1 (en) * | 2007-08-28 | 2009-03-05 | Cardiac Pacemakers, Inc. | Method and apparatus for inspiratory muscle stimulation using implantable device |
US20090099621A1 (en) * | 2007-10-10 | 2009-04-16 | Zheng Lin | Respiratory stimulation for treating periodic breathing |
US20090118785A1 (en) * | 2007-10-30 | 2009-05-07 | Ignagni Anthony R | Method of improving sleep disordered breathing |
US20090270963A1 (en) * | 2006-05-23 | 2009-10-29 | Publiekrechtelijke Rechtspersoon Academisch Ziekenhuis Leiden H.O.D.N. Leids Universitair Medi | Medical probe |
US7644714B2 (en) | 2005-05-27 | 2010-01-12 | Apnex Medical, Inc. | Devices and methods for treating sleep disorders |
US20100049037A1 (en) * | 2006-09-11 | 2010-02-25 | Koninklijke Philips Electronics N.V. | System and method for positioning electrodes on a patient body |
US20100106047A1 (en) * | 2007-02-01 | 2010-04-29 | Ls Biopath, Inc. | Electrical methods for detection and characterization of abnormal tissue and cells |
US20100179436A1 (en) * | 2007-02-01 | 2010-07-15 | Moshe Sarfaty | Optical system for detection and characterization of abnormal tissue and cells |
US20110060380A1 (en) * | 2009-09-10 | 2011-03-10 | Mark Gelfand | Respiratory rectification |
USD638852S1 (en) | 2009-12-04 | 2011-05-31 | Nellcor Puritan Bennett Llc | Ventilator display screen with an alarm icon |
US20110152706A1 (en) * | 2008-05-15 | 2011-06-23 | Inspire Medical Systems, Inc. | Method and apparatus for sensing respiratory pressure in an implantable stimulation system |
US8001967B2 (en) | 1997-03-14 | 2011-08-23 | Nellcor Puritan Bennett Llc | Ventilator breath display and graphic user interface |
US20110230932A1 (en) * | 2003-10-15 | 2011-09-22 | Rmx, Llc | Device and method for independently stimulating hemidiaphragms |
USD649157S1 (en) | 2009-12-04 | 2011-11-22 | Nellcor Puritan Bennett Llc | Ventilator display screen with a user interface |
US20120150061A1 (en) * | 2010-11-02 | 2012-06-14 | Industry-Academic Cooperation Foundation, Yonsei University | Sensor for Detecting Cancerous Tissue and Method of Manufacturing the Same |
US20120203293A1 (en) * | 2004-06-08 | 2012-08-09 | Greenberg Robert J | Locating a Neural Prosthesis using Impedance and Electrode Height |
US8244358B2 (en) | 2003-10-15 | 2012-08-14 | Rmx, Llc | Device and method for treating obstructive sleep apnea |
US8335992B2 (en) | 2009-12-04 | 2012-12-18 | Nellcor Puritan Bennett Llc | Visual indication of settings changes on a ventilator graphical user interface |
US8386046B2 (en) | 2011-01-28 | 2013-02-26 | Apnex Medical, Inc. | Screening devices and methods for obstructive sleep apnea therapy |
US8428726B2 (en) | 2007-10-30 | 2013-04-23 | Synapse Biomedical, Inc. | Device and method of neuromodulation to effect a functionally restorative adaption of the neuromuscular system |
US8433412B1 (en) | 2008-02-07 | 2013-04-30 | Respicardia, Inc. | Muscle and nerve stimulation |
US8443294B2 (en) | 2009-12-18 | 2013-05-14 | Covidien Lp | Visual indication of alarms on a ventilator graphical user interface |
US8453645B2 (en) | 2006-09-26 | 2013-06-04 | Covidien Lp | Three-dimensional waveform display for a breathing assistance system |
US8855771B2 (en) | 2011-01-28 | 2014-10-07 | Cyberonics, Inc. | Screening devices and methods for obstructive sleep apnea therapy |
US8924878B2 (en) | 2009-12-04 | 2014-12-30 | Covidien Lp | Display and access to settings on a ventilator graphical user interface |
US8934992B2 (en) | 2011-09-01 | 2015-01-13 | Inspire Medical Systems, Inc. | Nerve cuff |
US8938299B2 (en) | 2008-11-19 | 2015-01-20 | Inspire Medical Systems, Inc. | System for treating sleep disordered breathing |
US8983572B2 (en) | 2010-10-29 | 2015-03-17 | Inspire Medical Systems, Inc. | System and method for patient selection in treating sleep disordered breathing |
US20150141767A1 (en) * | 2013-10-02 | 2015-05-21 | The Board Of Trustees Of The University Of Illinois | Organ Mounted Electronics |
WO2015109401A1 (en) * | 2014-01-21 | 2015-07-30 | Simon Fraser University | Systems and related methods for optimization of multi-electrode nerve pacing |
US9119925B2 (en) | 2009-12-04 | 2015-09-01 | Covidien Lp | Quick initiation of respiratory support via a ventilator user interface |
US9186511B2 (en) | 2006-10-13 | 2015-11-17 | Cyberonics, Inc. | Obstructive sleep apnea treatment devices, systems and methods |
US9205262B2 (en) | 2011-05-12 | 2015-12-08 | Cyberonics, Inc. | Devices and methods for sleep apnea treatment |
US9262588B2 (en) | 2009-12-18 | 2016-02-16 | Covidien Lp | Display of respiratory data graphs on a ventilator graphical user interface |
US9486628B2 (en) | 2009-03-31 | 2016-11-08 | Inspire Medical Systems, Inc. | Percutaneous access for systems and methods of treating sleep apnea |
US9498625B2 (en) | 2012-12-19 | 2016-11-22 | Viscardia, Inc. | Hemodynamic performance enhancement through asymptomatic diaphragm stimulation |
US9744354B2 (en) | 2008-12-31 | 2017-08-29 | Cyberonics, Inc. | Obstructive sleep apnea treatment devices, systems and methods |
US20170312508A1 (en) * | 2016-04-29 | 2017-11-02 | Viscardia, Inc. | Implantable medical devices, systems, and methods for selection of optimal diaphragmatic stimulation parameters to affect pressures within the intrathoracic cavity |
US9889299B2 (en) | 2008-10-01 | 2018-02-13 | Inspire Medical Systems, Inc. | Transvenous method of treating sleep apnea |
US9950129B2 (en) | 2014-10-27 | 2018-04-24 | Covidien Lp | Ventilation triggering using change-point detection |
US9987488B1 (en) | 2007-06-27 | 2018-06-05 | Respicardia, Inc. | Detecting and treating disordered breathing |
US10039920B1 (en) | 2017-08-02 | 2018-08-07 | Lungpacer Medical, Inc. | Systems and methods for intravascular catheter positioning and/or nerve stimulation |
US10293164B2 (en) | 2017-05-26 | 2019-05-21 | Lungpacer Medical Inc. | Apparatus and methods for assisted breathing by transvascular nerve stimulation |
US10335592B2 (en) | 2012-12-19 | 2019-07-02 | Viscardia, Inc. | Systems, devices, and methods for improving hemodynamic performance through asymptomatic diaphragm stimulation |
US10362967B2 (en) | 2012-07-09 | 2019-07-30 | Covidien Lp | Systems and methods for missed breath detection and indication |
US10406366B2 (en) | 2006-11-17 | 2019-09-10 | Respicardia, Inc. | Transvenous phrenic nerve stimulation system |
US10406367B2 (en) | 2012-06-21 | 2019-09-10 | Lungpacer Medical Inc. | Transvascular diaphragm pacing system and methods of use |
US20190350475A1 (en) * | 2018-05-21 | 2019-11-21 | Vine Medical LLC | Multi-tip probe for obtaining bioelectrical measurements |
US10485971B2 (en) | 2014-10-31 | 2019-11-26 | Avent, Inc. | Non-invasive nerve stimulation system and method |
US10512772B2 (en) | 2012-03-05 | 2019-12-24 | Lungpacer Medical Inc. | Transvascular nerve stimulation apparatus and methods |
US10561843B2 (en) | 2007-01-29 | 2020-02-18 | Lungpacer Medical, Inc. | Transvascular nerve stimulation apparatus and methods |
US10583297B2 (en) | 2011-08-11 | 2020-03-10 | Inspire Medical Systems, Inc. | Method and system for applying stimulation in treating sleep disordered breathing |
US10857363B2 (en) | 2014-08-26 | 2020-12-08 | Rmx, Llc | Devices and methods for reducing intrathoracic pressure |
US10898709B2 (en) | 2015-03-19 | 2021-01-26 | Inspire Medical Systems, Inc. | Stimulation for treating sleep disordered breathing |
US10940308B2 (en) | 2017-08-04 | 2021-03-09 | Lungpacer Medical Inc. | Systems and methods for trans-esophageal sympathetic ganglion recruitment |
US10987511B2 (en) | 2018-11-08 | 2021-04-27 | Lungpacer Medical Inc. | Stimulation systems and related user interfaces |
US11266838B1 (en) | 2019-06-21 | 2022-03-08 | Rmx, Llc | Airway diagnostics utilizing phrenic nerve stimulation device and method |
US11298540B2 (en) | 2017-08-11 | 2022-04-12 | Inspire Medical Systems, Inc. | Cuff electrode |
US11357979B2 (en) | 2019-05-16 | 2022-06-14 | Lungpacer Medical Inc. | Systems and methods for sensing and stimulation |
US11383083B2 (en) | 2014-02-11 | 2022-07-12 | Livanova Usa, Inc. | Systems and methods of detecting and treating obstructive sleep apnea |
US11458312B2 (en) | 2019-09-26 | 2022-10-04 | Viscardia, Inc. | Implantable medical systems, devices, and methods for affecting cardiac function through diaphragm stimulation, and for monitoring diaphragmatic health |
US11471683B2 (en) | 2019-01-29 | 2022-10-18 | Synapse Biomedical, Inc. | Systems and methods for treating sleep apnea using neuromodulation |
US11672934B2 (en) | 2020-05-12 | 2023-06-13 | Covidien Lp | Remote ventilator adjustment |
US11707619B2 (en) | 2013-11-22 | 2023-07-25 | Lungpacer Medical Inc. | Apparatus and methods for assisted breathing by transvascular nerve stimulation |
US11771900B2 (en) | 2019-06-12 | 2023-10-03 | Lungpacer Medical Inc. | Circuitry for medical stimulation systems |
US11883658B2 (en) | 2017-06-30 | 2024-01-30 | Lungpacer Medical Inc. | Devices and methods for prevention, moderation, and/or treatment of cognitive injury |
US11957914B2 (en) | 2020-03-27 | 2024-04-16 | Viscardia, Inc. | Implantable medical systems, devices and methods for delivering asymptomatic diaphragmatic stimulation |
Families Citing this family (219)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20060161071A1 (en) | 1997-01-27 | 2006-07-20 | Lynn Lawrence A | Time series objectification system and method |
US9042952B2 (en) | 1997-01-27 | 2015-05-26 | Lawrence A. Lynn | System and method for automatic detection of a plurality of SPO2 time series pattern types |
US8932227B2 (en) | 2000-07-28 | 2015-01-13 | Lawrence A. Lynn | System and method for CO2 and oximetry integration |
US9521971B2 (en) | 1997-07-14 | 2016-12-20 | Lawrence A. Lynn | System and method for automatic detection of a plurality of SPO2 time series pattern types |
US9053222B2 (en) | 2002-05-17 | 2015-06-09 | Lawrence A. Lynn | Patient safety processor |
US20060195041A1 (en) | 2002-05-17 | 2006-08-31 | Lynn Lawrence A | Centralized hospital monitoring system for automatically detecting upper airway instability and for preventing and aborting adverse drug reactions |
US7206635B2 (en) * | 2001-06-07 | 2007-04-17 | Medtronic, Inc. | Method and apparatus for modifying delivery of a therapy in response to onset of sleep |
US20080077192A1 (en) | 2002-05-03 | 2008-03-27 | Afferent Corporation | System and method for neuro-stimulation |
DE10248590B4 (en) * | 2002-10-17 | 2016-10-27 | Resmed R&D Germany Gmbh | Method and device for carrying out a signal-processing observation of a measurement signal associated with the respiratory activity of a person |
US7477932B2 (en) | 2003-05-28 | 2009-01-13 | Cardiac Pacemakers, Inc. | Cardiac waveform template creation, maintenance and use |
US7575553B2 (en) * | 2003-09-18 | 2009-08-18 | Cardiac Pacemakers, Inc. | Methods and systems for assessing pulmonary disease |
US7787946B2 (en) | 2003-08-18 | 2010-08-31 | Cardiac Pacemakers, Inc. | Patient monitoring, diagnosis, and/or therapy systems and methods |
US7887493B2 (en) | 2003-09-18 | 2011-02-15 | Cardiac Pacemakers, Inc. | Implantable device employing movement sensing for detecting sleep-related disorders |
US7510531B2 (en) * | 2003-09-18 | 2009-03-31 | Cardiac Pacemakers, Inc. | System and method for discrimination of central and obstructive disordered breathing events |
US20050107838A1 (en) * | 2003-09-18 | 2005-05-19 | Lovett Eric G. | Subcutaneous cardiac rhythm management with disordered breathing detection and treatment |
US7396333B2 (en) | 2003-08-18 | 2008-07-08 | Cardiac Pacemakers, Inc. | Prediction of disordered breathing |
US7662101B2 (en) * | 2003-09-18 | 2010-02-16 | Cardiac Pacemakers, Inc. | Therapy control based on cardiopulmonary status |
US8002553B2 (en) | 2003-08-18 | 2011-08-23 | Cardiac Pacemakers, Inc. | Sleep quality data collection and evaluation |
US20060167523A1 (en) * | 2003-10-15 | 2006-07-27 | Tehrani Amir J | Device and method for improving upper airway functionality |
US20050085874A1 (en) * | 2003-10-17 | 2005-04-21 | Ross Davis | Method and system for treating sleep apnea |
US20060247693A1 (en) | 2005-04-28 | 2006-11-02 | Yanting Dong | Non-captured intrinsic discrimination in cardiac pacing response classification |
US7319900B2 (en) * | 2003-12-11 | 2008-01-15 | Cardiac Pacemakers, Inc. | Cardiac response classification using multiple classification windows |
US8521284B2 (en) | 2003-12-12 | 2013-08-27 | Cardiac Pacemakers, Inc. | Cardiac response classification using multisite sensing and pacing |
US7774064B2 (en) | 2003-12-12 | 2010-08-10 | Cardiac Pacemakers, Inc. | Cardiac response classification using retriggerable classification windows |
US7421296B1 (en) * | 2004-01-26 | 2008-09-02 | Pacesetter, Inc. | Termination of respiratory oscillations characteristic of Cheyne-Stokes respiration |
US7363085B1 (en) * | 2004-01-26 | 2008-04-22 | Pacesetters, Inc. | Augmenting hypoventilation |
US8942779B2 (en) | 2004-02-05 | 2015-01-27 | Early Sense Ltd. | Monitoring a condition of a subject |
WO2005074361A2 (en) | 2004-02-05 | 2005-08-18 | Earlysense Ltd. | Techniques for prediction and monitoring of respiration-manifested clinical episodes |
US7314451B2 (en) | 2005-04-25 | 2008-01-01 | Earlysense Ltd. | Techniques for prediction and monitoring of clinical episodes |
US8403865B2 (en) | 2004-02-05 | 2013-03-26 | Earlysense Ltd. | Prediction and monitoring of clinical episodes |
US8491492B2 (en) | 2004-02-05 | 2013-07-23 | Earlysense Ltd. | Monitoring a condition of a subject |
US20070118054A1 (en) * | 2005-11-01 | 2007-05-24 | Earlysense Ltd. | Methods and systems for monitoring patients for clinical episodes |
US7751894B1 (en) * | 2004-03-04 | 2010-07-06 | Cardiac Pacemakers, Inc. | Systems and methods for indicating aberrant behavior detected by an implanted medical device |
US20050197588A1 (en) * | 2004-03-04 | 2005-09-08 | Scott Freeberg | Sleep disordered breathing alert system |
