Model-based PEEP optimisation in mechanical ventilation

BioMedical Engineering OnLine

Yeong Shiong Chiew³  J Geoffrey Chase³  Geoffrey M Shaw¹  Ashwath Sundaresan³  Thomas Desaive² 

[1] Department of Intensive Care, Christchurch Hospital, New Zealand

[2] Thermodynamics of Irreversible Processes, Institute of Physics, University of Liège, Belgium

[3] Department of Mechanical Engineering, University of Canterbury, New Zealand

关键词: Mechanical Ventilation;    Critical care;    PEEP;    Compliance;    Elastance;    ALI;    ARDS;   

Others  :  798137
DOI  :  10.1186/1475-925X-10-111

 received in 2011-11-07, accepted in 2011-12-23,  发布年份 2011

【 摘 要 】

Background

Acute Respiratory Distress Syndrome (ARDS) patients require mechanical ventilation (MV) for breathing support. Patient-specific PEEP is encouraged for treating different patients but there is no well established method in optimal PEEP selection.

Methods

A study of 10 patients diagnosed with ALI/ARDS whom underwent recruitment manoeuvre is carried out. Airway pressure and flow data are used to identify patient-specific constant lung elastance (E_lung) and time-variant dynamic lung elastance (E_drs) at each PEEP level (increments of 5cmH₂O), for a single compartment linear lung model using integral-based methods. Optimal PEEP is estimated using E_lung versus PEEP, E_drs-Pressure curve and E_drs Area at minimum elastance (maximum compliance) and the inflection of the curves (diminishing return). Results are compared to clinically selected PEEP values. The trials and use of the data were approved by the New Zealand South Island Regional Ethics Committee.

Results

Median absolute percentage fitting error to the data when estimating time-variant E_drs is 0.9% (IQR = 0.5-2.4) and 5.6% [IQR: 1.8-11.3] when estimating constant E_lung. Both E_lung and E_drs decrease with PEEP to a minimum, before rising, and indicating potential over-inflation. Median E_drs over all patients across all PEEP values was 32.2 cmH₂O/l [IQR: 26.1-46.6], reflecting the heterogeneity of ALI/ARDS patients, and their response to PEEP, that complicates standard approaches to PEEP selection. All E_drs-Pressure curves have a clear inflection point before minimum E_drs, making PEEP selection straightforward. Model-based selected PEEP using the proposed metrics were higher than clinically selected values in 7/10 cases.

Conclusion

Continuous monitoring of the patient-specific E_lung and E_drs and minimally invasive PEEP titration provide a unique, patient-specific and physiologically relevant metric to optimize PEEP selection with minimal disruption of MV therapy.

【 授权许可】

   
2011 Chiew et al; licensee BioMed Central Ltd.

【 图 表 】

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