Time-Varying Respiratory Elastance for Spontaneously Breathing Patients

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• 作者：Yeong Shiong Chiew^* ; ^{Yeongshiong.chiew@canterbury.ac.nz" class="auth_mail" title="E-mail the corresponding author} ; Sarah F. Poole^* ; Daniel P. Redmond^* ; Erwin J. van Drunen^* ; Nor Salwa Damanhuri^* ; Christopher Pretty^* ; Paul D. Docherty^* ; Bernard Lambermont^** ; Geoffrey M. Shaw^*** ; ^{Geoff.Shaw@cdhb.govt.nz" class="auth_mail" title="E-mail the corresponding author} ; Thomas Desaive^** ; ^{Tdesaive@ulg.ac.be" class="auth_mail" title="E-mail the corresponding author} ; J. Geoffrey Chase^*
• 刊名：IFAC-PapersOnLine
• 出版年：2014
• 出版时间：2014
• 年：2014
• 卷：47
• 期：3
• 页码：5659-5664
• 全文大小：1995 K

文摘

Respiratory mechanics models can be used to optimise patient-specific mechanical ventilation (MV), but are limited to fully sedated MV patients who are not spontaneously breathing. This research presents a non-invasive model-based method to determine respiratory mechanics of spontaneously breathing MV patients. Patient-specific respiratory mechanics of 22 spontaneously breathing patients are described using a single compartment lung model with time-varying elastance (E_drs). The normalised E_drs trajectories and the area under the curves (AUCE_drs) are calculated using clinical data from 22 patients ventilated using pressure support (PS) and neurally adjusted ventilatory assist (NAVA). E_drs trajectories are also compared between ventilation modes. E_drs for PS ventilation were significantly higher compared to NAVA (p < 0.05). E_drs trajectories were more variable during NAVA than PS (p < 0.05). 20 of 22 patients had AUCE_drs &gt; 25 cmH₂Os/l. The AUCE_drs is a surrogate of elastance, and thus can be used as a respiratory failure severity indicator. This non-invasive model-based approach captures unique dynamic respiratory mechanics for spontaneously breathing patients during PS and NAVA. The model is fully general and is applicable to both fully controlled and partially assisted MV modes, with the resulting potential to standardise treatment for all MV patients.