Critical Care; Dynamic Elastance; Mechanical Ventilation; Optimal PEEP; Over-distension; Pressure-Volume Curve; Ventilator-induced Lung; Critical care; Dynamic elastance; Elastance; Mechanical ventilation; Optimal positive-end-expiratory-pressure; Positive end expiratory pressures; Pressure level; Pressure-volume curves; Ventilator-induced lung; Control and Systems Engineering
Abstract :
[en] Acute respiratory distress syndrome (ARDS) patients usually require support from ventilation in the intensive care unit (ICU). Recruitment maneuvers (RMs) with positive-end-expiratory-pressure (PEEP) are a common way to recruit alveoli and improve oxygenation. However, excessive PEEP can worsen alveoli status and thus increase the risk of ventilator-induced lung injury (VILI). To date, standards for optimal patient-specific PEEP determination remain unclear, resulting in variability and uncertainty in care and thus requiring personalized care approaches. This research examines the conventional approach, dynamic elastance (Edyn), and a validated over-distension index (OD) from prior work identified from pressure-volume curves. Overall, in the studied pilot trial, the optimal PEEP selection outcome matches between Edyn and OD methods within 0-2cmH2O (0-1 PEEP levels) variation for 16 out of 18 patients. The variation in the rest 2 patients are 4cmH2O (2 PEEP levels). While possible limitation for Edyn is addressed and discussed, the over-distention index OD shows greater potential in routine care being more intuitive, general, and predictive.
Disciplines :
Mechanical engineering Cardiovascular & respiratory systems
Author, co-author :
Sun, Qianhui ; Université de Liège - ULiège > Département d'astrophysique, géophysique et océanographie (AGO) > Thermodynamique des phénomènes irréversibles ; Department of Mechanical Engineering, Dept of Mechanical Eng, Centre for Bio-Engineering, University of Canterbury, Christchurch, New Zealand
Chase, J Geoffrey ; Université de Liège - ULiège > Département d'astrophysique, géophysique et océanographie (AGO) > Thermodynamique des phénomènes irréversibles ; Department of Mechanical Engineering, Dept of Mechanical Eng, Centre for Bio-Engineering, University of Canterbury, Christchurch, New Zealand
Zhou, Cong; Department of Mechanical Engineering, Dept of Mechanical Eng, Centre for Bio-Engineering, University of Canterbury, Christchurch, New Zealand
Tawhai, Merryn H.; Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
Knopp, Jennifer L.; Department of Mechanical Engineering, Dept of Mechanical Eng, Centre for Bio-Engineering, University of Canterbury, Christchurch, New Zealand
Möller, Knut; Institute for Technical Medicine, Furtwangen University, Villingen-Schwenningen, Germany
Shaw, Geoffrey M.; Department of Intensive Care, Christchurch Hospital, Christchurch, New Zealand
Desaive, Thomas ; Université de Liège - ULiège > Département d'astrophysique, géophysique et océanographie (AGO) > Thermodynamique des phénomènes irréversibles
Language :
English
Title :
PEEP Selection: Dynamic Elastance versus An Over-distension Measurement
Publication date :
19 November 2024
Event name :
12th IFAC Symposium on Biological and Medical Systems BMS 2024
This work was supported the NZ Tertiary Education Commission (TEC) fund MedTech CoRE (Centre of Research Excellence; #3705718), the NZ National Science Challenge 7, Science for Technology and Innovation (2019-S3-CRS), and the Service Public Federal Strategie et Appui (BOSA) - DIGITWIN4PH.This work was supported the NZ Tertiary Education Commission (TEC) fund MedTech CoRE (Centre of Research Excellence; #3705718), the NZ National Science Challenge 7, Science for Technology and Innovation (2019-S3-CRS), and the Service Public F\u00E9d\u00E9ral Strat\u00E9g ie et Appui (OSA)B \u2013 DIGITWIN4PH.
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