# US 10,499,835 B2 · Methods and systems for determining fluid responsiveness in the presence of noise > Agents: this data is available as JSON from the patentgrep API and MCP server — see https://patentgrep.com/llms.txt - Number: US 10,499,835 B2 - Document ID: US10499835B2 - Status: Granted - Kind: B2 - Application number: 15/064,500 - Filed: 2016-03-08 - Published: 2016-09-29 - Granted: 2019-12-10 - Earliest claimed: 2015-03-24 - Assignees: Covidien LP - Applicants: Covidien LP - Inventors: Paul S. Addison; Scott McGonigle; James N. Watson - Web page: https://patentgrep.com/patent/US10499835B2 ## CPC - A61B 5/14551: {for measuring blood gases} - A61B 5/02416: {using photoplethysmograph signals, e.g. generated by infrared radiation (A61B5/14552 takes precedence)} - A61B 5/7207: {of noise induced by motion artifacts} - A61B 5/7275: {Determining trends in physiological measurement data; Predicting development of a medical condition based on physiological measurements, e.g. determining a risk factor} - G16H 20/40: relating to mechanical, radiation or invasive therapies, e.g. surgery, laser therapy, dialysis or acupuncture - G16H 50/30: for calculating health indices; for individual health risk assessment - A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D) - G16H: HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA ## Abstract Methods and systems are provided for determining fluid responsiveness in the presence of noise. The system may determine an instantaneous value indicative of fluid responsiveness. In some embodiments, the system may determine a difference between an instantaneous value indicative of fluid responsiveness and a previous value indicative of fluid responsiveness, and select an update characteristic based on whether the difference indicates that the fluid responsiveness is increasing or decreasing. In some embodiments, the system may determine a parameter indicative of fluid responsiveness based on the update characteristic and a previously reported value indicative of fluid responsiveness. ## Claims ### Claim 1 A physiological monitoring system comprising: a sensor configured to: detect light absorbed through tissue of a subject, and generate a physiological signal based on the detected light; and a processor coupled to the sensor configured to: receive the physiological signal, determine an instantaneous value indicative of fluid responsiveness of the subject based on the physiological signal, determine a difference between the instantaneous value indicative of fluid responsiveness and a previous value indicative of fluid responsiveness of the subject, select an update characteristic based on the difference, wherein a first update characteristic is selected based on the difference being indicative of increasing fluid responsiveness of the subject and a second update characteristic is selected based on the difference being indicative of decreasing fluid responsiveness of the subject, wherein the first update characteristic is different than the second update characteristic, and determine a parameter indicative of fluid responsiveness of the subject based on the selected update characteristic and a previously reported value indicative of fluid responsiveness. ### Claim 2 (depends on 1) The physiological monitoring system of claim 1, wherein determining the instantaneous value indicative of fluid responsiveness comprises determining a maximum amplitude and a minimum amplitude of the physiological signal during a period. ### Claim 3 (depends on 1) The physiological monitoring system of claim 1, wherein the first update characteristic is smaller than the second update characteristic. ### Claim 4 (depends on 1) The physiological monitoring system of claim 1, wherein the processor is further configured to select the update characteristic based on an amount of difference between the instantaneous value indicative of fluid responsiveness and the previous value indicative of fluid responsiveness. ### Claim 5 (depends on 1) The physiological monitoring system of claim 1, wherein the update characteristic comprises a filter weight applied to the instantaneous value indicative of fluid responsiveness. ### Claim 6 (depends on 5) The physiological monitoring system of claim 5, wherein the filter weight is selected as one of a set of constant weights based on whether the difference is positive or negative. ### Claim 7 (depends on 6) The physiological monitoring system of claim 6, wherein the selected constant weight is smaller when the difference indicates the fluid responsiveness of the subject is increasing. ### Claim 8 (depends on 5) The physiological monitoring system of claim 5, wherein the filter weight is selected by evaluating a function based on the difference between the instantaneous value indicative of fluid responsiveness and the previous value indicative of fluid responsiveness. ### Claim 9 (depends on 1) The physiological monitoring system of claim 1, wherein the update characteristic comprises an amount of change added to the previously reported value indicative of fluid responsiveness. ### Claim 10 (depends on 9) The physiological monitoring system of claim 9, wherein the difference comprises an amount of difference and wherein the amount of change is selected by