Ventilation inhomogeneity in CDH infants – A new attitude within a simulation study

Stankiewicz, B.; Mierzewska-Schmidt, Magdalena; Górczyńska, Krystyna; Pałko, Krzysztof Jakub; Baranowski, Artur; Kozarski, Maciej; Darowski, M.

doi:10.1016/j.bbe.2021.08.002

Cited by 1 publication

(4 citation statements)

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“…The main study results confirm the pilot study results 9 and indicate the following: there are strong and significant correlations between respiratory system impedance (Z), ventilation parameters (WOB vt , PIP, MAP) and ventilation inhomogeneity degree, described by the T 1 /T 2 index (0.8–0.9, P < 0.001); the correlations are dependent on respiratory rate (RR) and the ratio between chest wall compliance and lung compliance (C W /C L ); these dependencies can be expressed in the form of characteristics consisted of several curves of polynomial functions (Fig. 3 , Supplementary Tables S1 –S5 online); the work of breathing (WOB vt ), PIP, and MAP highly correlate with respiratory system impedance (Z) (0.8–09, P < 0.001) (Fig.…”

Section: Discussionsupporting

confidence: 83%

“…Evaluation of lung inhomogeneity can be accomplished using Multi Breath Washout (MBW), Electrical Impedance Tomography (EIT) or Hyperpolarized 3-Helium Magnetic Resonance Imaging (HP 3-He MRI). However, they are hardly accessible in daily clinical practice due to high costs, extensive workload and the problems with standardization 9 , 14 – 20 .…”

Section: Discussionmentioning

confidence: 99%

“…Secondly, this index could probably be useful in the prediction of optimal PIP and MAP values at the bedside, corresponding to the degree of lung ventilation inhomogeneity. Thirdly, in selected cases, the use of the above measurements could possibly help to decide on changing ventilation strategy from CMV to HFV; for example using algorithms similar to that proposed by us 9 . However, further extensive studies are necessary.…”

Section: Discussionmentioning

confidence: 99%

“…In our previous pilot study 9 , we proposed a new index of VI—T 1 /T 2 that is a ratio of time constants of gas flows in both lungs (R 1 ·C 1 /R 2 ·C 2 ), and we put forward some ideas on how it can be used in clinical conditions. The T 1 /T 2 index pertains to the two-compartments of the RLC (R—resistance, L—inertance, C—compliance) respiratory system model 10 , numerically implemented in the Infant Hybrid Respiratory Simulator (IHRS) 10 , 11 .…”

Section: Introductionmentioning

confidence: 99%

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A new method of ventilation inhomogeneity assessment based on a simulation study using clinical data on congenital diaphragmatic hernia cases

Stankiewicz

Mierzewska-Schmidt

Pałko

et al. 2022

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Congenital Diaphragmatic Hernia (CDH) is a diaphragm defect associated with lung hypoplasia and ventilation inhomogeneity (VI). The affected neonates are usually born with respiratory failure and require mechanical ventilation after birth. However, significant interindividual VI differences make ventilation difficult. So far, there are no clinical methods of VI assessment that could be applied to optimize ventilation at the bedside. A new VI index is a ratio of time constants T1/T2 of gas flows in both lungs. Pressure-controlled ventilation simulations were conducted using an infant hybrid (numerical-physical) respiratory simulator connected to a ventilator. The parameters of the respiratory system model and ventilator settings were based on retrospective clinical data taken from three neonates (2, 2.6, 3.6 kg) treated in the Paediatric Teaching Clinical Hospital of the Medical University of Warsaw. We searched for relationships between respiratory system impedance (Z) and ventilation parameters: work of breathing (WOB), peak inspiratory pressure (PIP), and mean airway pressure (MAP). The study showed the increased VI described by the T1/T2 index value highly correlated with elevated Z, WOB, PIP and MAP (0.8–0.9, the Spearman correlation coefficients were significant at P < 0.001). It indicates that the T1/T2 index may help to improve the ventilation therapy of CDH neonates.

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