US7371220B1 (en) * | 2004-06-30 | 2008-05-13 | Pacesetter, Inc. | System and method for real-time apnea/hypopnea detection using an implantable medical system |
US7269458B2 (en) * | 2004-08-09 | 2007-09-11 | Cardiac Pacemakers, Inc. | Cardiopulmonary functional status assessment via heart rate response detection by implantable cardiac device |
US7389143B2 (en) | 2004-08-12 | 2008-06-17 | Cardiac Pacemakers, Inc. | Cardiopulmonary functional status assessment via metabolic response detection by implantable cardiac device |
JP2006136511A (en) * | 2004-11-12 | 2006-06-01 | Matsushita Electric Ind Co Ltd | Drum type washing/drying machine |
US20090216293A1 (en) * | 2004-11-22 | 2009-08-27 | Mitsuru Sasaki | Apnea preventing stimulation apparatus |
US8473058B2 (en) * | 2004-11-22 | 2013-06-25 | Mitsuru Sasaki | Apnea preventing stimulation apparatus |
US7966072B2 (en) * | 2005-02-18 | 2011-06-21 | Palo Alto Investors | Methods and compositions for treating obesity-hypoventilation syndrome |
US7680534B2 (en) | 2005-02-28 | 2010-03-16 | Cardiac Pacemakers, Inc. | Implantable cardiac device with dyspnea measurement |
US7704211B1 (en) * | 2005-03-21 | 2010-04-27 | Pacesetter, Inc. | Method and apparatus for assessing fluid level in lungs |
US7404799B1 (en) * | 2005-04-05 | 2008-07-29 | Pacesetter, Inc. | System and method for detection of respiration patterns via integration of intracardiac electrogram signals |
US7630763B2 (en) | 2005-04-20 | 2009-12-08 | Cardiac Pacemakers, Inc. | Thoracic or intracardiac impedance detection with automatic vector selection |
US7392086B2 (en) | 2005-04-26 | 2008-06-24 | Cardiac Pacemakers, Inc. | Implantable cardiac device and method for reduced phrenic nerve stimulation |
US7499751B2 (en) * | 2005-04-28 | 2009-03-03 | Cardiac Pacemakers, Inc. | Cardiac signal template generation using waveform clustering |
US8900154B2 (en) * | 2005-05-24 | 2014-12-02 | Cardiac Pacemakers, Inc. | Prediction of thoracic fluid accumulation |
US20060271121A1 (en) | 2005-05-25 | 2006-11-30 | Cardiac Pacemakers, Inc. | Closed loop impedance-based cardiac resynchronization therapy systems, devices, and methods |
US8364455B2 (en) * | 2005-06-09 | 2013-01-29 | Maquet Critical Care Ab | Simulator for use with a breathing-assist device |
US8036750B2 (en) | 2005-06-13 | 2011-10-11 | Cardiac Pacemakers, Inc. | System for neural control of respiration |
US20070021678A1 (en) * | 2005-07-19 | 2007-01-25 | Cardiac Pacemakers, Inc. | Methods and apparatus for monitoring physiological responses to steady state activity |
US9839781B2 (en) | 2005-08-22 | 2017-12-12 | Cardiac Pacemakers, Inc. | Intracardiac impedance and its applications |
US8494618B2 (en) * | 2005-08-22 | 2013-07-23 | Cardiac Pacemakers, Inc. | Intracardiac impedance and its applications |
US7731663B2 (en) | 2005-09-16 | 2010-06-08 | Cardiac Pacemakers, Inc. | System and method for generating a trend parameter based on respiration rate distribution |
US7974691B2 (en) * | 2005-09-21 | 2011-07-05 | Cardiac Pacemakers, Inc. | Method and apparatus for controlling cardiac resynchronization therapy using cardiac impedance |
JP2009515174A (en) * | 2005-11-04 | 2009-04-09 | レスメド・リミテッド | Method and apparatus for supporting diagnosis and management of sleep breathing disorders |
US7766840B2 (en) * | 2005-12-01 | 2010-08-03 | Cardiac Pacemakers, Inc. | Method and system for heart failure status evaluation based on a disordered breathing index |
US8281792B2 (en) * | 2005-12-31 | 2012-10-09 | John W Royalty | Electromagnetic diaphragm assist device and method for assisting a diaphragm function |
WO2007115118A1 (en) * | 2006-03-29 | 2007-10-11 | Catholic Healthcare West | Vagus nerve stimulation method |
KR100845464B1 (en) * | 2006-06-14 | 2008-07-10 | (주)머티리얼솔루션테크놀로지 | Implantable diaphragm stimulator and breathing pacemaker using the same |
US20080071185A1 (en) * | 2006-08-08 | 2008-03-20 | Cardiac Pacemakers, Inc. | Periodic breathing during activity |
US8226570B2 (en) | 2006-08-08 | 2012-07-24 | Cardiac Pacemakers, Inc. | Respiration monitoring for heart failure using implantable device |
US8103341B2 (en) | 2006-08-25 | 2012-01-24 | Cardiac Pacemakers, Inc. | System for abating neural stimulation side effects |
US8121692B2 (en) | 2006-08-30 | 2012-02-21 | Cardiac Pacemakers, Inc. | Method and apparatus for neural stimulation with respiratory feedback |
US8050765B2 (en) | 2006-08-30 | 2011-11-01 | Cardiac Pacemakers, Inc. | Method and apparatus for controlling neural stimulation during disordered breathing |
US8209013B2 (en) | 2006-09-14 | 2012-06-26 | Cardiac Pacemakers, Inc. | Therapeutic electrical stimulation that avoids undesirable activation |
US7917194B1 (en) * | 2006-11-15 | 2011-03-29 | Pacesetter, Inc. | Method and apparatus for detecting pulmonary edema |
US9968266B2 (en) | 2006-12-27 | 2018-05-15 | Cardiac Pacemakers, Inc. | Risk stratification based heart failure detection algorithm |
WO2008123903A1 (en) * | 2007-02-09 | 2008-10-16 | Mayo Foundation For Medical Education And Research | Peripheral oxistimulator apparatus and methods |
US20080228093A1 (en) * | 2007-03-13 | 2008-09-18 | Yanting Dong | Systems and methods for enhancing cardiac signal features used in morphology discrimination |
US20080234556A1 (en) * | 2007-03-20 | 2008-09-25 | Cardiac Pacemakers, Inc. | Method and apparatus for sensing respiratory activities using sensor in lymphatic system |
US20080243016A1 (en) * | 2007-03-28 | 2008-10-02 | Cardiac Pacemakers, Inc. | Pulmonary Artery Pressure Signals And Methods of Using |
US11259802B2 (en) * | 2007-04-13 | 2022-03-01 | Covidien Lp | Powered surgical instrument |
US7950560B2 (en) * | 2007-04-13 | 2011-05-31 | Tyco Healthcare Group Lp | Powered surgical instrument |
US8585607B2 (en) | 2007-05-02 | 2013-11-19 | Earlysense Ltd. | Monitoring, predicting and treating clinical episodes |
US8821418B2 (en) | 2007-05-02 | 2014-09-02 | Earlysense Ltd. | Monitoring, predicting and treating clinical episodes |
EP2152362B1 (en) * | 2007-05-28 | 2015-07-08 | St. Jude Medical AB | Implantable medical device for monitoring lung deficiency |
US8983609B2 (en) | 2007-05-30 | 2015-03-17 | The Cleveland Clinic Foundation | Apparatus and method for treating pulmonary conditions |
US20090024047A1 (en) * | 2007-07-20 | 2009-01-22 | Cardiac Pacemakers, Inc. | Devices and methods for respiration therapy |
US9037239B2 (en) | 2007-08-07 | 2015-05-19 | Cardiac Pacemakers, Inc. | Method and apparatus to perform electrode combination selection |
US8265736B2 (en) | 2007-08-07 | 2012-09-11 | Cardiac Pacemakers, Inc. | Method and apparatus to perform electrode combination selection |
EP2210639A3 (en) * | 2007-08-22 | 2014-08-06 | The Research Foundation Of State University Of New York | Breathing-gas delivery and sharing system |
US20090076346A1 (en) | 2007-09-14 | 2009-03-19 | Corventis, Inc. | Tracking and Security for Adherent Patient Monitor |
WO2009036256A1 (en) | 2007-09-14 | 2009-03-19 | Corventis, Inc. | Injectable physiological monitoring system |
US8897868B2 (en) | 2007-09-14 | 2014-11-25 | Medtronic, Inc. | Medical device automatic start-up upon contact to patient tissue |
EP2194864B1 (en) | 2007-09-14 | 2018-08-29 | Medtronic Monitoring, Inc. | System and methods for wireless body fluid monitoring |
US8460189B2 (en) | 2007-09-14 | 2013-06-11 | Corventis, Inc. | Adherent cardiac monitor with advanced sensing capabilities |
EP2200512A1 (en) | 2007-09-14 | 2010-06-30 | Corventis, Inc. | Adherent device for respiratory monitoring and sleep disordered breathing |
US8116841B2 (en) | 2007-09-14 | 2012-02-14 | Corventis, Inc. | Adherent device with multiple physiological sensors |
EP2210226A4 (en) * | 2007-10-12 | 2013-11-06 | Patientslikeme Inc | Self-improving method of using online communities to predict health-related outcomes |
US20170188940A9 (en) | 2007-11-26 | 2017-07-06 | Whispersom Corporation | Device to detect and treat Apneas and Hypopnea |
US8155744B2 (en) | 2007-12-13 | 2012-04-10 | The Cleveland Clinic Foundation | Neuromodulatory methods for treating pulmonary disorders |
US8346349B2 (en) * | 2008-01-16 | 2013-01-01 | Massachusetts Institute Of Technology | Method and apparatus for predicting patient outcomes from a physiological segmentable patient signal |
EP2254661B1 (en) | 2008-02-14 | 2015-10-07 | Cardiac Pacemakers, Inc. | Apparatus for phrenic stimulation detection |
EP2257216B1 (en) * | 2008-03-12 | 2021-04-28 | Medtronic Monitoring, Inc. | Heart failure decompensation prediction based on cardiac rhythm |
US20110054279A1 (en) * | 2008-03-27 | 2011-03-03 | Widemed Ltd. | Diagnosis of periodic breathing |
US8412317B2 (en) | 2008-04-18 | 2013-04-02 | Corventis, Inc. | Method and apparatus to measure bioelectric impedance of patient tissue |
US9883809B2 (en) | 2008-05-01 | 2018-02-06 | Earlysense Ltd. | Monitoring, predicting and treating clinical episodes |
US8882684B2 (en) | 2008-05-12 | 2014-11-11 | Earlysense Ltd. | Monitoring, predicting and treating clinical episodes |
JP5474937B2 (en) | 2008-05-07 | 2014-04-16 | ローレンス エー. リン, | Medical disorder pattern search engine |
US8229566B2 (en) * | 2008-06-25 | 2012-07-24 | Sheng Li | Method and apparatus of breathing-controlled electrical stimulation for skeletal muscles |
US8340746B2 (en) * | 2008-07-17 | 2012-12-25 | Massachusetts Institute Of Technology | Motif discovery in physiological datasets: a methodology for inferring predictive elements |
US8047999B2 (en) | 2008-09-19 | 2011-11-01 | Medtronic, Inc. | Filtering of a physiologic signal in a medical device |
US8302602B2 (en) | 2008-09-30 | 2012-11-06 | Nellcor Puritan Bennett Llc | Breathing assistance system with multiple pressure sensors |
US20100087893A1 (en) * | 2008-10-03 | 2010-04-08 | Solange Pasquet | Operant Conditioning-Based Device for Snoring and Obstructive Sleep Apnea and Method of Use |
US8644939B2 (en) * | 2008-11-18 | 2014-02-04 | Neurostream Technologies General Partnership | Method and device for the detection, identification and treatment of sleep apnea/hypopnea |
WO2010077851A2 (en) | 2008-12-15 | 2010-07-08 | Corventis, Inc. | Patient monitoring systems and methods |
EP2198779B1 (en) * | 2008-12-22 | 2018-09-19 | Sendsor GmbH | Device and method for early detection of exacerbations |
US20100204567A1 (en) * | 2009-02-09 | 2010-08-12 | The Cleveland Clinic Foundation | Ultrasound-guided delivery of a therapy delivery device to a phrenic nerve |
US8870773B2 (en) * | 2009-02-09 | 2014-10-28 | The Cleveland Clinic Foundation | Ultrasound-guided delivery of a therapy delivery device to a nerve target |
AU2010242036A1 (en) | 2009-04-30 | 2011-11-03 | Patientslikeme, Inc. | Systems and methods for encouragement of data submission in online communities |
US8378832B2 (en) * | 2009-07-09 | 2013-02-19 | Harry J. Cassidy | Breathing disorder treatment system and method |
WO2011008748A2 (en) | 2009-07-15 | 2011-01-20 | Cardiac Pacemakers, Inc. | Remote pace detection in an implantable medical device |
EP2453975B1 (en) | 2009-07-15 | 2016-11-02 | Cardiac Pacemakers, Inc. | Remote sensing in an implantable medical device |
EP2453977B1 (en) * | 2009-07-15 | 2017-11-08 | Cardiac Pacemakers, Inc. | Physiological vibration detection in an implanted medical device |
EP2470065A1 (en) * | 2009-08-28 | 2012-07-04 | Lynn, Lawrence Allan | Relational thermorespirometer spot vitals monitor |
US9072899B1 (en) * | 2009-09-04 | 2015-07-07 | Todd Nickloes | Diaphragm pacemaker |
AU2010291938B2 (en) * | 2009-09-14 | 2016-03-10 | Sleep Methods, Inc. | System and method for training and promoting a conditioned reflex intervention during sleep |
WO2011050283A2 (en) | 2009-10-22 | 2011-04-28 | Corventis, Inc. | Remote detection and monitoring of functional chronotropic incompetence |
US8409108B2 (en) * | 2009-11-05 | 2013-04-02 | Inovise Medical, Inc. | Multi-axial heart sounds and murmur detection for hemodynamic-condition assessment |
US9451897B2 (en) | 2009-12-14 | 2016-09-27 | Medtronic Monitoring, Inc. | Body adherent patch with electronics for physiologic monitoring |
JP2011213096A (en) * | 2010-03-19 | 2011-10-27 | Makita Corp | Power tool |
US8965498B2 (en) | 2010-04-05 | 2015-02-24 | Corventis, Inc. | Method and apparatus for personalized physiologic parameters |
US11723542B2 (en) * | 2010-08-13 | 2023-08-15 | Respiratory Motion, Inc. | Advanced respiratory monitor and system |
US8585604B2 (en) | 2010-10-29 | 2013-11-19 | Medtronic, Inc. | Integrated patient care |
US9186504B2 (en) | 2010-11-15 | 2015-11-17 | Rainbow Medical Ltd | Sleep apnea treatment |
US9457186B2 (en) | 2010-11-15 | 2016-10-04 | Bluewind Medical Ltd. | Bilateral feedback |
CN103221086B (en) * | 2010-11-23 | 2015-11-25 | 皇家飞利浦电子股份有限公司 | Fat hypoventilation syndrome disposal system |
US10292625B2 (en) | 2010-12-07 | 2019-05-21 | Earlysense Ltd. | Monitoring a sleeping subject |
US20120157799A1 (en) * | 2010-12-20 | 2012-06-21 | Abhilash Patangay | Using device based sensors to classify events and generate alerts |
US8827930B2 (en) * | 2011-01-10 | 2014-09-09 | Bioguidance Llc | System and method for patient monitoring |
US9744349B2 (en) | 2011-02-10 | 2017-08-29 | Respicardia, Inc. | Medical lead and implantation |
US10342939B2 (en) * | 2011-03-23 | 2019-07-09 | ResMed Pty Ltd | Detection of ventilation sufficiency |
EP2713870A4 (en) * | 2011-06-03 | 2014-10-22 | Los Angeles Childrens Hospital | Electrophysiological diagnosis and treatment for asthma |
US8706235B2 (en) | 2011-07-27 | 2014-04-22 | Medtronic, Inc. | Transvenous method to induce respiration |
US8478413B2 (en) | 2011-07-27 | 2013-07-02 | Medtronic, Inc. | Bilateral phrenic nerve stimulation with reduced dyssynchrony |
US9861817B2 (en) | 2011-07-28 | 2018-01-09 | Medtronic, Inc. | Medical device to provide breathing therapy |
