Static pressure-volume curve characteristics are moderate estimators of optimal airway pressures in a mathematical model of (primary/pulmonary) acute respiratory distress syndrome

Markhorst, Dick G.; Genderingen, Huibert R. van; Vught, A. J. van

doi:10.1007/s00134-004-2446-7

Cited by 22 publications

(12 citation statements)

References 26 publications

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“…22,[53][54][55][56][57][58][59] By doing so, less CDP is needed to maintain a certain lung volume on the inflation limb, because of the hysteresis of the respiratory system. In our view and practice, this can be achieved in clinical practice in patients with DAD by initially setting the CDP 3-5 cm H 2 O above the mean airway pressure on conventional mechanical ventilation, as the distal CDP is lower than the set proximal CDP.…”

Section: Best Hfov Approach and Oscillator Settings For Oxygenationmentioning

confidence: 99%

Reflections on Pediatric High-Frequency Oscillatory Ventilation From a Physiologic Perspective

2012

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Mechanical ventilation using low tidal volumes has become universally accepted to prevent ventilator-induced lung injury. High-frequency oscillatory ventilation (HFOV) allows pulmonary gas exchange using very small tidal volume (1-2 mL/kg) with concomitant decreased risk of atelectrauma. However, its use in pediatric critical care varies between only 3% and 30% of all ventilated children. This might be explained by the fact that the beneficial effect of HFOV on patient outcome has not been ascertained. Alternatively, in contrast with present recommendations, one can ask if HFOV has been employed in its most optimal fashion related especially to the indications for and timing of HFOV, as well as to using the best oscillator settings. The first was addressed in one small randomized study showing that early use of HFOV, instead of rescue use, was associated with improved survival. From a physiologic perspective, the oscillator settings could be refined. Lung volume is the main determinant of oxygenation in diffuse alveolar disease, suggesting using an open-lung strategy by recruitment maneuvers, although this is in practice not custom. Using such an approach, the patient can be oscillated on the deflation limb of the pressurevolume (P-V) curve, allowing less pressure required to maintain a certain amount of lung volume. Gas exchange is determined by the frequency and the oscillatory power setting, controlling the magnitude of the membrane displacement. Experimental work as well as preliminary human data have shown that it is possible to achieve the smallest tidal volume with concomitant adequate gas exchange when oscillating at high frequency and high fixed power setting. Future studies are needed to validate these novel approaches and to evaluate their effect on patient outcome.

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Section: Best Hfov Approach and Oscillator Settings For Oxygenationmentioning

confidence: 99%

Reflections on Pediatric High-Frequency Oscillatory Ventilation From a Physiologic Perspective

2012

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“…Moreover, clinical studies using CT scans have revealed that the lung units' threshold pressures (TOP and TCP) obey a normal (Gaussian) distribution [21]. In the model, mean and SD of TOP and TCP pressures were given the values shown in Table II to simulate different intensities of ARDS [26]. The mean indicates the pressure at which the maximum of recruitment (TOP) and derecruitment (TCP) of lung units occurs, whereas SD describes the spread of the lung units' population with respect to the TOP and TCP.…”

Section: Eit-based Monitoring Of Ventilated Ards Patientsmentioning

confidence: 99%

Absolute Electrical Impedance Tomography (aEIT) Guided Ventilation Therapy in Critical Care Patients: Simulations and Future Trends

Denaï

Mahfouf

Mohamad-Samuri

et al. 2010

IEEE Trans. Inform. Technol. Biomed.

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ReuseUnless indicated otherwise, fulltext items are protected by copyright with all rights reserved. The copyright exception in section 29 of the Copyright, Designs and Patents Act 1988 allows the making of a single copy solely for the purpose of non-commercial research or private study within the limits of fair dealing. The publisher or other rights-holder may allow further reproduction and re-use of this version -refer to the White Rose Research Online record for this item. Where records identify the publisher as the copyright holder, users can verify any specific terms of use on the publisher's website. TakedownIf you consider content in White Rose Research Online to be in breach of UK law, please notify us by emailing eprints@whiterose.ac.uk including the URL of the record and the reason for the withdrawal request. Abstract-Thoracic electrical impedance tomography (EIT) is a noninvasive, radiation-free monitoring technique whose aim is to reconstruct a cross-sectional image of the internal spatial distribution of conductivity from electrical measurements made by injecting small alternating currents via an electrode array placed on the surface of the thorax. The purpose of this paper is to discuss the fundamentals of EIT and demonstrate the principles of mechanical ventilation, lung recruitment, and EIT imaging on a comprehensive physiological model, which combines a model of respiratory mechanics, a model of the human lung absolute resistivity as a function of air content, and a 2-D finite-element mesh of the thorax to simulate EIT image reconstruction during mechanical ventilation. The overall model gives a good understanding of respiratory physiology and EIT monitoring techniques in mechanically ventilated patients. The model proposed here was able to reproduce consistent images of ventilation distribution in simulated acutely injured and collapsed lung conditions. A new advisory system architecture integrating a previously developed data-driven physiological model for continuous and noninvasive predictions of blood gas parameters with the regional lung function data/information generated from absolute EIT (aEIT) is proposed for monitoring and ventilator therapy management of critical care patients.

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“…These two states are governed only by the Threshold Opening Pressure (TOP) which the critical pressure above which the lung unit pops open and Threshold Closing Pressure (TCP) below which the unit collapses respectively. The model uses normally distributed TOP and TCP pressures with a specific mean and standard deviation [18] that may be adjusted to reflect the heterogeneous characteristic of alveoli under different abnormal lung conditions such as ARDS [19], [20]. Fig.…”

Section: A Model Of the Lung Mechanicsmentioning

confidence: 99%

Modeling and simulation of Electrical Impedance Tomography (EIT) on ventilated patients with ARDS lungs

Denaï

Mahfouf

Mills

2008

2008 8th IEEE International Conference on BioInformatics and BioEngineering

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Static pressure-volume curve characteristics are moderate estimators of optimal airway pressures in a mathematical model of (primary/pulmonary) acute respiratory distress syndrome

Cited by 22 publications

References 26 publications

Reflections on Pediatric High-Frequency Oscillatory Ventilation From a Physiologic Perspective

Reflections on Pediatric High-Frequency Oscillatory Ventilation From a Physiologic Perspective

Absolute Electrical Impedance Tomography (aEIT) Guided Ventilation Therapy in Critical Care Patients: Simulations and Future Trends

Modeling and simulation of Electrical Impedance Tomography (EIT) on ventilated patients with ARDS lungs

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