The Clinical Utilisation of Respiratory Elastance Software (CURE Soft): a bedside software for real-time respiratory mechanics monitoring and mechanical ventilation management

Abstract

BackgroundReal-time patient respiratory mechanics estimation can be used to guide mechanical ventilation settings, particularly, positive end-expiratory pressure (PEEP). This work presents a software, Clinical Utilisation of Respiratory Elastance (CURE Soft), using a time-varying respiratory elastance model to offer this ability to aid in mechanical ventilation treatment.ImplementationCURE Soft is a desktop application developed in JAVA. It has two modes of operation, 1) Online real-time monitoring decision support and, 2) Offline for user education purposes, auditing, or reviewing patient care. The CURE Soft has been tested in mechanically ventilated patients with respiratory failure. The clinical protocol, software testing and use of the data were approved by the New Zealand Southern Regional Ethics Committee.Results and discussionUsing CURE Soft, patient’s respiratory mechanics response to treatment and clinical protocol were monitored. Results showed that the patient’s respiratory elastance (Stiffness) changed with the use of muscle relaxants, and responded differently to ventilator settings. This information can be used to guide mechanical ventilation therapy and titrate optimal ventilator PEEP.ConclusionCURE Soft enables real-time calculation of model-based respiratory mechanics for mechanically ventilated patients. Results showed that the system is able to provide detailed, previously unavailable information on patient-specific respiratory mechanics and response to therapy in real-time. The additional insight available to clinicians provides the potential for improved decision-making, and thus improved patient care and outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/1475-925X-13-140) contains supplementary material, which is available to authorized users.

A polynomial model of patient-specific breathing effort during controlled mechanical ventilation

“…This shape models the effect of reversetriggering observed during mechanical ventilation volume control mode [5], [8]. The conventional single compartment lung model [6] is modified to include a patient effort function P e (t).…”

Respiratory mechanics assessment for reverse-triggered breathing cycles using pressure reconstruction

“…The airway pressure and flow data were collected using a bedside airway pressure, flow and respiratory mechanics monitoring tool connected to the ventilator [14]. The primary cause of respiratory failure of the patients are shown in Table 1.…”

“…Region B included 3 hours after the RM, during which time paralysing agents were metabolised, their effect weakened, and patient-specific SB efforts may reappear. sample of the progression of the study [14].…”

“…These 'unaffected' pressure waveforms can be used to estimate the patient-specific underlying respiratory mechanics in real-time, which can be used to guide MV therapy [10,13,14].…”

Implementation of a Non-Linear Autoregressive Model with Modified Gauss-Newton Parameter Identification to Determine Pulmonary Mechanics of Respiratory Patients that are Intermittently Resisting Ventilator Flow Patterns

“…PEEP was constant at P0 = 17 cmH2O. The airway pressure and flow signals from the ventilator were recorded using specialised software (Szlavecz et al, 2014). Approval for the use of this data was given by the New Zealand South Regional Ethics Committee (Ethics no: 13STH84).…”