Model-based PEEP optimisation in mechanical ventilation

ALI; ARDS; Compliance; Critical care; Elastance; Mechanical ventilation; PEEP; Biological organs; Heart valve prostheses; Optimization; Patient monitoring; Ventilation; Patient treatment

Abstract :

[en] Background: Acute Respiratory Distress Syndrome (ARDS) patients require mechanical ventilation (MV) for breathing support. Patient-specific PEEP is encouraged for treating different patients but there is no well established method in optimal PEEP selection.Methods: A study of 10 patients diagnosed with ALI/ARDS whom underwent recruitment manoeuvre is carried out. Airway pressure and flow data are used to identify patient-specific constant lung elastance (E lung) and time-variant dynamic lung elastance (E drs) at each PEEP level (increments of 5cmH 2O), for a single compartment linear lung model using integral-based methods. Optimal PEEP is estimated using E lungversus PEEP, E drs-Pressure curve and E drsArea at minimum elastance (maximum compliance) and the inflection of the curves (diminishing return). Results are compared to clinically selected PEEP values. The trials and use of the data were approved by the New Zealand South Island Regional Ethics Committee.Results: Median absolute percentage fitting error to the data when estimating time-variant E drsis 0.9% (IQR = 0.5-2.4) and 5.6% [IQR: 1.8-11.3] when estimating constant E lung. Both E lungand E drsdecrease with PEEP to a minimum, before rising, and indicating potential over-inflation. Median E drsover all patients across all PEEP values was 32.2 cmH 2O/l [IQR: 26.1-46.6], reflecting the heterogeneity of ALI/ARDS patients, and their response to PEEP, that complicates standard approaches to PEEP selection. All E drs-Pressure curves have a clear inflection point before minimum E drs, making PEEP selection straightforward. Model-based selected PEEP using the proposed metrics were higher than clinically selected values in 7/10 cases.Conclusion: Continuous monitoring of the patient-specific E lungand E drsand minimally invasive PEEP titration provide a unique, patient-specific and physiologically relevant metric to optimize PEEP selection with minimal disruption of MV therapy. © 2011 Chiew et al; licensee BioMed Central Ltd.

Disciplines :

Anesthesia & intensive care

Author, co-author :

Chiew, Y. S.; Department of Mechanical Engineering, University of Canterbury, New Zealand

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

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

Sundaresan, A.; Department of Mechanical Engineering, University of Canterbury, New Zealand

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

Language :

English

Title :

Model-based PEEP optimisation in mechanical ventilation

Publication date :

2011

Journal title :

BioMedical Engineering OnLine

eISSN :

1475-925X

Publisher :

BioMed Central, United Kingdom

Volume :

Pages :

111

Peer reviewed :

Peer Reviewed verified by ORBi

Available on ORBi :

since 26 September 2012

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