US8509902B2 (en) | 2011-07-28 | 2013-08-13 | Medtronic, Inc. | Medical device to provide breathing therapy |
US20130053717A1 (en) * | 2011-08-30 | 2013-02-28 | Nellcor Puritan Bennett Llc | Automatic ventilator challenge to induce spontaneous breathing efforts |
US8855783B2 (en) | 2011-09-09 | 2014-10-07 | Enopace Biomedical Ltd. | Detector-based arterial stimulation |
GB201116860D0 (en) * | 2011-09-30 | 2011-11-09 | Guy S And St Thomas Nhs Foundation Trust | Patent monitoring method and monitoring device |
US9364624B2 (en) | 2011-12-07 | 2016-06-14 | Covidien Lp | Methods and systems for adaptive base flow |
US9498589B2 (en) | 2011-12-31 | 2016-11-22 | Covidien Lp | Methods and systems for adaptive base flow and leak compensation |
CN104508343B (en) | 2012-01-26 | 2016-11-16 | Med-El电气医疗器械有限公司 | For treating the Neural monitoring method and system of pharyngeal obstacle |
WO2013112853A1 (en) * | 2012-01-27 | 2013-08-01 | T4 Analytics Llc | Anesthesia monitoring systems and methods of monitoring anesthesia |
US20130197385A1 (en) * | 2012-01-31 | 2013-08-01 | Medtronic, Inc. | Respiratory function detection |
US8844526B2 (en) | 2012-03-30 | 2014-09-30 | Covidien Lp | Methods and systems for triggering with unknown base flow |
BR112014027983B1 (en) | 2012-05-08 | 2022-05-24 | Aeromics, Inc | Use of selective aquaporin inhibitors |
US20150165207A1 (en) * | 2012-07-02 | 2015-06-18 | Medisci L.L.C. | Method and device for respiratory and cardiorespiratory support |
CN104661588B (en) * | 2012-07-27 | 2017-03-08 | 心脏起搏器股份公司 | Heart failure patient is layered |
CN102949770B (en) * | 2012-11-09 | 2015-04-22 | 张红璇 | External diaphragm pacing and breathing machine synergistic air supply method and device thereof |
CN103055417B (en) * | 2012-12-31 | 2015-09-09 | 中国人民解放军第三军医大学第一附属医院 | A kind of noinvasive transcutaneous electrostimulation instrument |
US20170112409A1 (en) * | 2013-02-06 | 2017-04-27 | BTS S.p.A. | Wireless probe for dental electromyography |
US9981096B2 (en) | 2013-03-13 | 2018-05-29 | Covidien Lp | Methods and systems for triggering with unknown inspiratory flow |
TWI505812B (en) * | 2013-04-15 | 2015-11-01 | Chi Mei Comm Systems Inc | System and method for displaying analysis of breath |
US9295397B2 (en) | 2013-06-14 | 2016-03-29 | Massachusetts Institute Of Technology | Method and apparatus for beat-space frequency domain prediction of cardiovascular death after acute coronary event |
WO2015020979A1 (en) | 2013-08-05 | 2015-02-12 | Cardiac Pacemakers, Inc. | System and method for detecting worsening of heart failure based on rapid shallow breathing index |
WO2015021348A2 (en) | 2013-08-09 | 2015-02-12 | Inspire Medical Systems, Inc. | Patient control for implantable medical device |
EP2839859B1 (en) * | 2013-08-20 | 2016-04-27 | Sorin CRM SAS | Active medical device, in particular a CRT resynchroniser, including predictive warning means for cardiac decompensation in the presence of central sleep apnoea |
CN112402434A (en) | 2013-11-06 | 2021-02-26 | 埃罗米克斯公司 | New formula |
WO2015069949A1 (en) | 2013-11-07 | 2015-05-14 | Safeop Surgical, Inc. | Systems and methods for detecting nerve function |
EP3071288B1 (en) | 2013-11-19 | 2018-11-14 | The Cleveland Clinic Foundation | System for treating obstructive sleep apnea using a neuromuscular stimulator |
WO2015095969A1 (en) * | 2013-12-27 | 2015-07-02 | St. Michael's Hospital | Device, method and system for providing ventilatory assist to a patient |
CN103800999A (en) * | 2014-02-25 | 2014-05-21 | 郑州雅晨生物科技有限公司 | Obstructive sleep apnea hypopnea syndrome therapeutic apparatus |
TWI645835B (en) | 2014-02-25 | 2019-01-01 | 萊鎂醫療器材股份有限公司 | Breathing airflow detecting device, method and application thereof |
JP6585609B2 (en) * | 2014-02-28 | 2019-10-02 | パウエル マンスフィールド, インコーポレイテッド | System for sensing EMG activity |
US20150283382A1 (en) * | 2014-04-04 | 2015-10-08 | Med-El Elektromedizinische Geraete Gmbh | Respiration Sensors For Recording Of Triggered Respiratory Signals In Neurostimulators |
US11141070B2 (en) | 2014-07-22 | 2021-10-12 | Teijin Pharma Limited | Heart failure evaluation method and diagnosis device |
US9659159B2 (en) | 2014-08-14 | 2017-05-23 | Sleep Data Services, Llc | Sleep data chain of custody |
US9808591B2 (en) | 2014-08-15 | 2017-11-07 | Covidien Lp | Methods and systems for breath delivery synchronization |
US10172593B2 (en) | 2014-09-03 | 2019-01-08 | Earlysense Ltd. | Pregnancy state monitoring |
KR102410215B1 (en) * | 2014-10-08 | 2022-06-17 | 엘지전자 주식회사 | Digital device and method for controlling same |
CN106999118B (en) | 2014-10-13 | 2020-07-17 | 葡萄糖传感器公司 | Analyte sensing device |
US9925346B2 (en) | 2015-01-20 | 2018-03-27 | Covidien Lp | Systems and methods for ventilation with unknown exhalation flow |
EP3064131A1 (en) * | 2015-03-03 | 2016-09-07 | BIOTRONIK SE & Co. KG | Combined vagus-phrenic nerve stimulation apparatus |
US9839786B2 (en) | 2015-04-17 | 2017-12-12 | Inspire Medical Systems, Inc. | System and method of monitoring for and reporting on patient-made stimulation therapy programming changes |
EP3334338B1 (en) * | 2015-08-11 | 2019-07-17 | Koninklijke Philips N.V. | Apparatus and method for processing electromyography signals related to respiratory activity |
EP3405103B1 (en) * | 2016-01-20 | 2021-10-27 | Soniphi LLC | Frequency analysis feedback system |
EP3445872A1 (en) | 2016-04-20 | 2019-02-27 | Glusense Ltd. | Fret-based glucose-detection molecules |
CN105748069B (en) * | 2016-04-21 | 2018-10-23 | 罗远明 | A kind of centric sleep apnea carbon dioxide inhalation therapy device |
CN105879223B (en) * | 2016-04-22 | 2017-02-08 | 广州雪利昂生物科技有限公司 | Method and apparatus for triggering external diaphragm pacemaker by using surface electromyogram signal as synchronization signal |
US11247039B2 (en) | 2016-05-03 | 2022-02-15 | Btl Healthcare Technologies A.S. | Device including RF source of energy and vacuum system |
US10583287B2 (en) | 2016-05-23 | 2020-03-10 | Btl Medical Technologies S.R.O. | Systems and methods for tissue treatment |
US10556122B1 (en) | 2016-07-01 | 2020-02-11 | Btl Medical Technologies S.R.O. | Aesthetic method of biological structure treatment by magnetic field |
WO2018022658A1 (en) * | 2016-07-25 | 2018-02-01 | Ctrl-Labs Corporation | Adaptive system for deriving control signals from measurements of neuromuscular activity |
US11399770B2 (en) | 2016-08-01 | 2022-08-02 | Med-El Elektromedizinische Geraete Gmbh | Respiratory triggered parasternal electromyographic recording in neurostimulators |
US11052241B2 (en) * | 2016-11-03 | 2021-07-06 | West Affum Holdings Corp. | Wearable cardioverter defibrillator (WCD) system measuring patient's respiration |
CN110325110B (en) | 2016-11-10 | 2022-08-09 | 纽约州立大学研究基金会 | Systems, methods, and biomarkers for airway obstruction |
US11426513B2 (en) * | 2016-11-29 | 2022-08-30 | Geoffrey Louis Tyson | Implantable devices for drug delivery in response to detected biometric parameters associated with an opioid drug overdose and associated systems and methods |
CN107019495B (en) * | 2017-03-13 | 2019-11-29 | 北京航空航天大学 | Apnea detection and prior-warning device and method based on smart phone and the mounted respiration transducer of nose |
JP7187473B2 (en) | 2017-03-22 | 2022-12-12 | セーフオプ サージカル インコーポレイテッド | Medical system and method for detecting changes in electrophysiological evoked potentials |
CN110868911B (en) | 2017-04-29 | 2022-10-11 | 心脏起搏器股份公司 | Heart failure event rate assessment |
EP3760280A1 (en) * | 2017-06-16 | 2021-01-06 | Alphatec Spine, Inc. | Systems, methods, and devices for detecting the threshold of nerve-muscle response using variable frequency stimulation |
WO2019046547A1 (en) | 2017-08-31 | 2019-03-07 | Mayo Foundation For Medical Education And Research | Systems and methods for controlling breathing |
CN108174034A (en) * | 2017-12-27 | 2018-06-15 | 苏鹏霄 | Using the system and method for APP real time monitoring sacral nerve neuromodulation devices |
US11031134B2 (en) * | 2018-02-05 | 2021-06-08 | International Business Machines Corporation | Monitoring individuals for water retention management |
US10722710B2 (en) | 2018-03-24 | 2020-07-28 | Moshe Hayik | Secretion clearance and cough assist |
US11058349B2 (en) | 2018-03-24 | 2021-07-13 | Ovadia Sagiv | Non-invasive handling of sleep apnea, snoring and emergency situations |
JP7167132B2 (en) * | 2018-03-26 | 2022-11-08 | テルモ株式会社 | A support system, a support method, a support program, and a recording medium recording the support program |
US11771899B2 (en) | 2018-07-10 | 2023-10-03 | The Cleveland Clinic Foundation | System and method for treating obstructive sleep apnea |
US11633560B2 (en) | 2018-11-10 | 2023-04-25 | Novaresp Technologies Inc. | Method and apparatus for continuous management of airway pressure for detection and/or prediction of respiratory failure |
US11894139B1 (en) | 2018-12-03 | 2024-02-06 | Patientslikeme Llc | Disease spectrum classification |
US11382563B2 (en) | 2019-03-01 | 2022-07-12 | Respiration AI, LLC | System and method for detecting ventilatory depression and for prompting a patient to breathe |
US11547307B2 (en) * | 2019-04-29 | 2023-01-10 | Technion Research And Development Foundation Ltd. | Quantification of the respiratory effort from hemodynamic measurements |
US11351380B2 (en) | 2019-05-02 | 2022-06-07 | Xii Medical, Inc. | Implantable stimulation power receiver, systems and methods |
US20200375665A1 (en) * | 2019-05-31 | 2020-12-03 | Canon U.S.A., Inc. | Medical continuum robot and methods thereof |
US11324954B2 (en) | 2019-06-28 | 2022-05-10 | Covidien Lp | Achieving smooth breathing by modified bilateral phrenic nerve pacing |
KR20210024874A (en) | 2019-08-26 | 2021-03-08 | 삼성전자주식회사 | Monitoring device inserted into human body and operating method thereof |
US11420061B2 (en) | 2019-10-15 | 2022-08-23 | Xii Medical, Inc. | Biased neuromodulation lead and method of using same |
WO2021141950A1 (en) * | 2020-01-06 | 2021-07-15 | W. L. Gore & Associates, Inc. | Conditioning algorithms for biomarker sensor measurements |
EP4069343A4 (en) * | 2020-02-26 | 2024-02-21 | Novaresp Tech Inc | Method and apparatus for determining and/or predicting sleep and respiratory behaviours for management of airway pressure |
US11878167B2 (en) | 2020-05-04 | 2024-01-23 | Btl Healthcare Technologies A.S. | Device and method for unattended treatment of a patient |
KR20230000081U (en) | 2020-05-04 | 2023-01-10 | 비티엘 헬쓰케어 테크놀로지스 에이.에스. | Device and method for unattended treatment of patients |
US11691010B2 (en) | 2021-01-13 | 2023-07-04 | Xii Medical, Inc. | Systems and methods for improving sleep disordered breathing |
CN116963800A (en) * | 2021-02-24 | 2023-10-27 | 美敦力公司 | Impedance-based electrode selection for sensing or stimulation |
US11896816B2 (en) | 2021-11-03 | 2024-02-13 | Btl Healthcare Technologies A.S. | Device and method for unattended treatment of a patient |
CN114376559B (en) * | 2022-01-18 | 2023-09-19 | 高昌生医股份有限公司 | Respiratory datum line tracking acceleration method |
US20240050743A1 (en) * | 2022-08-11 | 2024-02-15 | Stimdia Medical, Inc. | Apparatus and method for diaphragm stimulation |
Citations (89)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US240240A (en) * | 1881-04-19 | Beer-faucet | ||
US4827935A (en) * | 1986-04-24 | 1989-05-09 | Purdue Research Foundation | Demand electroventilator |
US4830008A (en) * | 1987-04-24 | 1989-05-16 | Meer Jeffrey A | Method and system for treatment of sleep apnea |
US5056519A (en) * | 1990-05-14 | 1991-10-15 | Vince Dennis J | Unilateral diaphragmatic pacer |
US5146918A (en) * | 1991-03-19 | 1992-09-15 | Medtronic, Inc. | Demand apnea control of central and obstructive sleep apnea |
US5174287A (en) * | 1991-05-28 | 1992-12-29 | Medtronic, Inc. | Airway feedback measurement system responsive to detected inspiration and obstructive apnea event |
US5211173A (en) * | 1991-01-09 | 1993-05-18 | Medtronic, Inc. | Servo muscle control |
US5215082A (en) * | 1991-04-02 | 1993-06-01 | Medtronic, Inc. | Implantable apnea generator with ramp on generator |
US5233983A (en) * | 1991-09-03 | 1993-08-10 | Medtronic, Inc. | Method and apparatus for apnea patient screening |
US5265604A (en) * | 1990-05-14 | 1993-11-30 | Vince Dennis J | Demand - diaphragmatic pacing (skeletal muscle pressure modified) |
US5281219A (en) * | 1990-11-23 | 1994-01-25 | Medtronic, Inc. | Multiple stimulation electrodes |
US5300094A (en) * | 1991-01-09 | 1994-04-05 | Medtronic, Inc. | Servo muscle control |
US5423372A (en) * | 1993-12-27 | 1995-06-13 | Ford Motor Company | Joining sand cores for making castings |
US5483969A (en) * | 1994-09-21 | 1996-01-16 | Medtronic, Inc. | Method and apparatus for providing a respiratory effort waveform for the treatment of obstructive sleep apnea |
US5485851A (en) * | 1994-09-21 | 1996-01-23 | Medtronic, Inc. | Method and apparatus for arousal detection |
US5522862A (en) * | 1994-09-21 | 1996-06-04 | Medtronic, Inc. | Method and apparatus for treating obstructive sleep apnea |
US5524632A (en) * | 1994-01-07 | 1996-06-11 | Medtronic, Inc. | Method for implanting electromyographic sensing electrodes |
US5540732A (en) * | 1994-09-21 | 1996-07-30 | Medtronic, Inc. | Method and apparatus for impedance detecting and treating obstructive airway disorders |
US5540731A (en) * | 1994-09-21 | 1996-07-30 | Medtronic, Inc. | Method and apparatus for pressure detecting and treating obstructive airway disorders |
US5540733A (en) * | 1994-09-21 | 1996-07-30 | Medtronic, Inc. | Method and apparatus for detecting and treating obstructive sleep apnea |
US5546952A (en) * | 1994-09-21 | 1996-08-20 | Medtronic, Inc. | Method and apparatus for detection of a respiratory waveform |
US5549655A (en) * | 1994-09-21 | 1996-08-27 | Medtronic, Inc. | Method and apparatus for synchronized treatment of obstructive sleep apnea |
