Abstract
The selection of optimal positive end-expiratory pressure (PEEP) levels during ventilation therapy of patients with ARDS (acute respiratory distress syndrome) remains a problem for clinicians. A particular mooted strategy states that minimizing the energy transferred to the lung during mechanical ventilation could potentially be used to determine the optimal, patient-specific PEEP levels. The dynamic elastance model of pulmonary mechanics could potentially be used to minimize the energy by localization of the patients’ minimum dynamic elastance range.
The sensitivity of the dynamic elastance model to variance in the airway resistance was analyzed. Subsequently, the airway resistance was determined using two alternate identification methods and was compared to the constant resistance obtained using the dynamic elastance model.
Both identification methods showed similar decreasing trends of the resistance during inspiration. This declining trend is an apparent exponential decrease. Results showed that the constant airway resistance, presumed by the dynamic elastance model, has to be rechecked and investigated.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
M. B. P. Amato, C. S. V. Barbas, D. M. Medeiros et al. (1998) Effect of a Protective-Ventilation Strategy on Mortality in the Acute Respiratory Distress Syndrome. N Engl J Med 338:347-54
J. Silversides and N. Ferguson (2013) Clinical review: Acute respiratory distress syndrome - clinical ventilator management and adjunct therapy. Critical Care 17:225
M. Donahoe (2011) Acute respiratory distress syndrome: A clinical review. Pulmonary Circulation 1:192-211
J. M. Halter, J. M. Steinberg, H. J. Schiller et al. (2003) Positive End-Expiratory Pressure after a Recruitment Maneuver Prevents Both Alveolar Collapse and Recruitment/Derecruitment. Am J Respir Crit Care Med 167:1620-6
Acute-Respiratory-Distress-Syndrome-Network (2000) Ventilation with Lower Tidal Volumes as Compared with Traditional Tidal Volumes for Acute Lung Injury and the Acute Respiratory Distress Syndrome. New England Journal of Medicine 342:1301-8
C. Cobelli (2008) Introduction to modeling in physiology and medicine. Academic Press, Amsterdam; Boston
J. H. T. Bates (2009) Lung Mechanics: An Inverse Modeling Approach. Cambridge University Press, United States of America, New York
Y. S. Chiew, J. G. Chase, G. Shaw et al. (2011) Model-based PEEP Optimisation in Mechanical Ventilation. BioMedical Engineering OnLine 10:111
E. van Drunen, Y. S. Chiew, C. Pretty et al. (2014) Visualisation of time-varying respiratory system elastance in experimental ARDS animal models. BMC Pulmonary Medicine 14:33
P. Suter, B. Fairley, and M. Isenberg (1975) Optimum End-Expiratory Airway Pressure in Patients with Acute Pulmonary Failure. N Engl J Med 292:284-9
Y. Chiew, C. Pretty, G. Shaw et al. (2015) Feasibility of titrating PEEP to minimum elastance for mechanically ventilated patients. Pilot and Feasibility Studies 1:1-10
B. Laufer, P. D. Docherty, Y. S. Chiew et al. (2015) Identifying pressure dependent elastance in lung mechanics with reduced influence of unmodelled effects, BMS 2015, Berlin, Germany, 2015
A. Knörzer, P. D. Docherty, Y. S. Chiew et al. (2014) Adjustments to the first order model of pulmonary mechanics to capture equivalent elastance at different pressure and PEEP levels, The 19th World Congress of the International Federation of Automatic Control, Cape Town, South Africa, 2014
K. Zilles and B. Tillmann (2010) Anatomie. Springer,
M. L. Mogensen, K. S. Steimle, D. S. Karbing et al. (2011) A model of perfusion of the healthy human lung. Computer Methods and Programs in Biomedicine 101:156-65
D. A. Kaminsky (2012) What Does Airway Resistance Tell Us About Lung Function? Respiratory Care 57:85-99
R. Kramme. (2011). Medizintechnik: Verfahren – Systeme – Informationsverarbeitung (4., vollständig überarbeitete und erweiterte Auflage ed.).
A. B. DuBois, S. Y. Botelho, and J. H. Comroe (1956) A new method for measuring airway resistance in man using a body plethysmograph: values in normal subjects and patients with respiratory disease. The Journal of Clinical Investigation 35:327-35
S. Blonshine and M. D. Goldman (2008) OPtimizing performance of respiratory airflow resistance measurements. Chest 134:1304-9
C. A. Stahl, K. Moller, S. Schumann et al. (2006) Dynamic versus static respiratory mechanics in acute lung injury and acute respiratory distress syndrome. Crit Care Med 34:2090 - 8
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer International Publishing Switzerland
About this paper
Cite this paper
Laufer, B., Kretschmer, J., Docherty, P.D., Chiew, Y.S., Möller, K. (2016). The Influence of Airway Resistance in the Dynamic Elastance Model. In: Kyriacou, E., Christofides, S., Pattichis, C. (eds) XIV Mediterranean Conference on Medical and Biological Engineering and Computing 2016. IFMBE Proceedings, vol 57. Springer, Cham. https://doi.org/10.1007/978-3-319-32703-7_12
Download citation
DOI: https://doi.org/10.1007/978-3-319-32703-7_12
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-32701-3
Online ISBN: 978-3-319-32703-7
eBook Packages: EngineeringEngineering (R0)