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

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 v...

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Autores principales: van Drunen, Erwin J, Chiew, Yeong Shiong, Pretty, Christopher, Shaw, Geoffrey M, Lambermont, Bernard, Janssen, Nathalie, Chase, J Geoffrey, Desaive, Thomas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4016000/
https://www.ncbi.nlm.nih.gov/pubmed/24581274
http://dx.doi.org/10.1186/1471-2466-14-33
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author van Drunen, Erwin J
Chiew, Yeong Shiong
Pretty, Christopher
Shaw, Geoffrey M
Lambermont, Bernard
Janssen, Nathalie
Chase, J Geoffrey
Desaive, Thomas
author_facet van Drunen, Erwin J
Chiew, Yeong Shiong
Pretty, Christopher
Shaw, Geoffrey M
Lambermont, Bernard
Janssen, Nathalie
Chase, J Geoffrey
Desaive, Thomas
author_sort van Drunen, Erwin J
collection PubMed
description 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.
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spelling pubmed-40160002014-05-23 Visualisation of time-varying respiratory system elastance in experimental ARDS animal models van Drunen, Erwin J Chiew, Yeong Shiong Pretty, Christopher Shaw, Geoffrey M Lambermont, Bernard Janssen, Nathalie Chase, J Geoffrey Desaive, Thomas BMC Pulm Med Technical Advance 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. BioMed Central 2014-03-02 /pmc/articles/PMC4016000/ /pubmed/24581274 http://dx.doi.org/10.1186/1471-2466-14-33 Text en Copyright © 2014 van Drunen et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.
spellingShingle Technical Advance
van Drunen, Erwin J
Chiew, Yeong Shiong
Pretty, Christopher
Shaw, Geoffrey M
Lambermont, Bernard
Janssen, Nathalie
Chase, J Geoffrey
Desaive, Thomas
Visualisation of time-varying respiratory system elastance in experimental ARDS animal models
title Visualisation of time-varying respiratory system elastance in experimental ARDS animal models
title_full Visualisation of time-varying respiratory system elastance in experimental ARDS animal models
title_fullStr Visualisation of time-varying respiratory system elastance in experimental ARDS animal models
title_full_unstemmed Visualisation of time-varying respiratory system elastance in experimental ARDS animal models
title_short Visualisation of time-varying respiratory system elastance in experimental ARDS animal models
title_sort visualisation of time-varying respiratory system elastance in experimental ards animal models
topic Technical Advance
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4016000/
https://www.ncbi.nlm.nih.gov/pubmed/24581274
http://dx.doi.org/10.1186/1471-2466-14-33
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