selecting one of a set of constant amounts of change based on the amount of difference. ### Claim 11 (depends on 10) The physiological monitoring system of claim 10, wherein the selected constant amount is smaller when the difference indicates the fluid responsiveness of the subject is increasing. ### Claim 12 (depends on 9) The physiological monitoring system of claim 9, wherein the difference comprises an amount of difference, and wherein the amount of change is selected by selecting one of a set of amount of change functions based on a comparison between the amount of difference and a threshold value indicative of noise. ### Claim 13 (depends on 12) The physiological monitoring system of claim 12, wherein: the amount of change function selected when the amount of difference is greater than the threshold comprises: determining an amount of excess over the threshold by subtracting the threshold from the amount of difference, and multiplying the amount of excess by a constant value less than 1; and the amount of change function selected when the amount of difference is less than or equal to the threshold consists of the amount of difference. ### Claim 14 (depends on 1) The physiological monitoring system of claim 1, wherein the update characteristic comprises a reduction factor applied to an amount of change. ### Claim 15 (depends on 14) The physiological monitoring system of claim 14, wherein the difference comprises an amount of difference, and wherein the reduction factor is selected by selecting one of a set of constant reduction factors based on a comparison between the amount of difference and a threshold. ### Claim 16 (depends on 15) The physiological monitoring system of claim 15, wherein the selected constant reduction factor is smaller when the amount of difference is greater than the threshold. ### Claim 17 (depends on 1) The physiological monitoring system of claim 1, wherein the previous value indicative of fluid responsiveness is at least one of a previous instantaneous value indicative of fluid responsiveness, an average of a plurality of previous instantaneous values indicative of fluid responsiveness, and the previously reported value indicative of fluid responsiveness. ### Claim 18 A method of determining fluid responsiveness of a subject, the method comprising: receiving a physiological signal indicative of light attenuated by the subject; determining, using a processor, an instantaneous value indicative of fluid responsiveness of the subject based on the physiological signal; determining, using the processor, a difference between the instantaneous value indicative of fluid responsiveness and a previous value indicative of fluid responsiveness of the subject; selecting, using the processor, an update characteristic based on whether the difference indicates the fluid responsiveness of the subject is increasing or decreasing, wherein a first update characteristic is selected based on the difference being indicative of increasing fluid responsiveness and a second update characteristic is selected based on the difference being indicative of decreasing fluid responsiveness, and wherein the first update characteristic is different than the second update characteristic; and determining, using the processor, a parameter indicative of fluid responsiveness of the subject based on the selected update characteristic and a previously reported value indicative of fluid responsiveness. ### Claim 19 (depends on 18) The method of claim 18, wherein the update characteristic comprises a filter weight applied to the instantaneous value indicative of fluid responsiveness. ### Claim 20 (depends on 18) The physiological monitoring system of claim 18, wherein the update characteristic comprises an amount of change added to the previously reported value indicative of fluid responsiveness. ### Claim 21 A physiological monitoring system comprising: an input configured to receive a physiological signal, wherein the physiological signal is indicative of light absorbed by a subject; a fluid responsiveness calculator coupled to the input configured to determine an instantaneous value indicative of fluid responsiveness of the subject based on the physiological signal; and a fluid responsiveness differential calculator coupled to the fluid responsiveness calculator configured to determine a difference between the instantaneous value indicative of fluid responsiveness and a previous value indicative of fluid responsiveness of the subject; wherein the fluid responsiveness calculator is further configured to: select a filter weight for the instantaneous value indicative of fluid responsiveness based on whether the difference indicates the fluid responsiveness of the subject is increasing or decreasing, wherein the selected filter weight is a first filter weight that is smaller when the difference indicates the fluid responsiveness of the subject is increasing than a second filter weight when the difference indicates that the fluid responsiveness of the subject is decreasing, and determine a parameter indicative of fluid responsiveness of the subject based on the selected filter weight, the instantaneous value indicative of fluid responsiveness, and one or more previous values indicative of fluid responsiveness.