A physiology-based mathematical model for the selection of appropriate ventilator controls for lung and diaphragm protection
- 1 February 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in Journal of Clinical Monitoring and Computing
- Vol. 35 (2), 363-378
- https://doi.org/10.1007/s10877-020-00479-x
Abstract
Mechanical ventilation is used to sustain respiratory function in patients with acute respiratory failure. To aid clinicians in consistently selecting lung- and diaphragm-protective ventilation settings, a physiology-based decision support system is needed. To form the foundation of such a system, a comprehensive physiological model which captures the dynamics of ventilation has been developed. The Lung and Diaphragm Protective Ventilation (LDPV) model centers around respiratory drive and incorporates respiratory system mechanics, ventilator mechanics, and blood acid–base balance. The model uses patient-specific parameters as inputs and outputs predictions of a patient’s transpulmonary and esophageal driving pressures (outputs most clinically relevant to lung and diaphragm safety), as well as their blood pH, under various ventilator and sedation conditions. Model simulations and global optimization techniques were used to evaluate and characterize the model. The LDPV model is demonstrated to describe a CO2 respiratory response that is comparable to what is found in literature. Sensitivity analysis of the model indicate that the ventilator and sedation settings incorporated in the model have a significant impact on the target output parameters. Finally, the model is seen to be able to provide robust predictions of esophageal pressure, transpulmonary pressure and blood pH for patient parameters with realistic variability. The LDPV model is a robust physiological model which produces outputs which directly target and reflect the risk of ventilator-induced lung and diaphragm injury. Ventilation and sedation parameters are seen to modulate the model outputs in accordance with what is currently known in literature.Keywords
Funding Information
- Canadian Institutes of Health Research
- University of Toronto, Faculty of Applied Science and Engineering
This publication has 53 references indexed in Scilit:
- Stewart's Physicochemical Approach in Neurosurgical Patients With Hyperchloremic Metabolic Acidosis During Propofol AnesthesiaJournal of Neurosurgical Anesthesiology, 2008
- An effective screening design for sensitivity analysis of large modelsEnvironmental Modelling & Software, 2007
- Incidence of Propofol Infusion Syndrome during Noninvasive Radiofrequency Ablation for Atrial Flutter or FibrillationAnesthesiology, 2007
- Stewart and beyond: New models of acid-base balanceKidney International, 2003
- Effect of Different Levels of Pressure Support and Proportional Assist Ventilation on Breathing Pattern, Work of Breathing and Gas Exchange in Mechanically Ventilated Hypercapnic COPD Patients with Acute Respiratory FailureRespiration, 2003
- Proportional assist ventilation (PAV): a significant advance or a futile struggle between logic and practice?Thorax, 2002
- Respiratory Sites of Action of PropofolAnesthesiology, 2001
- Propofol Depresses the Hypoxic Ventilatory Response during Conscious Sedation and IsohypercapniaAnesthesiology, 1993
- Determination of Intravascular Migration of an Epidural Catheter Using the Air TechniqueAnesthesiology, 1993
- Factorial Sampling Plans for Preliminary Computational ExperimentsTechnometrics, 1991