Model-based advice for mechanical ventilation: From research (INVENT) to product (Beacon Caresystem)

Abstract

This paper describes the structure and functionality of a physiological model-based system for providing advice on the settings of mechanical ventilation. Use of the system is presented with examples of patients on support and control modes of mechanical ventilation.

Prediction of lung mechanics throughout recruitment maneuvers in pressure-controlled ventilation

“…Measured pressure-flow data was truncated to 60 data points per breath, to ensure equal weighting of inspiration and expiration (30 points each). In the data studied, the median [IQR] of the end of inspiration occurred at 27 [23][24][25][26][27][28][29][30] points, so this cut-off split the data into approximately equal sections of inspiration and expiration data. Truncation of data to 30 points also served to capture the beginning of expiration mechanics while avoiding the endexpiratory pause plateau of near-zero flow, typically occurring at the end of expiration, which creates identifiability issues and does not provide significant added information on dynamic behaviours.…”

“…Personalizing MV accounting for inter-and intra-patient variability using computational modelling has been described in simulations [24] , retrospective comparison studies [25] or prospective feasibility/pilot studies aiming to provide recommendations [15,26,27] . One group has recently commercialized a model-based decision support system, which does not use prediction of outcomes, but their published data is limited to small, feasibility studies [28,29] . To our knowledge, no large, outcome-focused trial assessing the clinical utility and efficacy of model-based MV has been published, with or without prediction of outcomes by the model.…”

A Pilot Bench Study of Decision Support for Proportional Assist Ventilation

“…The Beacon Caresystem (Mermaid Care A/S, Nørresundby, Denmark) is a model-based decision support system (DSS) for mechanical ventilation which applies models of physiology and clinical preferences regarding goals of mechanical ventilation [3,4]. The system has been shown to provide appropriate advice in patients on controlled mechanical ventilation and pressure support ventilation [5,6].…”

Determining the appropriate model complexity for patient-specific advice on mechanical ventilation

“…This paper describes the mathematical models included in the decision support system for mechanical ventilation, known in its research version as the INVENT system [36,43] and in its commercial version as Beacon Caresystem [38] (Mermaid Care, Nørresundby, Denmark). In describing these models, the paper focuses on parameter identification rather than a description of the system as a whole.…”