US5678535A (en) * | 1995-04-21 | 1997-10-21 | Dimarco; Anthony Fortunato | Method and apparatus for electrical stimulation of the respiratory muscles to achieve artificial ventilation in a patient |
US5797923A (en) * | 1997-05-12 | 1998-08-25 | Aiyar; Harish | Electrode delivery instrument |
US5800470A (en) * | 1994-01-07 | 1998-09-01 | Medtronic, Inc. | Respiratory muscle electromyographic rate responsive pacemaker |
US5814086A (en) * | 1996-10-18 | 1998-09-29 | Pacesetter Ab | Perex respiratory system stimulation upon tachycardia detection |
US5895360A (en) * | 1996-06-26 | 1999-04-20 | Medtronic, Inc. | Gain control for a periodic signal and method regarding same |
US5944680A (en) * | 1996-06-26 | 1999-08-31 | Medtronic, Inc. | Respiratory effort detection method and apparatus |
US6021352A (en) * | 1996-06-26 | 2000-02-01 | Medtronic, Inc, | Diagnostic testing methods and apparatus for implantable therapy devices |
US6099479A (en) * | 1996-06-26 | 2000-08-08 | Medtronic, Inc. | Method and apparatus for operating therapy system |
US6251126B1 (en) * | 1998-04-23 | 2001-06-26 | Medtronic Inc | Method and apparatus for synchronized treatment of obstructive sleep apnea |
US6269269B1 (en) * | 1998-04-23 | 2001-07-31 | Medtronic Inc. | Method and apparatus for synchronized treatment of obstructive sleep apnea |
US6345202B2 (en) * | 1998-08-14 | 2002-02-05 | Advanced Bionics Corporation | Method of treating obstructive sleep apnea using implantable electrodes |
US20020049482A1 (en) * | 2000-06-14 | 2002-04-25 | Willa Fabian | Lifestyle management system |
US6415183B1 (en) * | 1999-12-09 | 2002-07-02 | Cardiac Pacemakers, Inc. | Method and apparatus for diaphragmatic pacing |
US6463327B1 (en) * | 1998-06-11 | 2002-10-08 | Cprx Llc | Stimulatory device and methods to electrically stimulate the phrenic nerve |
US20020193839A1 (en) * | 2001-06-07 | 2002-12-19 | Cho Yong Kyun | Method for providing a therapy to a patient involving modifying the therapy after detecting an onset of sleep in the patient, and implantable medical device embodying same |
US20020193697A1 (en) * | 2001-04-30 | 2002-12-19 | Cho Yong Kyun | Method and apparatus to detect and treat sleep respiratory events |
US6512949B1 (en) * | 1999-07-12 | 2003-01-28 | Medtronic, Inc. | Implantable medical device for measuring time varying physiologic conditions especially edema and for responding thereto |
US6542774B2 (en) * | 1996-04-30 | 2003-04-01 | Medtronic, Inc. | Method and device for electronically controlling the beating of a heart |
US6572543B1 (en) * | 1996-06-26 | 2003-06-03 | Medtronic, Inc | Sensor, method of sensor implant and system for treatment of respiratory disorders |
US6574507B1 (en) * | 1998-07-06 | 2003-06-03 | Ela Medical S.A. | Active implantable medical device for treating sleep apnea syndrome by electrostimulation |
US20030127091A1 (en) * | 1999-12-15 | 2003-07-10 | Chang Yung Chi | Scientific respiration for self-health-care |
US20030153955A1 (en) * | 2002-02-14 | 2003-08-14 | Euljoon Park | Cardiac stimulation device including sleep apnea prevention and treatment |
US20030153956A1 (en) * | 2002-02-14 | 2003-08-14 | Euljoon Park | Cardiac stimulation device including sleep apnea prevention and treatment |
US20030153954A1 (en) * | 2002-02-14 | 2003-08-14 | Euljoon Park | Sleep apnea therapy device using dynamic overdrive pacing |
US6633779B1 (en) * | 2000-11-27 | 2003-10-14 | Science Medicus, Inc. | Treatment of asthma and respiratory disease by means of electrical neuro-receptive waveforms |
US20030195571A1 (en) * | 2002-04-12 | 2003-10-16 | Burnes John E. | Method and apparatus for the treatment of central sleep apnea using biventricular pacing |
US20030204213A1 (en) * | 2002-04-30 | 2003-10-30 | Jensen Donald N. | Method and apparatus to detect and monitor the frequency of obstructive sleep apnea |
US6651652B1 (en) * | 1998-06-30 | 2003-11-25 | Siemens-Elema Ab | Method for identifying respiration attempts by analyzing neuroelectrical signals, and respiration detector and respiratory aid system operating according to the method |
US20040077953A1 (en) * | 2002-10-18 | 2004-04-22 | Turcott Robert G. | Hemodynamic analysis |
US20040088015A1 (en) * | 2002-10-31 | 2004-05-06 | Casavant David A. | Respiratory nerve stimulation |
US20040111040A1 (en) * | 2002-12-04 | 2004-06-10 | Quan Ni | Detection of disordered breathing |
US20040134496A1 (en) * | 2003-01-10 | 2004-07-15 | Cho Yong K. | Method and apparatus for detecting respiratory disturbances |
US20040138719A1 (en) * | 2003-01-10 | 2004-07-15 | Cho Yong K. | System and method for automatically monitoring and delivering therapy for sleep-related disordered breathing |
US20040176809A1 (en) * | 2001-06-07 | 2004-09-09 | Medtronic, Inc. | Method and apparatus for modifying delivery of a therapy in response to onset of sleep |
US20040225226A1 (en) * | 2000-08-17 | 2004-11-11 | Ilife Systems, Inc. | System and method for detecting the onset of an obstructive sleep apnea event |
US20040237963A1 (en) * | 1998-05-22 | 2004-12-02 | Michael Berthon-Jones | Ventilatory assistance for treatment of cardiac failure and Cheyne-Stokes breathing |
US20050021102A1 (en) * | 2003-07-23 | 2005-01-27 | Ignagni Anthony R. | System and method for conditioning a diaphragm of a patient |
US20050039745A1 (en) * | 2003-08-18 | 2005-02-24 | Stahmann Jeffrey E. | Adaptive therapy for disordered breathing |
US20050043772A1 (en) * | 2003-08-18 | 2005-02-24 | Stahmann Jeffrey E. | Therapy triggered by prediction of disordered breathing |
US20050043644A1 (en) * | 2003-08-18 | 2005-02-24 | Stahmann Jeffrey E. | Prediction of disordered breathing |
US20050055060A1 (en) * | 2003-09-05 | 2005-03-10 | Steve Koh | Determination of respiratory characteristics from AV conduction intervals |
US20050065567A1 (en) * | 2003-09-18 | 2005-03-24 | Cardiac Pacemakers, Inc. | Therapy control based on cardiopulmonary status |
US20050065563A1 (en) * | 2003-09-23 | 2005-03-24 | Avram Scheiner | Paced ventilation therapy by an implantable cardiac device |
US20050061320A1 (en) * | 2003-09-18 | 2005-03-24 | Cardiac Pacemakers, Inc. | Coordinated use of respiratory and cardiac therapies for sleep disordered breathing |
US20050061315A1 (en) * | 2003-09-18 | 2005-03-24 | Kent Lee | Feedback system and method for sleep disordered breathing therapy |
US20050061319A1 (en) * | 2003-09-18 | 2005-03-24 | Cardiac Pacemakers, Inc. | Methods and systems for implantably monitoring external breathing therapy |
US20050074741A1 (en) * | 2003-09-18 | 2005-04-07 | Kent Lee | System and method for discrimination of central and obstructive disordered breathing events |
US20050080461A1 (en) * | 2003-09-18 | 2005-04-14 | Stahmann Jeffrey E. | System and method for moderating a therapy delivered during sleep using physiologic data acquired during non-sleep |
US6881192B1 (en) * | 2002-06-12 | 2005-04-19 | Pacesetter, Inc. | Measurement of sleep apnea duration and evaluation of response therapies using duration metrics |
US20050085734A1 (en) * | 2003-10-15 | 2005-04-21 | Tehrani Amir J. | Heart failure patient treatment and management device |
US20050101833A1 (en) * | 2003-09-02 | 2005-05-12 | Biotronik Gmbh & Co. Kg | Apparatus for the treatment of sleep apnea |
US20050107860A1 (en) * | 2003-07-23 | 2005-05-19 | Ignagni Anthony R. | Mapping probe system for neuromuscular electrical stimulation apparatus |
US20050119711A1 (en) * | 2003-01-10 | 2005-06-02 | Cho Yong K. | Apparatus and method for monitoring for disordered breathing |
US20050115561A1 (en) * | 2003-08-18 | 2005-06-02 | Stahmann Jeffrey E. | Patient monitoring, diagnosis, and/or therapy systems and methods |
US20050145246A1 (en) * | 2003-09-18 | 2005-07-07 | Hartley Jesse W. | Posture detection system and method |
US20050148897A1 (en) * | 2003-12-24 | 2005-07-07 | Cho Yong K. | Implantable medical device with sleep disordered breathing monitoring |
US20050165457A1 (en) * | 2004-01-26 | 2005-07-28 | Michael Benser | Tiered therapy for respiratory oscillations characteristic of Cheyne-Stokes respiration |
US20050224076A1 (en) * | 2004-04-07 | 2005-10-13 | Pari Gmbh Spezialisten Fur Effektive Inhalation | Aerosol generation device and inhalation device therewith |
US20050261600A1 (en) * | 2004-05-20 | 2005-11-24 | Airmatrix Technologies, Inc. | Method and system for diagnosing central versus obstructive apnea |
US20060058852A1 (en) * | 2004-09-10 | 2006-03-16 | Steve Koh | Multi-variable feedback control of stimulation for inspiratory facilitation |
US20060122622A1 (en) * | 2004-12-06 | 2006-06-08 | Csaba Truckai | Bone treatment systems and methods |
US20060142815A1 (en) * | 2003-10-15 | 2006-06-29 | Tehrani Amir J | Device and method for treating obstructive sleep apnea |
US20060149334A1 (en) * | 2003-10-15 | 2006-07-06 | Tehrani Amir J | Device and method for controlling breathing |
US20060155341A1 (en) * | 2003-10-15 | 2006-07-13 | Tehrani Amir J | Device and method for biasing lung volume |
US7082331B1 (en) * | 2004-04-21 | 2006-07-25 | Pacesetter, Inc. | System and method for applying therapy during hyperpnea phase of periodic breathing using an implantable medical device |
US20060167523A1 (en) * | 2003-10-15 | 2006-07-27 | Tehrani Amir J | Device and method for improving upper airway functionality |
US20060247729A1 (en) * | 2003-10-15 | 2006-11-02 | Tehrani Amir J | Multimode device and method for controlling breathing |
Family Cites Families (110)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US101833A (en) * | 1870-04-12 | Improved coal-box | ||
US61320A (en) * | 1867-01-22 | of lewiston | ||
US61315A (en) * | 1867-01-22 | Improved apparatus for decomposing animal and vegetable substances | ||
US85734A (en) * | 1869-01-12 | Improvement in gr | ||
US61319A (en) * | 1867-01-22 | Improvement in pumps | ||
US99479A (en) * | 1870-02-01 | Edwin r | ||
US21795A (en) * | 1858-10-12 | Improvement in cotton-gins | ||
US540731A (en) * | 1895-06-11 | Wire-reel | ||
US176809A (en) * | 1876-05-02 | Improvement in machinery for cutting waved edges on leather | ||
US39745A (en) * | 1863-09-01 | Improvement in hoisting apparatus | ||
US167523A (en) * | 1875-09-07 | Improvement in sole-channeling machines | ||
US155341A (en) * | 1874-09-22 | Improvement in fertilizers | ||
US237963A (en) * | 1881-02-22 | Manufacture of sheet-iron | ||
US127091A (en) * | 1872-05-21 | Improvement in spark-arresters | ||
US142815A (en) * | 1873-09-16 | Improvement in car-couplings | ||
US115561A (en) * | 1871-06-06 | Improvement in electro-sviagnetic separators | ||
US138719A (en) * | 1873-05-06 | Improvement in fly-switches | ||
US149334A (en) * | 1874-04-07 | Improvement in railroad-frogs | ||
US88015A (en) * | 1869-03-23 | Improvement in lifting-jacks | ||
US85866A (en) * | 1869-01-12 | Improved bed-bottom | ||
US85868A (en) * | 1869-01-12 | Improvement in steam water-elevators | ||
US522862A (en) * | 1894-07-10 | Sawhorse | ||
US74741A (en) * | 1868-02-18 | George w | ||
US204213A (en) * | 1878-05-28 | Improvement in loom-pickers | ||
US247729A (en) * | 1881-09-27 | Corset-stay | ||
US111040A (en) * | 1871-01-17 | Improvement in fluid-meters | ||
US85865A (en) * | 1869-01-12 | Improvement in threshing-knives | ||
US193697A (en) * | 1877-07-31 | Improvement in mowers | ||
US174287A (en) * | 1876-02-29 | Improvement in tool-holders | ||
US300094A (en) * | 1884-06-10 | Machine | ||
US345202A (en) * | 1886-07-06 | Treating lac | ||
US85869A (en) * | 1869-01-12 | Improvement in horse-rakes | ||
US146918A (en) * | 1874-01-27 | Improvement in car-couplings | ||
US65563A (en) * | 1867-06-11 | Julius hackert | ||
US85867A (en) * | 1869-01-12 | Improvement in blind-fastener | ||
US119711A (en) * | 1871-10-10 | Improvement in staple-machines | ||
US540733A (en) * | 1895-06-11 | Ernst gerstenberg and herman barghausen | ||
US215082A (en) * | 1879-05-06 | Improvement in type-writing machines | ||
US55060A (en) * | 1866-05-29 | Improvement in harvester-rakes | ||
US59240A (en) * | 1866-10-30 | Maeshall t | ||
US36294A (en) * | 1862-08-26 | Improved portable sugar-evaporatx | ||
US122622A (en) * | 1872-01-09 | Improvement in compartment-cars for railways | ||
US148897A (en) * | 1874-03-24 | Improvement in machines for pressing pantaloons | ||
US225226A (en) * | 1880-03-09 | Rotary engine | ||
US281219A (en) * | 1883-07-10 | Half to alonzo e | ||
US65567A (en) * | 1867-06-11 | Improved soeew machine | ||
US211173A (en) * | 1879-01-07 | Improvement in wagon-tracks for roads | ||
US574507A (en) * | 1897-01-05 | Account-keeping book | ||
US540732A (en) * | 1895-06-11 | Martin freund | ||
US56519A (en) * | 1866-07-24 | Improvement in clamps for holding saws | ||
US77953A (en) * | 1868-05-19 | b i c k e | ||
US681192A (en) * | 1900-11-19 | 1901-08-27 | Natural Food Company | Marking-machine. |
US678535A (en) * | 1901-02-02 | 1901-07-16 | Austen Bigg | Hoe. |
US911218A (en) * | 1908-02-17 | 1909-02-02 | Elias B Wrenn | Trace-holder. |
US1496918A (en) * | 1922-08-23 | 1924-06-10 | Frederick M Baldwin | Signaling device for vehicles |
US3773051A (en) | 1972-03-01 | 1973-11-20 | Research Corp | Method and apparatus for stimulation of body tissue |
US4146918A (en) * | 1978-01-18 | 1979-03-27 | Albert Tureck | Photographic flash reflector and diffuser system |
US5329931A (en) * | 1989-02-21 | 1994-07-19 | William L. Clauson | Apparatus and method for automatic stimulation of mammals in response to blood gas analysis |
US5190036A (en) * | 1991-02-28 | 1993-03-02 | Linder Steven H | Abdominal binder for effectuating cough stimulation |
US5572543A (en) | 1992-04-09 | 1996-11-05 | Deutsch Aerospace Ag | Laser system with a micro-mechanically moved mirror |
FR2739760B1 (en) * | 1995-10-11 | 1997-12-12 | Salomon Sa | METHOD AND DEVICE FOR HEATING AN INTERIOR SHOE LINING |
FR2739782B1 (en) * | 1995-10-13 | 1997-12-19 | Ela Medical Sa | ACTIVE IMPLANTABLE MEDICAL DEVICE, IN PARTICULAR HEART STIMULATOR, WITH CONTROLLED OPERATION AND REDUCED CONSUMPTION |
