Estimation of Inspiratory Respiratory Elastance Using Expiratory Data

Lungs; Mathematical models; Mechanical ventilation; Parameter identification; Respiratory elastance; Biological organs; Estimation; Identification (control systems); Respiratory mechanics; Ventilation; Conventional methods; Elastance; Linear relationships; Models of Respiratory Mechanics; Muscle activities; Spontaneous breathing; Patient treatment

Abstract :

[en] Models of respiratory mechanics can be used to titrate patient-specific mechanical ventilation (MV) settings in critical care, but often perform poorly in the presence of patient breathing effort. Respiratory mechanics are conventionally calculated using only inspiratory data. Muscle activity is normally assumed relatively minimal or absent during passive expiration regardless of the presence of inspiratory spontaneous breathing (SB) efforts. Hence, this study assesses whether expiratory lung elastance can be used to estimate inspiratory lung elastance for spontaneously breathing, reverse triggered patients. Clinical data from recruitment manoeuvres in fully sedated patients were used to determine a relationship between inspiratory and expiratory modeled lung elastance. The validity of this relationship was assessed using data recorded pre- and post- sedation from different patients. A strong, linear relationship was found between inspiratory and expiratory elastance in fully sedated patients, with gradient 1.04 [95% CI: 1.03-1.07] and intercept 1.66 [1.06-2.08] with R2 = 0.94. After adjustment according to the linear relationship, expiratory elastance produced stable estimations post sedation, with similar median and variance as inspiratory elastance. However, variation in estimates pre-sedation, although significantly improved, may be larger than clinically acceptable in some cases. The results of this study show that the typically ignored expiratory data may be able to provide insight into patient condition when conventional methods fail. Clinically, these methods could have an impact in guiding MV therapy by providing clinicians with information about lung mechanics under the effect of patient SB effort. © 2018

Disciplines :

Anesthesia & intensive care

Author, co-author :

Howe, S. L.; Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand

Chase, J. G.; Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand

Redmond, D. P.; Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand

Morton, S. E.; Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand

Kim, K. T.; Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand

Pretty, C.; Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand

Shaw, G. M.; Department of Intensive Care, Christchurch Hospital, Christchurch, New Zealand

Tawhai, M. H.; Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand

Desaive, Thomas ; Université de Liège - ULiège > Département d'astrophys., géophysique et océanographie (AGO) > Thermodynamique des phénomènes irréversibles

Language :

English

Title :

Estimation of Inspiratory Respiratory Elastance Using Expiratory Data

Publication date :

2018

Event name :

BMS 2018

Event date :

3-5 septembre 2018

Audience :

International

Journal title :

IFAC-PapersOnLine

ISSN :

2405-8971

eISSN :

2405-8963

Publisher :

Elsevier B.V.

Volume :

Issue :

Pages :

204-208

Peer reviewed :

Peer Reviewed verified by ORBi

Available on ORBi :

since 08 June 2020

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