Visualisation of time-varying respiratory system elastance in experimental ARDS animal models

BMC Pulmonary Medicine

Thomas Desaive³  J Geoffrey Chase⁴  Nathalie Janssen²  Bernard Lambermont²  Geoffrey M Shaw¹  Christopher Pretty⁴  Yeong Shiong Chiew⁴  Erwin J van Drunen⁴ 

[1] Christchurch Hospital, Christchurch 8011, New Zealand;University Hospital of Liège, Liège, Belgium;University of Liège, Liège, Belgium;University of Canterbury, Christchurch 8041, New Zealand

关键词: Monitoring;    ARDS;    Model-based methods;    Time-varying elastance;    PEEP;    Mechanical ventilation;   

Others  :  866514
DOI  :  10.1186/1471-2466-14-33

 received in 2013-07-04, accepted in 2014-02-19,  发布年份 2014

【 摘 要 】

Background

Patients with acute respiratory distress syndrome (ARDS) risk lung collapse, severely altering the breath-to-breath respiratory mechanics. Model-based estimation of respiratory mechanics characterising patient-specific condition and response to treatment may be used to guide mechanical ventilation (MV). This study presents a model-based approach to monitor time-varying patient-ventilator interaction to guide positive end expiratory pressure (PEEP) selection.

Methods

The single compartment lung model was extended to monitor dynamic time-varying respiratory system elastance, E_drs, within each breathing cycle. Two separate animal models were considered, each consisting of three fully sedated pure pietrain piglets (oleic acid ARDS and lavage ARDS). A staircase recruitment manoeuvre was performed on all six subjects after ARDS was induced. The E_drs was mapped across each breathing cycle for each subject.

Results

Six time-varying, breath-specific E_drs maps were generated, one for each subject. Each E_drs map shows the subject-specific response to mechanical ventilation (MV), indicating the need for a model-based approach to guide MV. This method of visualisation provides high resolution insight into the time-varying respiratory mechanics to aid clinical decision making. Using the E_drs maps, minimal time-varying elastance was identified, which can be used to select optimal PEEP.

Conclusions

Real-time continuous monitoring of in-breath mechanics provides further insight into lung physiology. Therefore, there is potential for this new monitoring method to aid clinicians in guiding MV treatment. These are the first such maps generated and they thus show unique results in high resolution. The model is limited to a constant respiratory resistance throughout inspiration which may not be valid in some cases. However, trends match clinical expectation and the results highlight both the subject-specificity of the model, as well as significant inter-subject variability.

【 授权许可】

   
2014 van Drunen et al.; licensee BioMed Central Ltd.

【 图 表 】

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