US5830008A (en) | 1996-12-17 | 1998-11-03 | The Whitaker Corporation | Panel mountable connector |
US5876353A (en) * | 1997-01-31 | 1999-03-02 | Medtronic, Inc. | Impedance monitor for discerning edema through evaluation of respiratory rate |
WO1999020339A1 (en) | 1997-10-17 | 1999-04-29 | Respironics, Inc. | Muscle stimulating device and method for diagnosing and treating a breathing disorder |
US6021362A (en) * | 1998-02-17 | 2000-02-01 | Maggard; Karl J. | Method and apparatus for dispensing samples and premiums |
CN103641885A (en) | 1998-05-06 | 2014-03-19 | 基因技术股份有限公司 | Protein purification by ion exchange chromatography |
US6234985B1 (en) * | 1998-06-11 | 2001-05-22 | Cprx Llc | Device and method for performing cardiopulmonary resuscitation |
US6312399B1 (en) | 1998-06-11 | 2001-11-06 | Cprx, Llc | Stimulatory device and methods to enhance venous blood return during cardiopulmonary resuscitation |
AU5130199A (en) * | 1998-07-27 | 2000-02-21 | Case Western Reserve University | Method and apparatus for closed-loop stimulation of the hypoglossal nerve in human patients to treat obstructive sleep apnea |
US6212435B1 (en) * | 1998-11-13 | 2001-04-03 | Respironics, Inc. | Intraoral electromuscular stimulation device and method |
US7117032B2 (en) | 1999-03-01 | 2006-10-03 | Quantum Intech, Inc. | Systems and methods for facilitating physiological coherence using respiration training |
US7577475B2 (en) * | 1999-04-16 | 2009-08-18 | Cardiocom | System, method, and apparatus for combining information from an implanted device with information from a patient monitoring apparatus |
US6314324B1 (en) | 1999-05-05 | 2001-11-06 | Respironics, Inc. | Vestibular stimulation system and method |
US6527729B1 (en) * | 1999-11-10 | 2003-03-04 | Pacesetter, Inc. | Method for monitoring patient using acoustic sensor |
US6600949B1 (en) * | 1999-11-10 | 2003-07-29 | Pacesetter, Inc. | Method for monitoring heart failure via respiratory patterns |
US6480733B1 (en) | 1999-11-10 | 2002-11-12 | Pacesetter, Inc. | Method for monitoring heart failure |
US6336903B1 (en) | 1999-11-16 | 2002-01-08 | Cardiac Intelligence Corp. | Automated collection and analysis patient care system and method for diagnosing and monitoring congestive heart failure and outcomes thereof |
US6752765B1 (en) * | 1999-12-01 | 2004-06-22 | Medtronic, Inc. | Method and apparatus for monitoring heart rate and abnormal respiration |
US6418346B1 (en) * | 1999-12-14 | 2002-07-09 | Medtronic, Inc. | Apparatus and method for remote therapy and diagnosis in medical devices via interface systems |
US6710094B2 (en) * | 1999-12-29 | 2004-03-23 | Styrochem Delaware, Inc. | Processes for preparing patterns for use in metal castings |
US6589188B1 (en) * | 2000-05-05 | 2003-07-08 | Pacesetter, Inc. | Method for monitoring heart failure via respiratory patterns |
US6357438B1 (en) * | 2000-10-19 | 2002-03-19 | Mallinckrodt Inc. | Implantable sensor for proportional assist ventilation |
US6572949B1 (en) * | 2001-08-30 | 2003-06-03 | Carlton Paul Lewis | Paint mask and method of using |
FR2829917B1 (en) | 2001-09-24 | 2004-06-11 | Ela Medical Sa | ACTIVE MEDICAL DEVICE INCLUDING MEANS FOR DIAGNOSING THE RESPIRATORY PROFILE |
US8391989B2 (en) * | 2002-12-18 | 2013-03-05 | Cardiac Pacemakers, Inc. | Advanced patient management for defining, identifying and using predetermined health-related events |
US20030225339A1 (en) | 2002-05-06 | 2003-12-04 | Respironics Novametrix | Methods for inducing temporary changes in ventilation for estimation of hemodynamic performance |
SE0202537D0 (en) * | 2002-08-28 | 2002-08-28 | Siemens Elema Ab | Nerve stimulation apparatus |
JP4095391B2 (en) * | 2002-09-24 | 2008-06-04 | キヤノン株式会社 | Position detection method |
JP4309111B2 (en) * | 2002-10-02 | 2009-08-05 | 株式会社スズケン | Health management system, activity state measuring device and data processing device |
US8672852B2 (en) * | 2002-12-13 | 2014-03-18 | Intercure Ltd. | Apparatus and method for beneficial modification of biorhythmic activity |
US20050020240A1 (en) * | 2003-02-07 | 2005-01-27 | Darin Minter | Private wireless network |
US20050261747A1 (en) | 2003-05-16 | 2005-11-24 | Schuler Eleanor L | Method and system to control respiration by means of neuro-electrical coded signals |
US7532934B2 (en) * | 2003-09-18 | 2009-05-12 | Cardiac Pacemakers, Inc. | Snoring detection system and method |
US7610094B2 (en) * | 2003-09-18 | 2009-10-27 | Cardiac Pacemakers, Inc. | Synergistic use of medical devices for detecting medical disorders |
US6905788B2 (en) * | 2003-09-12 | 2005-06-14 | Eastman Kodak Company | Stabilized OLED device |
US8140164B2 (en) * | 2003-10-15 | 2012-03-20 | Rmx, Llc | Therapeutic diaphragm stimulation device and method |
US20120158091A1 (en) * | 2003-10-15 | 2012-06-21 | Rmx, Llc | Therapeutic diaphragm stimulation device and method |
US8265759B2 (en) | 2003-10-15 | 2012-09-11 | Rmx, Llc | Device and method for treating disorders of the cardiovascular system or heart |
US20080161878A1 (en) | 2003-10-15 | 2008-07-03 | Tehrani Amir J | Device and method to for independently stimulating hemidiaphragms |
US9259573B2 (en) * | 2003-10-15 | 2016-02-16 | Rmx, Llc | Device and method for manipulating exhalation |
WO2005074361A2 (en) | 2004-02-05 | 2005-08-18 | Earlysense Ltd. | Techniques for prediction and monitoring of respiration-manifested clinical episodes |
US7070568B1 (en) * | 2004-03-02 | 2006-07-04 | Pacesetter, Inc. | System and method for diagnosing and tracking congestive heart failure based on the periodicity of Cheyne-Stokes Respiration using an implantable medical device |
US7245971B2 (en) | 2004-04-21 | 2007-07-17 | Pacesetter, Inc. | System and method for applying therapy during hyperpnea phase of periodic breathing using an implantable medical device |
JP4396380B2 (en) | 2004-04-26 | 2010-01-13 | アイシン・エィ・ダブリュ株式会社 | Traffic information transmission device and transmission method |
US20060122661A1 (en) * | 2004-12-03 | 2006-06-08 | Mandell Lee J | Diaphragmatic pacing with activity monitor adjustment |
US7680538B2 (en) | 2005-03-31 | 2010-03-16 | Case Western Reserve University | Method of treating obstructive sleep apnea using electrical nerve stimulation |
US8036750B2 (en) | 2005-06-13 | 2011-10-11 | Cardiac Pacemakers, Inc. | System for neural control of respiration |
US20080021506A1 (en) * | 2006-05-09 | 2008-01-24 | Massachusetts General Hospital | Method and device for the electrical treatment of sleep apnea and snoring |
US8280513B2 (en) | 2006-12-22 | 2012-10-02 | Rmx, Llc | Device and method to treat flow limitations |
-
2003
- 2003-10-15 US US10/686,891 patent/US8467876B2/en active Active
-
2004
- 2004-10-15 US US10/966,421 patent/US8255056B2/en active Active
- 2004-10-15 WO PCT/US2004/034103 patent/WO2005037366A1/en active Application Filing
- 2004-10-15 US US10/966,484 patent/US20050085869A1/en not_active Abandoned
- 2004-10-15 US US10/966,474 patent/US8412331B2/en active Active
- 2004-10-15 DE DE112004001953T patent/DE112004001953T5/en not_active Withdrawn
- 2004-10-15 DE DE112004001954.0T patent/DE112004001954B4/en not_active Expired - Fee Related
- 2004-10-15 WO PCT/US2004/034213 patent/WO2005037174A2/en active Application Filing
- 2004-10-15 WO PCT/US2004/034170 patent/WO2005037220A2/en active Application Filing
- 2004-10-15 US US10/966,472 patent/US8200336B2/en active Active
- 2004-10-15 WO PCT/US2004/033850 patent/WO2005037172A2/en active Application Filing
- 2004-10-15 US US10/966,487 patent/US20050085734A1/en not_active Abandoned
- 2004-10-15 WO PCT/US2004/034212 patent/WO2005037173A2/en active Application Filing
- 2004-10-15 DE DE112004001957T patent/DE112004001957T5/en not_active Withdrawn
- 2004-10-15 WO PCT/US2004/034211 patent/WO2005037077A2/en active Application Filing
-
2005
- 2005-10-11 US US11/246,439 patent/US20060030894A1/en not_active Abandoned
- 2005-10-13 US US11/249,718 patent/US8348941B2/en active Active
-
2006
- 2006-09-25 US US11/526,949 patent/US8509901B2/en not_active Expired - Fee Related
-
2007
- 2007-10-31 US US11/981,831 patent/US20080183240A1/en not_active Abandoned
- 2007-10-31 US US11/981,727 patent/US20080183239A1/en not_active Abandoned
- 2007-10-31 US US11/981,800 patent/US8116872B2/en active Active
-
2008
- 2008-04-01 US US12/080,133 patent/US20080188903A1/en not_active Abandoned
-
2013
- 2013-03-26 US US13/851,003 patent/US20130296973A1/en not_active Abandoned
- 2013-06-11 US US13/915,316 patent/US20130296964A1/en not_active Abandoned
Patent Citations (99)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US240240A (en) * | 1881-04-19 | Beer-faucet | ||
US4827935A (en) * | 1986-04-24 | 1989-05-09 | Purdue Research Foundation | Demand electroventilator |
US4830008A (en) * | 1987-04-24 | 1989-05-16 | Meer Jeffrey A | Method and system for treatment of sleep apnea |
US5265604A (en) * | 1990-05-14 | 1993-11-30 | Vince Dennis J | Demand - diaphragmatic pacing (skeletal muscle pressure modified) |
US5056519A (en) * | 1990-05-14 | 1991-10-15 | Vince Dennis J | Unilateral diaphragmatic pacer |
US5281219A (en) * | 1990-11-23 | 1994-01-25 | Medtronic, Inc. | Multiple stimulation electrodes |
US5211173A (en) * | 1991-01-09 | 1993-05-18 | Medtronic, Inc. | Servo muscle control |
US5300094A (en) * | 1991-01-09 | 1994-04-05 | Medtronic, Inc. | Servo muscle control |
US5146918A (en) * | 1991-03-19 | 1992-09-15 | Medtronic, Inc. | Demand apnea control of central and obstructive sleep apnea |
US5215082A (en) * | 1991-04-02 | 1993-06-01 | Medtronic, Inc. | Implantable apnea generator with ramp on generator |
US5174287A (en) * | 1991-05-28 | 1992-12-29 | Medtronic, Inc. | Airway feedback measurement system responsive to detected inspiration and obstructive apnea event |
US5233983A (en) * | 1991-09-03 | 1993-08-10 | Medtronic, Inc. | Method and apparatus for apnea patient screening |
US5423372A (en) * | 1993-12-27 | 1995-06-13 | Ford Motor Company | Joining sand cores for making castings |
US5524632A (en) * | 1994-01-07 | 1996-06-11 | Medtronic, Inc. | Method for implanting electromyographic sensing electrodes |
US5800470A (en) * | 1994-01-07 | 1998-09-01 | Medtronic, Inc. | Respiratory muscle electromyographic rate responsive pacemaker |
US5485851A (en) * | 1994-09-21 | 1996-01-23 | Medtronic, Inc. | Method and apparatus for arousal detection |
US5483969A (en) * | 1994-09-21 | 1996-01-16 | Medtronic, Inc. | Method and apparatus for providing a respiratory effort waveform for the treatment of obstructive sleep apnea |
US5540732A (en) * | 1994-09-21 | 1996-07-30 | Medtronic, Inc. | Method and apparatus for impedance detecting and treating obstructive airway disorders |
US5540731A (en) * | 1994-09-21 | 1996-07-30 | Medtronic, Inc. | Method and apparatus for pressure detecting and treating obstructive airway disorders |
US5540733A (en) * | 1994-09-21 | 1996-07-30 | Medtronic, Inc. | Method and apparatus for detecting and treating obstructive sleep apnea |
US5546952A (en) * | 1994-09-21 | 1996-08-20 | Medtronic, Inc. | Method and apparatus for detection of a respiratory waveform |
US5549655A (en) * | 1994-09-21 | 1996-08-27 | Medtronic, Inc. | Method and apparatus for synchronized treatment of obstructive sleep apnea |
US5522862A (en) * | 1994-09-21 | 1996-06-04 | Medtronic, Inc. | Method and apparatus for treating obstructive sleep apnea |
US5678535A (en) * | 1995-04-21 | 1997-10-21 | Dimarco; Anthony Fortunato | Method and apparatus for electrical stimulation of the respiratory muscles to achieve artificial ventilation in a patient |
US5911218A (en) * | 1995-04-21 | 1999-06-15 | Dimarco; Anthony Fortunato | Method and apparatus for electrical stimulation of the respiratory muscles to achieve artificial ventilation in a patient |
US6542774B2 (en) * | 1996-04-30 | 2003-04-01 | Medtronic, Inc. | Method and device for electronically controlling the beating of a heart |
US6572543B1 (en) * | 1996-06-26 | 2003-06-03 | Medtronic, Inc | Sensor, method of sensor implant and system for treatment of respiratory disorders |
US5895360A (en) * | 1996-06-26 | 1999-04-20 | Medtronic, Inc. | Gain control for a periodic signal and method regarding same |
US5944680A (en) * | 1996-06-26 | 1999-08-31 | Medtronic, Inc. | Respiratory effort detection method and apparatus |
US6021352A (en) * | 1996-06-26 | 2000-02-01 | Medtronic, Inc, | Diagnostic testing methods and apparatus for implantable therapy devices |
US6099479A (en) * | 1996-06-26 | 2000-08-08 | Medtronic, Inc. | Method and apparatus for operating therapy system |
US5814086A (en) * | 1996-10-18 | 1998-09-29 | Pacesetter Ab | Perex respiratory system stimulation upon tachycardia detection |
US5797923A (en) * | 1997-05-12 | 1998-08-25 | Aiyar; Harish | Electrode delivery instrument |
US6251126B1 (en) * | 1998-04-23 | 2001-06-26 | Medtronic Inc | Method and apparatus for synchronized treatment of obstructive sleep apnea |
US6269269B1 (en) * | 1998-04-23 | 2001-07-31 | Medtronic Inc. | Method and apparatus for synchronized treatment of obstructive sleep apnea |
US20040237963A1 (en) * | 1998-05-22 | 2004-12-02 | Michael Berthon-Jones | Ventilatory assistance for treatment of cardiac failure and Cheyne-Stokes breathing |
US6463327B1 (en) * | 1998-06-11 | 2002-10-08 | Cprx Llc | Stimulatory device and methods to electrically stimulate the phrenic nerve |
US6651652B1 (en) * | 1998-06-30 | 2003-11-25 | Siemens-Elema Ab | Method for identifying respiration attempts by analyzing neuroelectrical signals, and respiration detector and respiratory aid system operating according to the method |
US6574507B1 (en) * | 1998-07-06 | 2003-06-03 | Ela Medical S.A. | Active implantable medical device for treating sleep apnea syndrome by electrostimulation |
US6345202B2 (en) * | 1998-08-14 | 2002-02-05 | Advanced Bionics Corporation | Method of treating obstructive sleep apnea using implantable electrodes |
