Quantifying neonatal pulmonary mechanics in mechanical ventilation

Kim, Kyeong Tae; Knopp, Jennifer L.; Dixon, Bronwyn; Chase, J. Geoffrey

doi:10.1016/j.bspc.2019.04.015

Cited by 24 publications

(7 citation statements)

References 45 publications

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“…To mitigate small fluctuations in data, breath filtering criteria are included to ensure an individual breath is a full breath. The criteria are based on the work of Kim et al , 35 modified to suit the adult cohort in this research, and defined for each breath: Start of inspiration is defined as the first overall increase in flow (flow rate > 0.1 L/s) and pressure (Pressure > (PEEP + 2 cmH 2 O)). Data is checked over the next 8 data points (0.16 s) to ensure constant positive flow.…”

Section: Methodsmentioning

confidence: 99%

Stochastic Modelling of Respiratory System Elastance for Mechanically Ventilated Respiratory Failure Patients

et al. 2021

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While lung protective mechanical ventilation (MV) guidelines have been developed to avoid ventilator-induced lung injury (VILI), a one-size-fits-all approach cannot benefit every individual patient. Hence, there is significant need for the ability to provide patient-specific MV settings to ensure safety, and optimise patient care. Model-based approaches enable patient-specific care by identifying time-varying patient-specific parameters, such as respiratory elastance, E rs , to capture inter- and intra-patient variability. However, patient-specific parameters evolve with time, as a function of disease progression and patient condition, making predicting their future values crucial for recommending patient-specific MV settings. This study employs stochastic modelling to predict future E rs values using retrospective patient data to develop and validate a model indicating future intra-patient variability of E rs . Cross validation results show stochastic modelling can predict future elastance ranges with 92.59 and 68.56% of predicted values within the 5–95% and the 25–75% range, respectively. This range can be used to ensure patients receive adequate minute ventilation should elastance rise and minimise the risk of VILI should elastance fall. The results show the potential for model-based protocols using stochastic model prediction of future E rs values to provide safe and patient-specific MV. These results warrant further investigation to validate its clinical utility.

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Section: Methodsmentioning

confidence: 99%

Stochastic Modelling of Respiratory System Elastance for Mechanically Ventilated Respiratory Failure Patients

et al. 2021

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“…Data was sampled at 125Hz, the output frequency from the ventilator. Further details of data acquisition can be found in preliminary study 19 .…”

Section: Patient Data and Data Acquisitionmentioning

confidence: 99%

“…A linear single compartment model with Jarreau's equation for pressure loss across endotracheal tube (ETT) is used to estimate patient specific lung elastance and resistance 12,15,20 . The equation used has been previously defined in NICU populations 19 . The model is fit using linear regression to every breath to find inspiratory elastance (Ers) and airway resistance (Rrs).…”

Section: Model Fittingmentioning

confidence: 99%

“…Ers is the inverse of compliance. ΔPETT is used to capture the pressure drop over the ET tube which is defined according to Jarreau's equation 19,20 .…”

Section: Model Fittingmentioning

confidence: 99%

“…It is useful when comparing infants with large variations in weight as larger infants typically have larger (and more developed) lungs. Larger lung volumes result in different apparent elastances for a given underlying tissue stiffness 19,21 . Specific elastance (Especific) is the reciprocal of specific compliance, which is a metric used to measure the intrinsic elasticity of the lung tissue independent of lung volume, as previously described 19,22 .…”

Section: Male Infants Vs Female Infantsmentioning

confidence: 99%

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Mechanically ventilated premature babies have sex differences in specific elastance: A pilot study

Kim

Knopp

Dixon

et al. 2019

Pediatric Pulmonology

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Objectives:A pilot study to compare pulmonary mechanics in a NICU cohort, specifically, comparing lung elastance between male and female infants in the neonatal ICU (NICU).Hypothesis: Anecdotally, male infants are harder to ventilate than females. We hypothesise that males have higher model-based elastance (converse: lower specific compliance) compared to females, reflecting underlying stiffer lungs. Study design:A clinically validated, single compartment model is used to identify specific elastance (inverse of specific compliance) and resistance for each breath. Specific elastance accounts for weight differences when comparing male and female infants. Relative percent breath-to-breath variability (%ΔE) in specific elastance is also compared. Level of asynchrony was determined. Patient-subject selection: 10 invasively mechanically ventilated patients from ChristchurchWomen's Hospital.Methodology: Airway pressure and flow data from 10 invasive MV infants from Christchurch Women's Hospital Neonatal Intensive Care Unit, New Zealand was prospectively recorded under standard MV care. Model-based specific elastance and resistance are identified for each breath, as well as relative percent breath-to-breath variability (%ΔE) in specific elastance. Results: Male infants overall had higher specific elastance compared to females infants (p ≤ 0.01), with median [interquartile range (IQR)] for males of 1.91[1.33-2.48]cmH2O.kg/ml compared to 1.31[0.86-2.02]cmH2O.kg/ml in females. Male infants had lower variability with %ΔE of -0.03[-7.56 -8.01]% versus female infants of -0.59[12.56 -12.86]%. Males had 14.75% asynchronous breaths whereas females had 17.54%.Conclusion: Overall, males had higher specific elastance and correspondingly lower breathto-breath variability. These results indicate male and female infants may require different MV settings, modes and monitoring.

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