US6512949B1 (en) * | 1999-07-12 | 2003-01-28 | Medtronic, Inc. | Implantable medical device for measuring time varying physiologic conditions especially edema and for responding thereto |
US6415183B1 (en) * | 1999-12-09 | 2002-07-02 | Cardiac Pacemakers, Inc. | Method and apparatus for diaphragmatic pacing |
US20030127091A1 (en) * | 1999-12-15 | 2003-07-10 | Chang Yung Chi | Scientific respiration for self-health-care |
US20020049482A1 (en) * | 2000-06-14 | 2002-04-25 | Willa Fabian | Lifestyle management system |
US20040225226A1 (en) * | 2000-08-17 | 2004-11-11 | Ilife Systems, Inc. | System and method for detecting the onset of an obstructive sleep apnea event |
US6633779B1 (en) * | 2000-11-27 | 2003-10-14 | Science Medicus, Inc. | Treatment of asthma and respiratory disease by means of electrical neuro-receptive waveforms |
US20020193697A1 (en) * | 2001-04-30 | 2002-12-19 | Cho Yong Kyun | Method and apparatus to detect and treat sleep respiratory events |
US20040059240A1 (en) * | 2001-04-30 | 2004-03-25 | Medtronic, Inc. | Method and apparatus to detect and treat sleep respiratory events |
US20040176809A1 (en) * | 2001-06-07 | 2004-09-09 | Medtronic, Inc. | Method and apparatus for modifying delivery of a therapy in response to onset of sleep |
US20020193839A1 (en) * | 2001-06-07 | 2002-12-19 | Cho Yong Kyun | Method for providing a therapy to a patient involving modifying the therapy after detecting an onset of sleep in the patient, and implantable medical device embodying same |
US20030153953A1 (en) * | 2002-02-14 | 2003-08-14 | Euljoon Park | Stimulation device for sleep apnea prevention, detection and treatment |
US20030153956A1 (en) * | 2002-02-14 | 2003-08-14 | Euljoon Park | Cardiac stimulation device including sleep apnea prevention and treatment |
US20030153955A1 (en) * | 2002-02-14 | 2003-08-14 | Euljoon Park | Cardiac stimulation device including sleep apnea prevention and treatment |
US20030153954A1 (en) * | 2002-02-14 | 2003-08-14 | Euljoon Park | Sleep apnea therapy device using dynamic overdrive pacing |
US20030195571A1 (en) * | 2002-04-12 | 2003-10-16 | Burnes John E. | Method and apparatus for the treatment of central sleep apnea using biventricular pacing |
US20030204213A1 (en) * | 2002-04-30 | 2003-10-30 | Jensen Donald N. | Method and apparatus to detect and monitor the frequency of obstructive sleep apnea |
US6881192B1 (en) * | 2002-06-12 | 2005-04-19 | Pacesetter, Inc. | Measurement of sleep apnea duration and evaluation of response therapies using duration metrics |
US20040077953A1 (en) * | 2002-10-18 | 2004-04-22 | Turcott Robert G. | Hemodynamic analysis |
US20040088015A1 (en) * | 2002-10-31 | 2004-05-06 | Casavant David A. | Respiratory nerve stimulation |
US20040111040A1 (en) * | 2002-12-04 | 2004-06-10 | Quan Ni | Detection of disordered breathing |
US20040138719A1 (en) * | 2003-01-10 | 2004-07-15 | Cho Yong K. | System and method for automatically monitoring and delivering therapy for sleep-related disordered breathing |
US20050119711A1 (en) * | 2003-01-10 | 2005-06-02 | Cho Yong K. | Apparatus and method for monitoring for disordered breathing |
US20040134496A1 (en) * | 2003-01-10 | 2004-07-15 | Cho Yong K. | Method and apparatus for detecting respiratory disturbances |
US20050021102A1 (en) * | 2003-07-23 | 2005-01-27 | Ignagni Anthony R. | System and method for conditioning a diaphragm of a patient |
US20050107860A1 (en) * | 2003-07-23 | 2005-05-19 | Ignagni Anthony R. | Mapping probe system for neuromuscular electrical stimulation apparatus |
US20050039745A1 (en) * | 2003-08-18 | 2005-02-24 | Stahmann Jeffrey E. | Adaptive therapy for disordered breathing |
US20050043772A1 (en) * | 2003-08-18 | 2005-02-24 | Stahmann Jeffrey E. | Therapy triggered by prediction of disordered breathing |
US20050043644A1 (en) * | 2003-08-18 | 2005-02-24 | Stahmann Jeffrey E. | Prediction of disordered breathing |
US20050115561A1 (en) * | 2003-08-18 | 2005-06-02 | Stahmann Jeffrey E. | Patient monitoring, diagnosis, and/or therapy systems and methods |
US20050101833A1 (en) * | 2003-09-02 | 2005-05-12 | Biotronik Gmbh & Co. Kg | Apparatus for the treatment of sleep apnea |
US20050055060A1 (en) * | 2003-09-05 | 2005-03-10 | Steve Koh | Determination of respiratory characteristics from AV conduction intervals |
US20050074741A1 (en) * | 2003-09-18 | 2005-04-07 | Kent Lee | System and method for discrimination of central and obstructive disordered breathing events |
US20050080461A1 (en) * | 2003-09-18 | 2005-04-14 | Stahmann Jeffrey E. | System and method for moderating a therapy delivered during sleep using physiologic data acquired during non-sleep |
US20050061319A1 (en) * | 2003-09-18 | 2005-03-24 | Cardiac Pacemakers, Inc. | Methods and systems for implantably monitoring external breathing therapy |
US20050145246A1 (en) * | 2003-09-18 | 2005-07-07 | Hartley Jesse W. | Posture detection system and method |
US20050061315A1 (en) * | 2003-09-18 | 2005-03-24 | Kent Lee | Feedback system and method for sleep disordered breathing therapy |
US20050061320A1 (en) * | 2003-09-18 | 2005-03-24 | Cardiac Pacemakers, Inc. | Coordinated use of respiratory and cardiac therapies for sleep disordered breathing |
US20050065567A1 (en) * | 2003-09-18 | 2005-03-24 | Cardiac Pacemakers, Inc. | Therapy control based on cardiopulmonary status |
US20050065563A1 (en) * | 2003-09-23 | 2005-03-24 | Avram Scheiner | Paced ventilation therapy by an implantable cardiac device |
US20050085865A1 (en) * | 2003-10-15 | 2005-04-21 | Tehrani Amir J. | Breathing disorder detection and therapy delivery device and method |
US20060142815A1 (en) * | 2003-10-15 | 2006-06-29 | Tehrani Amir J | Device and method for treating obstructive sleep apnea |
US20050085866A1 (en) * | 2003-10-15 | 2005-04-21 | Tehrani Amir J. | Breathing disorder and precursor predictor and therapy delivery device and method |
US20050085868A1 (en) * | 2003-10-15 | 2005-04-21 | Tehrani Amir J. | Breathing therapy device and method |
US20050085734A1 (en) * | 2003-10-15 | 2005-04-21 | Tehrani Amir J. | Heart failure patient treatment and management device |
US20070021795A1 (en) * | 2003-10-15 | 2007-01-25 | Inspiration Medical, Inc. | Device and method for adding to breathing |
US20060247729A1 (en) * | 2003-10-15 | 2006-11-02 | Tehrani Amir J | Multimode device and method for controlling breathing |
US20060167523A1 (en) * | 2003-10-15 | 2006-07-27 | Tehrani Amir J | Device and method for improving upper airway functionality |
US20060155341A1 (en) * | 2003-10-15 | 2006-07-13 | Tehrani Amir J | Device and method for biasing lung volume |
US20060030894A1 (en) * | 2003-10-15 | 2006-02-09 | Tehrani Amir J | Breathing disorder detection and therapy device for providing intrinsic breathing |
US20060036294A1 (en) * | 2003-10-15 | 2006-02-16 | Tehrani Amir J | Patient compliance management device and method |
US20060149334A1 (en) * | 2003-10-15 | 2006-07-06 | Tehrani Amir J | Device and method for controlling breathing |
US20050085867A1 (en) * | 2003-10-15 | 2005-04-21 | Tehrani Amir J. | System and method for diaphragm stimulation |
US20050148897A1 (en) * | 2003-12-24 | 2005-07-07 | Cho Yong K. | Implantable medical device with sleep disordered breathing monitoring |
US20050165457A1 (en) * | 2004-01-26 | 2005-07-28 | Michael Benser | Tiered therapy for respiratory oscillations characteristic of Cheyne-Stokes respiration |
US20050224076A1 (en) * | 2004-04-07 | 2005-10-13 | Pari Gmbh Spezialisten Fur Effektive Inhalation | Aerosol generation device and inhalation device therewith |
US7082331B1 (en) * | 2004-04-21 | 2006-07-25 | Pacesetter, Inc. | System and method for applying therapy during hyperpnea phase of periodic breathing using an implantable medical device |
US20050261600A1 (en) * | 2004-05-20 | 2005-11-24 | Airmatrix Technologies, Inc. | Method and system for diagnosing central versus obstructive apnea |
US20060058852A1 (en) * | 2004-09-10 | 2006-03-16 | Steve Koh | Multi-variable feedback control of stimulation for inspiratory facilitation |
US20060122622A1 (en) * | 2004-12-06 | 2006-06-08 | Csaba Truckai | Bone treatment systems and methods |
Cited By (244)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US8001967B2 (en) | 1997-03-14 | 2011-08-23 | Nellcor Puritan Bennett Llc | Ventilator breath display and graphic user interface |
US8555881B2 (en) | 1997-03-14 | 2013-10-15 | Covidien Lp | Ventilator breath display and graphic interface |
US8555882B2 (en) | 1997-03-14 | 2013-10-15 | Covidien Lp | Ventilator breath display and graphic user interface |
US20050021102A1 (en) * | 2003-07-23 | 2005-01-27 | Ignagni Anthony R. | System and method for conditioning a diaphragm of a patient |
US8406885B2 (en) | 2003-07-23 | 2013-03-26 | Synapse Biomedical, Inc. | System and method for conditioning a diaphragm of a patient |
US20110060381A1 (en) * | 2003-07-23 | 2011-03-10 | Ignagni Anthony R | System and Method for Conditioning a Diaphragm of a Patient |
US7840270B2 (en) | 2003-07-23 | 2010-11-23 | Synapse Biomedical, Inc. | System and method for conditioning a diaphragm of a patient |
US8706236B2 (en) | 2003-07-23 | 2014-04-22 | Synapse Biomedical, Inc. | System and method for conditioning a diaphragm of a patient |
US20080188904A1 (en) * | 2003-10-15 | 2008-08-07 | Tehrani Amir J | Device and method for treating disorders of the cardiovascular system or heart |
US20060036294A1 (en) * | 2003-10-15 | 2006-02-16 | Tehrani Amir J | Patient compliance management device and method |
US20060247729A1 (en) * | 2003-10-15 | 2006-11-02 | Tehrani Amir J | Multimode device and method for controlling breathing |
US20110230932A1 (en) * | 2003-10-15 | 2011-09-22 | Rmx, Llc | Device and method for independently stimulating hemidiaphragms |
US8335567B2 (en) | 2003-10-15 | 2012-12-18 | Rmx, Llc | Multimode device and method for controlling breathing |
US20050085867A1 (en) * | 2003-10-15 | 2005-04-21 | Tehrani Amir J. | System and method for diaphragm stimulation |
US8255056B2 (en) | 2003-10-15 | 2012-08-28 | Rmx, Llc | Breathing disorder and precursor predictor and therapy delivery device and method |
US7979128B2 (en) | 2003-10-15 | 2011-07-12 | Rmx, Llc | Device and method for gradually controlling breathing |
US8244358B2 (en) | 2003-10-15 | 2012-08-14 | Rmx, Llc | Device and method for treating obstructive sleep apnea |
US7970475B2 (en) | 2003-10-15 | 2011-06-28 | Rmx, Llc | Device and method for biasing lung volume |
US8348941B2 (en) | 2003-10-15 | 2013-01-08 | Rmx, Llc | Demand-based system for treating breathing disorders |
US20050085734A1 (en) * | 2003-10-15 | 2005-04-21 | Tehrani Amir J. | Heart failure patient treatment and management device |
US8412331B2 (en) | 2003-10-15 | 2013-04-02 | Rmx, Llc | Breathing therapy device and method |
US9370657B2 (en) | 2003-10-15 | 2016-06-21 | Rmx, Llc | Device for manipulating tidal volume and breathing entrainment |
US20080167695A1 (en) * | 2003-10-15 | 2008-07-10 | Tehrani Amir J | Therapeutic diaphragm stimulation device and method |
US9259573B2 (en) | 2003-10-15 | 2016-02-16 | Rmx, Llc | Device and method for manipulating exhalation |
US8116872B2 (en) | 2003-10-15 | 2012-02-14 | Rmx, Llc | Device and method for biasing and stimulating respiration |
US20080208281A1 (en) * | 2003-10-15 | 2008-08-28 | Tehrani Amir J | Device and method for biasing and stimulating respiration |
US20060030894A1 (en) * | 2003-10-15 | 2006-02-09 | Tehrani Amir J | Breathing disorder detection and therapy device for providing intrinsic breathing |
US20060155341A1 (en) * | 2003-10-15 | 2006-07-13 | Tehrani Amir J | Device and method for biasing lung volume |
US20060149334A1 (en) * | 2003-10-15 | 2006-07-06 | Tehrani Amir J | Device and method for controlling breathing |
US8265759B2 (en) | 2003-10-15 | 2012-09-11 | Rmx, Llc | Device and method for treating disorders of the cardiovascular system or heart |
US8467876B2 (en) * | 2003-10-15 | 2013-06-18 | Rmx, Llc | Breathing disorder detection and therapy delivery device and method |
US8200336B2 (en) | 2003-10-15 | 2012-06-12 | Rmx, Llc | System and method for diaphragm stimulation |
US8160711B2 (en) | 2003-10-15 | 2012-04-17 | Rmx, Llc | Multimode device and method for controlling breathing |
US8509901B2 (en) | 2003-10-15 | 2013-08-13 | Rmx, Llc | Device and method for adding to breathing |
US8140164B2 (en) | 2003-10-15 | 2012-03-20 | Rmx, Llc | Therapeutic diaphragm stimulation device and method |
US20060122662A1 (en) * | 2003-10-15 | 2006-06-08 | Tehrani Amir J | Device and method for increasing functional residual capacity |
US20120203293A1 (en) * | 2004-06-08 | 2012-08-09 | Greenberg Robert J | Locating a Neural Prosthesis using Impedance and Electrode Height |
US9597495B2 (en) * | 2004-06-08 | 2017-03-21 | Second Sight Medical Products, Inc. | Locating a neural prosthesis using impedance and electrode height |
US20070265611A1 (en) * | 2004-07-23 | 2007-11-15 | Ignagni Anthony R | Ventilatory assist system and methods to improve respiratory function |
US7962215B2 (en) | 2004-07-23 | 2011-06-14 | Synapse Biomedical, Inc. | Ventilatory assist system and methods to improve respiratory function |
WO2006062710A1 (en) * | 2004-12-03 | 2006-06-15 | The Alfred E. Mann Foundation For Scientific Research | Diaphragmatic pacing with physiological need adjustment |
US20060122661A1 (en) * | 2004-12-03 | 2006-06-08 | Mandell Lee J | Diaphragmatic pacing with activity monitor adjustment |
US7644714B2 (en) | 2005-05-27 | 2010-01-12 | Apnex Medical, Inc. | Devices and methods for treating sleep disorders |
US20070044669A1 (en) * | 2005-08-24 | 2007-03-01 | Geise Gregory D | Aluminum can compacting mechanism with improved actuation handle assembly |
US9050005B2 (en) | 2005-08-25 | 2015-06-09 | Synapse Biomedical, Inc. | Method and apparatus for transgastric neurostimulation |
US20070049793A1 (en) * | 2005-08-25 | 2007-03-01 | Ignagni Anthony R | Method And Apparatus For Transgastric Neurostimulation |
US11305119B2 (en) * | 2005-11-18 | 2022-04-19 | Zoll Respicardia, Inc. | System and method to modulate phrenic nerve to prevent sleep apnea |
US20070118183A1 (en) * | 2005-11-18 | 2007-05-24 | Mark Gelfand | System and method to modulate phrenic nerve to prevent sleep apnea |
US8244359B2 (en) * | 2005-11-18 | 2012-08-14 | Respicardia, Inc. | System and method to modulate phrenic nerve to prevent sleep apnea |
US20160001072A1 (en) * | 2005-11-18 | 2016-01-07 | Respicardia, Inc. | System and method to modulate phrenic nerve to prevent sleep apnea |
US10518090B2 (en) | 2005-11-18 | 2019-12-31 | Respicardia, Inc. | System and method to modulate phrenic nerve to prevent sleep apnea |
US20070150023A1 (en) * | 2005-12-02 | 2007-06-28 | Ignagni Anthony R | Transvisceral neurostimulation mapping device and method |
US8676323B2 (en) | 2006-03-09 | 2014-03-18 | Synapse Biomedical, Inc. | Ventilatory assist system and methods to improve respiratory function |
US20080125828A1 (en) * | 2006-03-09 | 2008-05-29 | Ignagni Anthony R | Ventilatory assist system and methods to improve respiratory function |
US8021310B2 (en) | 2006-04-21 | 2011-09-20 | Nellcor Puritan Bennett Llc | Work of breathing display for a ventilation system |
US8597198B2 (en) | 2006-04-21 | 2013-12-03 | Covidien Lp | Work of breathing display for a ventilation system |
US10582880B2 (en) | 2006-04-21 | 2020-03-10 | Covidien Lp | Work of breathing display for a ventilation system |
US20070272242A1 (en) * | 2006-04-21 | 2007-11-29 | Sanborn Warren G | Work of breathing display for a ventilation system |
US20090270963A1 (en) * | 2006-05-23 | 2009-10-29 | Publiekrechtelijke Rechtspersoon Academisch Ziekenhuis Leiden H.O.D.N. Leids Universitair Medi | Medical probe |
US8983627B2 (en) * | 2006-05-23 | 2015-03-17 | Publiekrechtelijke Rechtspersoon Academisch Ziekenhuis Leiden H.O.D.N. Leids Universitair Medisch Centrum | Medical probe for electro-stimulation and bio-feedback training of pelvic floor musculature |
US9656067B2 (en) | 2006-05-23 | 2017-05-23 | Publiekrechtelijke Rechtspersoon Academisch Ziekenhuis Leiden H.O.D.N. Leids Universitair Medisch Centrum | Medical probe for electro-stimulation and training of pelvic floor musculature |
US20100049037A1 (en) * | 2006-09-11 | 2010-02-25 | Koninklijke Philips Electronics N.V. | System and method for positioning electrodes on a patient body |
US8577439B2 (en) * | 2006-09-11 | 2013-11-05 | Koninklijke Philips N.V. | System and method for positioning electrodes on a patient body |
US8453645B2 (en) | 2006-09-26 | 2013-06-04 | Covidien Lp | Three-dimensional waveform display for a breathing assistance system |
US20080072902A1 (en) * | 2006-09-27 | 2008-03-27 | Nellcor Puritan Bennett Incorporated | Preset breath delivery therapies for a breathing assistance system |
US8428727B2 (en) | 2006-10-13 | 2013-04-23 | Apnex Medical, Inc. | Obstructive sleep apnea treatment devices, systems and methods |
USRE48024E1 (en) | 2006-10-13 | 2020-06-02 | Livanova Usa, Inc. | Obstructive sleep apnea treatment devices, systems and methods |
US8718783B2 (en) | 2006-10-13 | 2014-05-06 | Cyberonics, Inc. | Obstructive sleep apnea treatment devices, systems and methods |
USRE48025E1 (en) | 2006-10-13 | 2020-06-02 | Livanova Usa, Inc. | Obstructive sleep apnea treatment devices, systems and methods |
US20080103407A1 (en) * | 2006-10-13 | 2008-05-01 | Apnex Medical, Inc. | Obstructive sleep apnea treatment devices, systems and methods |
US8498712B2 (en) | 2006-10-13 | 2013-07-30 | Apnex Medical, Inc. | Obstructive sleep apnea treatment devices, systems and methods |
US11517746B2 (en) | 2006-10-13 | 2022-12-06 | Livanova Usa, Inc. | Obstructive sleep apnea treatment devices, systems and methods |
US8417343B2 (en) | 2006-10-13 | 2013-04-09 | Apnex Medical, Inc. | Obstructive sleep apnea treatment devices, systems and methods |
US8639354B2 (en) | 2006-10-13 | 2014-01-28 | Cyberonics, Inc. | Obstructive sleep apnea treatment devices, systems and methods |
US8626304B2 (en) | 2006-10-13 | 2014-01-07 | Cyberonics, Inc. | Obstructive sleep apnea treatment devices, systems and methods |
US10632308B2 (en) | 2006-10-13 | 2020-04-28 | Livanova Usa, Inc. | Obstructive sleep apnea treatment devices, systems and methods |
US11471685B2 (en) | 2006-10-13 | 2022-10-18 | Livanova Usa, Inc. | Obstructive sleep apnea treatment devices, systems and methods |
US9186511B2 (en) | 2006-10-13 | 2015-11-17 | Cyberonics, Inc. | Obstructive sleep apnea treatment devices, systems and methods |
US8744589B2 (en) | 2006-10-13 | 2014-06-03 | Cyberonics, Inc. | Obstructive sleep apnea treatment devices, systems and methods |
US8311645B2 (en) | 2006-10-13 | 2012-11-13 | Apnex Medical, Inc. | Obstructive sleep apnea treatment devices, systems and methods |
US7809442B2 (en) | 2006-10-13 | 2010-10-05 | Apnex Medical, Inc. | Obstructive sleep apnea treatment devices, systems and methods |
US20080109047A1 (en) * | 2006-10-26 | 2008-05-08 | Pless Benjamin D | Apnea treatment device |
US10406366B2 (en) | 2006-11-17 | 2019-09-10 | Respicardia, Inc. | Transvenous phrenic nerve stimulation system |
US20080154330A1 (en) * | 2006-12-22 | 2008-06-26 | Tehrani Amir J | Device and method to treat flow limitations |
US8280513B2 (en) * | 2006-12-22 | 2012-10-02 | Rmx, Llc | Device and method to treat flow limitations |
US20080208282A1 (en) * | 2007-01-22 | 2008-08-28 | Mark Gelfand | Device and method for the treatment of breathing disorders and cardiac disorders |
US8909341B2 (en) | 2007-01-22 | 2014-12-09 | Respicardia, Inc. | Device and method for the treatment of breathing disorders and cardiac disorders |
US10300270B2 (en) | 2007-01-22 | 2019-05-28 | Respicardia, Inc. | Device and method for the treatment of breathing disorders and cardiac disorders |
US9744351B1 (en) | 2007-01-22 | 2017-08-29 | Respicardia, Inc. | Device and method for the treatment of breathing disorders and cardiac disorders |
US11027130B2 (en) * | 2007-01-29 | 2021-06-08 | Lungpacer Medical Inc. | Transvascular nerve stimulation apparatus and methods |
US10792499B2 (en) | 2007-01-29 | 2020-10-06 | Lungpacer Medical Inc. | Transvascular nerve stimulation apparatus and methods |
US10561843B2 (en) | 2007-01-29 | 2020-02-18 | Lungpacer Medical, Inc. | Transvascular nerve stimulation apparatus and methods |
US10864374B2 (en) | 2007-01-29 | 2020-12-15 | Lungpacer Medical Inc. | Transvascular nerve stimulation apparatus and methods |
US10765867B2 (en) | 2007-01-29 | 2020-09-08 | Lungpacer Medical Inc. | Transvascular nerve stimulation apparatus and methods |
US20100106047A1 (en) * | 2007-02-01 | 2010-04-29 | Ls Biopath, Inc. | Electrical methods for detection and characterization of abnormal tissue and cells |
US8437845B2 (en) * | 2007-02-01 | 2013-05-07 | Ls Biopath, Inc. | Electrical methods for detection and characterization of abnormal tissue and cells |
US8417328B2 (en) * | 2007-02-01 | 2013-04-09 | Ls Biopath, Inc. | Electrical systems for detection and characterization of abnormal tissue and cells |
US20100121173A1 (en) * | 2007-02-01 | 2010-05-13 | Moshe Sarfaty | Electrical systems for detection and characterization of abnormal tissue and cells |
US20130230883A1 (en) * | 2007-02-01 | 2013-09-05 | Ls Biopath, Inc. | Methods for detection and characterization of abnormal tissue and cells using an electrical system |
US9566030B2 (en) | 2007-02-01 | 2017-02-14 | Ls Biopath, Inc. | Optical system for detection and characterization of abnormal tissue and cells |
US8865076B2 (en) * | 2007-02-01 | 2014-10-21 | Ls Biopath, Inc. | Methods for detection and characterization of abnormal tissue and cells using an electrical system |
US20100179436A1 (en) * | 2007-02-01 | 2010-07-15 | Moshe Sarfaty | Optical system for detection and characterization of abnormal tissue and cells |
US9079016B2 (en) | 2007-02-05 | 2015-07-14 | Synapse Biomedical, Inc. | Removable intramuscular electrode |
US20080188867A1 (en) * | 2007-02-05 | 2008-08-07 | Ignagni Anthony R | Removable intramuscular electrode |
US20080287820A1 (en) * | 2007-05-17 | 2008-11-20 | Synapse Biomedical, Inc. | Devices and methods for assessing motor point electromyogram as a biomarker |
US9820671B2 (en) | 2007-05-17 | 2017-11-21 | Synapse Biomedical, Inc. | Devices and methods for assessing motor point electromyogram as a biomarker |
US11305114B2 (en) | 2007-06-27 | 2022-04-19 | Zoll Respicardia, Inc. | Detecting and treating disordered breathing |
US9987488B1 (en) | 2007-06-27 | 2018-06-05 | Respicardia, Inc. | Detecting and treating disordered breathing |
US20090024176A1 (en) * | 2007-07-17 | 2009-01-22 | Joonkyoo Anthony Yun | Methods and devices for producing respiratory sinus arrhythmia |
US8135471B2 (en) | 2007-08-28 | 2012-03-13 | Cardiac Pacemakers, Inc. | Method and apparatus for inspiratory muscle stimulation using implantable device |
US20090062882A1 (en) * | 2007-08-28 | 2009-03-05 | Cardiac Pacemakers, Inc. | Method and apparatus for inspiratory muscle stimulation using implantable device |
US8914113B2 (en) | 2007-08-28 | 2014-12-16 | Cardiac Pacemakers, Inc. | Method and apparatus for inspiratory muscle stimulation using implantable device |
US8838245B2 (en) | 2007-10-10 | 2014-09-16 | Cardiac Pacemakers, Inc. | Respiratory stimulation for treating periodic breathing |
US20090099621A1 (en) * | 2007-10-10 | 2009-04-16 | Zheng Lin | Respiratory stimulation for treating periodic breathing |
US8428711B2 (en) | 2007-10-10 | 2013-04-23 | Cardiac Pacemakers, Inc. | Respiratory stimulation for treating periodic breathing |
US9138580B2 (en) | 2007-10-30 | 2015-09-22 | Synapse Biomedical, Inc. | Device and method of neuromodulation to effect a functionally restorative adaption of the neuromuscular system |
US20090118785A1 (en) * | 2007-10-30 | 2009-05-07 | Ignagni Anthony R | Method of improving sleep disordered breathing |
US8428726B2 (en) | 2007-10-30 | 2013-04-23 | Synapse Biomedical, Inc. | Device and method of neuromodulation to effect a functionally restorative adaption of the neuromuscular system |
US8478412B2 (en) | 2007-10-30 | 2013-07-02 | Synapse Biomedical, Inc. | Method of improving sleep disordered breathing |
US11865333B2 (en) | 2008-02-07 | 2024-01-09 | Zoll Respicardia, Inc. | Transvascular medical lead |
US9295846B2 (en) | 2008-02-07 | 2016-03-29 | Respicardia, Inc. | Muscle and nerve stimulation |
US11389648B2 (en) | 2008-02-07 | 2022-07-19 | Zoll Respicardia, Inc. | Transvascular medical lead |
US8433412B1 (en) | 2008-02-07 | 2013-04-30 | Respicardia, Inc. | Muscle and nerve stimulation |
US10932682B2 (en) | 2008-05-15 | 2021-03-02 | Inspire Medical Systems, Inc. | Method and apparatus for sensing respiratory pressure in an implantable stimulation system |
US20110152706A1 (en) * | 2008-05-15 | 2011-06-23 | Inspire Medical Systems, Inc. | Method and apparatus for sensing respiratory pressure in an implantable stimulation system |
US11806537B2 (en) | 2008-10-01 | 2023-11-07 | Inspire Medical Systems, Inc. | Transvenous method of treating sleep apnea |
US11083899B2 (en) | 2008-10-01 | 2021-08-10 | Inspire Medical Systems, Inc. | Transvenous method of treating sleep apnea |
US9889299B2 (en) | 2008-10-01 | 2018-02-13 | Inspire Medical Systems, Inc. | Transvenous method of treating sleep apnea |
US10888267B2 (en) | 2008-11-19 | 2021-01-12 | Inspire Medical Systems, Inc. | Method of treating sleep disordered breathing |
US8938299B2 (en) | 2008-11-19 | 2015-01-20 | Inspire Medical Systems, Inc. | System for treating sleep disordered breathing |
US10632306B2 (en) | 2008-12-31 | 2020-04-28 | Livanova Usa, Inc. | Obstructive sleep apnea treatment devices, systems and methods |
US11400287B2 (en) | 2008-12-31 | 2022-08-02 | Livanova Usa, Inc. | Obstructive sleep apnea treatment devices, systems and methods |
US9744354B2 (en) | 2008-12-31 | 2017-08-29 | Cyberonics, Inc. | Obstructive sleep apnea treatment devices, systems and methods |
US10737094B2 (en) | 2008-12-31 | 2020-08-11 | Livanova Usa, Inc. | Obstructive sleep apnea treatment devices, systems and methods |
US10105538B2 (en) | 2008-12-31 | 2018-10-23 | Cyberonics, Inc. | Obstructive sleep apnea treatment devices, systems and methods |
US10543366B2 (en) | 2009-03-31 | 2020-01-28 | Inspire Medical Systems, Inc. | Percutaneous access for systems and methods of treating sleep-related disordered breathing |
US9486628B2 (en) | 2009-03-31 | 2016-11-08 | Inspire Medical Systems, Inc. | Percutaneous access for systems and methods of treating sleep apnea |
US20110060380A1 (en) * | 2009-09-10 | 2011-03-10 | Mark Gelfand | Respiratory rectification |
US11883659B2 (en) | 2009-09-10 | 2024-01-30 | Zoll Respicardia, Inc. | Systems for treating disordered breathing by comparing stimulated and unstimulated breathing |
US9999768B2 (en) | 2009-09-10 | 2018-06-19 | Respicardia, Inc. | Respiratory rectification |
US8233987B2 (en) | 2009-09-10 | 2012-07-31 | Respicardia, Inc. | Respiratory rectification |
US9119925B2 (en) | 2009-12-04 | 2015-09-01 | Covidien Lp | Quick initiation of respiratory support via a ventilator user interface |
USD638852S1 (en) | 2009-12-04 | 2011-05-31 | Nellcor Puritan Bennett Llc | Ventilator display screen with an alarm icon |
USD649157S1 (en) | 2009-12-04 | 2011-11-22 | Nellcor Puritan Bennett Llc | Ventilator display screen with a user interface |
US8335992B2 (en) | 2009-12-04 | 2012-12-18 | Nellcor Puritan Bennett Llc | Visual indication of settings changes on a ventilator graphical user interface |
US8924878B2 (en) | 2009-12-04 | 2014-12-30 | Covidien Lp | Display and access to settings on a ventilator graphical user interface |
US8499252B2 (en) | 2009-12-18 | 2013-07-30 | Covidien Lp | Display of respiratory data graphs on a ventilator graphical user interface |
US9262588B2 (en) | 2009-12-18 | 2016-02-16 | Covidien Lp | Display of respiratory data graphs on a ventilator graphical user interface |
US8443294B2 (en) | 2009-12-18 | 2013-05-14 | Covidien Lp | Visual indication of alarms on a ventilator graphical user interface |
US8983572B2 (en) | 2010-10-29 | 2015-03-17 | Inspire Medical Systems, Inc. | System and method for patient selection in treating sleep disordered breathing |
US20120150061A1 (en) * | 2010-11-02 | 2012-06-14 | Industry-Academic Cooperation Foundation, Yonsei University | Sensor for Detecting Cancerous Tissue and Method of Manufacturing the Same |
US9113838B2 (en) | 2011-01-28 | 2015-08-25 | Cyberonics, Inc. | Screening devices and methods for obstructive sleep apnea therapy |
US11529514B2 (en) | 2011-01-28 | 2022-12-20 | Livanova Usa, Inc. | Obstructive sleep apnea treatment devices, systems and methods |
US9555247B2 (en) | 2011-01-28 | 2017-01-31 | Cyberonics, Inc. | Screening devices and methods for obstructive sleep apnea therapy |
US11000208B2 (en) | 2011-01-28 | 2021-05-11 | Livanova Usa, Inc. | Screening devices and methods for obstructive sleep apnea therapy |
US9913982B2 (en) | 2011-01-28 | 2018-03-13 | Cyberonics, Inc. | Obstructive sleep apnea treatment devices, systems and methods |
US8386046B2 (en) | 2011-01-28 | 2013-02-26 | Apnex Medical, Inc. | Screening devices and methods for obstructive sleep apnea therapy |
US8855771B2 (en) | 2011-01-28 | 2014-10-07 | Cyberonics, Inc. | Screening devices and methods for obstructive sleep apnea therapy |
US10231645B2 (en) | 2011-01-28 | 2019-03-19 | Livanova Usa, Inc. | Screening devices and methods for obstructive sleep apnea therapy |
US9205262B2 (en) | 2011-05-12 | 2015-12-08 | Cyberonics, Inc. | Devices and methods for sleep apnea treatment |
US9757564B2 (en) | 2011-05-12 | 2017-09-12 | Cyberonics, Inc. | Devices and methods for sleep apnea treatment |
US10583297B2 (en) | 2011-08-11 | 2020-03-10 | Inspire Medical Systems, Inc. | Method and system for applying stimulation in treating sleep disordered breathing |
US11511117B2 (en) | 2011-08-11 | 2022-11-29 | Inspire Medical Systems, Inc. | Method and system for applying stimulation in treating sleep disordered breathing |
US11806525B2 (en) | 2011-09-01 | 2023-11-07 | Inspire Medical Systems, Inc. | Nerve cuff |
US10286206B2 (en) | 2011-09-01 | 2019-05-14 | Inspire Medical Systems, Inc. | Nerve cuff |
US8934992B2 (en) | 2011-09-01 | 2015-01-13 | Inspire Medical Systems, Inc. | Nerve cuff |
US11285315B2 (en) | 2011-09-01 | 2022-03-29 | Inspire Medical Systems, Inc. | Nerve cuff |
US10864375B2 (en) | 2011-10-03 | 2020-12-15 | Livanova Usa, Inc. | Devices and methods for sleep apnea treatment |
US10052484B2 (en) | 2011-10-03 | 2018-08-21 | Cyberonics, Inc. | Devices and methods for sleep apnea treatment |
US10512772B2 (en) | 2012-03-05 | 2019-12-24 | Lungpacer Medical Inc. | Transvascular nerve stimulation apparatus and methods |
US11369787B2 (en) | 2012-03-05 | 2022-06-28 | Lungpacer Medical Inc. | Transvascular nerve stimulation apparatus and methods |
US11357985B2 (en) | 2012-06-21 | 2022-06-14 | Lungpacer Medical Inc. | Transvascular diaphragm pacing systems and methods of use |
US10406367B2 (en) | 2012-06-21 | 2019-09-10 | Lungpacer Medical Inc. | Transvascular diaphragm pacing system and methods of use |
US10589097B2 (en) | 2012-06-21 | 2020-03-17 | Lungpacer Medical Inc. | Transvascular diaphragm pacing systems and methods of use |
US10561844B2 (en) | 2012-06-21 | 2020-02-18 | Lungpacer Medical Inc. | Diaphragm pacing systems and methods of use |
US10362967B2 (en) | 2012-07-09 | 2019-07-30 | Covidien Lp | Systems and methods for missed breath detection and indication |
US11642042B2 (en) | 2012-07-09 | 2023-05-09 | Covidien Lp | Systems and methods for missed breath detection and indication |
US10335592B2 (en) | 2012-12-19 | 2019-07-02 | Viscardia, Inc. | Systems, devices, and methods for improving hemodynamic performance through asymptomatic diaphragm stimulation |
US9694185B2 (en) | 2012-12-19 | 2017-07-04 | Viscardia, Inc. | Hemodynamic performance enhancement through asymptomatic diaphragm stimulation |
US11020596B2 (en) | 2012-12-19 | 2021-06-01 | Viscardia, Inc. | Hemodynamic performance enhancement through asymptomatic diaphragm stimulation |
US11147968B2 (en) | 2012-12-19 | 2021-10-19 | Viscardia, Inc. | Systems, devices, and methods for improving hemodynamic performance through asymptomatic diaphragm stimulation |
US9968786B2 (en) | 2012-12-19 | 2018-05-15 | Viscardia, Inc. | Hemodynamic performance enhancement through asymptomatic diaphragm stimulation |
US10315035B2 (en) | 2012-12-19 | 2019-06-11 | Viscardia, Inc. | Hemodynamic performance enhancement through asymptomatic diaphragm stimulation |
US11684783B2 (en) | 2012-12-19 | 2023-06-27 | Viscardia, Inc. | Hemodynamic performance enhancement through asymptomatic diaphragm stimulation |
US11666757B2 (en) | 2012-12-19 | 2023-06-06 | Viscardia, Inc. | Systems, devices, and methods for improving hemodynamic performance through asymptomatic diaphragm stimulation |
US9498625B2 (en) | 2012-12-19 | 2016-11-22 | Viscardia, Inc. | Hemodynamic performance enhancement through asymptomatic diaphragm stimulation |
US20150141767A1 (en) * | 2013-10-02 | 2015-05-21 | The Board Of Trustees Of The University Of Illinois | Organ Mounted Electronics |
US10820862B2 (en) * | 2013-10-02 | 2020-11-03 | The Board Of Trustees Of The University Of Illinois | Organ mounted electronics |
US11707619B2 (en) | 2013-11-22 | 2023-07-25 | Lungpacer Medical Inc. | Apparatus and methods for assisted breathing by transvascular nerve stimulation |
US10391314B2 (en) | 2014-01-21 | 2019-08-27 | Lungpacer Medical Inc. | Systems and related methods for optimization of multi-electrode nerve pacing |
EP3566743A1 (en) * | 2014-01-21 | 2019-11-13 | Lungpacer Medical Inc. | Systems for optimization of multi-electrode nerve pacing |
JP2017503596A (en) * | 2014-01-21 | 2017-02-02 | サイモン フレーザー ユニバーシティーSimon Fraser University | System and associated method for optimization of multi-electrode neural pacing |
US9597509B2 (en) | 2014-01-21 | 2017-03-21 | Simon Fraser University | Systems and related methods for optimization of multi-electrode nerve pacing |
EP3824949A1 (en) * | 2014-01-21 | 2021-05-26 | Lungpacer Medical Inc. | Systems for optimization of multi-electrode nerve pacing |
JP2021079157A (en) * | 2014-01-21 | 2021-05-27 | ラングペーサー メディカル インコーポレイテッドLungpacer Medical Inc. | Stimulation system |
AU2015208640B2 (en) * | 2014-01-21 | 2020-02-20 | Lungpacer Medical Inc. | Systems and related methods for optimization of multi-electrode nerve pacing |
US11311730B2 (en) | 2014-01-21 | 2022-04-26 | Lungpacer Medical Inc. | Systems and related methods for optimization of multi-electrode nerve pacing |
JP2019136604A (en) * | 2014-01-21 | 2019-08-22 | ラングペーサー メディカル インコーポレイテッドLungpacer Medical Inc. | Diaphragm pacing system |
CN109805911A (en) * | 2014-01-21 | 2019-05-28 | 隆佩瑟尔医疗公司 | For optimizing the system and correlation technique of multi-electrode nerve pace-making |
JP7153373B2 (en) | 2014-01-21 | 2022-10-14 | ラングペーサー メディカル インコーポレイテッド | Diaphragmatic pacing system |
CN105916549A (en) * | 2014-01-21 | 2016-08-31 | 西蒙·弗雷泽大学 | Systems and related methods for optimization of multi-electrode nerve pacing |
EP3096835A4 (en) * | 2014-01-21 | 2017-08-09 | Simon Fraser University | Systems and related methods for optimization of multi-electrode nerve pacing |
WO2015109401A1 (en) * | 2014-01-21 | 2015-07-30 | Simon Fraser University | Systems and related methods for optimization of multi-electrode nerve pacing |
US20220212013A1 (en) * | 2014-01-21 | 2022-07-07 | Lungpacer Medical Inc. | Systems and related methods for optimization of multi-electrode nerve pacing |
US9333363B2 (en) | 2014-01-21 | 2016-05-10 | Simon Fraser University | Systems and related methods for optimization of multi-electrode nerve pacing |
US11383083B2 (en) | 2014-02-11 | 2022-07-12 | Livanova Usa, Inc. | Systems and methods of detecting and treating obstructive sleep apnea |
US11497915B2 (en) | 2014-08-26 | 2022-11-15 | Rmx, Llc | Devices and methods for reducing intrathoracic pressure |
US10857363B2 (en) | 2014-08-26 | 2020-12-08 | Rmx, Llc | Devices and methods for reducing intrathoracic pressure |
US9950129B2 (en) | 2014-10-27 | 2018-04-24 | Covidien Lp | Ventilation triggering using change-point detection |
US10940281B2 (en) | 2014-10-27 | 2021-03-09 | Covidien Lp | Ventilation triggering |
US11712174B2 (en) | 2014-10-27 | 2023-08-01 | Covidien Lp | Ventilation triggering |
US10485971B2 (en) | 2014-10-31 | 2019-11-26 | Avent, Inc. | Non-invasive nerve stimulation system and method |
US11850424B2 (en) | 2015-03-19 | 2023-12-26 | Inspire Medical Systems, Inc. | Stimulation for treating sleep disordered breathing |
US11806526B2 (en) | 2015-03-19 | 2023-11-07 | Inspire Medical Systems, Inc. | Stimulation for treating sleep disordered breathing |
US10898709B2 (en) | 2015-03-19 | 2021-01-26 | Inspire Medical Systems, Inc. | Stimulation for treating sleep disordered breathing |
US11400286B2 (en) * | 2016-04-29 | 2022-08-02 | Viscardia, Inc. | Implantable medical devices, systems, and methods for selection of optimal diaphragmatic stimulation parameters to affect pressures within the intrathoracic cavity |
US10493271B2 (en) * | 2016-04-29 | 2019-12-03 | Viscardia, Inc. | Implantable medical devices, systems, and methods for selection of optimal diaphragmatic stimulation parameters to affect pressures within the intrathoracic cavity |
US20170312508A1 (en) * | 2016-04-29 | 2017-11-02 | Viscardia, Inc. | Implantable medical devices, systems, and methods for selection of optimal diaphragmatic stimulation parameters to affect pressures within the intrathoracic cavity |
US10537735B2 (en) | 2016-04-29 | 2020-01-21 | Viscardia, Inc. | Implantable medical devices and methods for real-time or near real-time adjustment of diaphragmatic stimulation parameters to affect pressures within the intrathoracic cavity |
US10369361B2 (en) | 2016-04-29 | 2019-08-06 | Viscardia, Inc. | Leads for implantable medical device that affects pressures within the intrathoracic cavity through diaphragmatic stimulation |
US10293164B2 (en) | 2017-05-26 | 2019-05-21 | Lungpacer Medical Inc. | Apparatus and methods for assisted breathing by transvascular nerve stimulation |
US11883658B2 (en) | 2017-06-30 | 2024-01-30 | Lungpacer Medical Inc. | Devices and methods for prevention, moderation, and/or treatment of cognitive injury |
US10926087B2 (en) | 2017-08-02 | 2021-02-23 | Lungpacer Medical Inc. | Systems and methods for intravascular catheter positioning and/or nerve stimulation |
US10195429B1 (en) | 2017-08-02 | 2019-02-05 | Lungpacer Medical Inc. | Systems and methods for intravascular catheter positioning and/or nerve stimulation |
US10039920B1 (en) | 2017-08-02 | 2018-08-07 | Lungpacer Medical, Inc. | Systems and methods for intravascular catheter positioning and/or nerve stimulation |
US11090489B2 (en) | 2017-08-02 | 2021-08-17 | Lungpacer Medical, Inc. | Systems and methods for intravascular catheter positioning and/or nerve stimulation |
US11944810B2 (en) | 2017-08-04 | 2024-04-02 | Lungpacer Medical Inc. | Systems and methods for trans-esophageal sympathetic ganglion recruitment |
US10940308B2 (en) | 2017-08-04 | 2021-03-09 | Lungpacer Medical Inc. | Systems and methods for trans-esophageal sympathetic ganglion recruitment |
US11298540B2 (en) | 2017-08-11 | 2022-04-12 | Inspire Medical Systems, Inc. | Cuff electrode |
US20190350475A1 (en) * | 2018-05-21 | 2019-11-21 | Vine Medical LLC | Multi-tip probe for obtaining bioelectrical measurements |
US11109787B2 (en) * | 2018-05-21 | 2021-09-07 | Vine Medical LLC | Multi-tip probe for obtaining bioelectrical measurements |
US10987511B2 (en) | 2018-11-08 | 2021-04-27 | Lungpacer Medical Inc. | Stimulation systems and related user interfaces |
US11717673B2 (en) | 2018-11-08 | 2023-08-08 | Lungpacer Medical Inc. | Stimulation systems and related user interfaces |
US11890462B2 (en) | 2018-11-08 | 2024-02-06 | Lungpacer Medical Inc. | Stimulation systems and related user interfaces |
US11471683B2 (en) | 2019-01-29 | 2022-10-18 | Synapse Biomedical, Inc. | Systems and methods for treating sleep apnea using neuromodulation |
US11357979B2 (en) | 2019-05-16 | 2022-06-14 | Lungpacer Medical Inc. | Systems and methods for sensing and stimulation |
US11771900B2 (en) | 2019-06-12 | 2023-10-03 | Lungpacer Medical Inc. | Circuitry for medical stimulation systems |
US11266838B1 (en) | 2019-06-21 | 2022-03-08 | Rmx, Llc | Airway diagnostics utilizing phrenic nerve stimulation device and method |
US11458312B2 (en) | 2019-09-26 | 2022-10-04 | Viscardia, Inc. | Implantable medical systems, devices, and methods for affecting cardiac function through diaphragm stimulation, and for monitoring diaphragmatic health |
US11911616B2 (en) | 2019-09-26 | 2024-02-27 | Viscardia, Inc. | Implantable medical systems, devices, and methods for affecting cardiac function through diaphragm stimulation, and for monitoring diaphragmatic health |
US11925803B2 (en) | 2019-09-26 | 2024-03-12 | Viscardia, Inc. | Implantable medical systems, devices, and methods for affecting cardiac function through diaphragm stimulation, and for monitoring diaphragmatic health |
US11524158B2 (en) | 2019-09-26 | 2022-12-13 | Viscardia, Inc. | Implantable medical systems, devices, and methods for affecting cardiac function through diaphragm stimulation, and for monitoring diaphragmatic health |
US11957914B2 (en) | 2020-03-27 | 2024-04-16 | Viscardia, Inc. | Implantable medical systems, devices and methods for delivering asymptomatic diaphragmatic stimulation |
US11672934B2 (en) | 2020-05-12 | 2023-06-13 | Covidien Lp | Remote ventilator adjustment |
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