Abstract
BackgroundAcute Respiratory Distress Syndrome (ARDS) is characterized by inflammation, filling of the lung with fluid and the collapse of lung units. Mechanical ventilation (MV) is used to treat ARDS using positive end expiratory pressure (PEEP) to recruit and retain lung units, thus increasing pulmonary volume and dynamic functional residual capacity (dFRC) at the end of expiration. However, simple, non-invasive methods to estimate dFRC do not exist.MethodsFour model-based methods for estimating dFRC are compared based on their performance on two separate clinical data cohorts. The methods are derived from either stress-strain theory or a single compartment lung model, and use commonly controlled or measured parameters (lung compliance, plateau airway pressure, pressure-volume (PV) data). Population constants are determined for the stress-strain approach, which is implemented using data at both single and multiple PEEP levels. Estimated values are compared to clinically measured values to assess the reliability of each method for each cohort individually and combined.ResultsThe stress-strain multiple breath (at multiple PEEP levels) method produced an overall correlation coefficient R2 = 0.966. The stress-strain single breath method produced R2 = 0.530. The single compartment single breath method produced R2 = 0.415. A combined method at single and multiple PEEP levels produced R2 = 0.963.ConclusionsThe results suggest that model-based, single breath and non-invasive approaches to estimating dFRC may be viable in a clinical scenario, ensuring no interruption to MV. The models provide a means of estimating dFRC at any PEEP level. However, model limitations and large estimation errors limit the use of the methods at very low PEEP.
Highlights
Acute Respiratory Distress Syndrome (ARDS) is characterized by inflammation, filling of the lung with fluid and the collapse of lung units
ARDS is associated with lung inflammation and fluid filling causing a loss of functional lung units resulting in a stiffer lung with reduced intrapulmonary gas volume known as the “baby lung” [2]
Auto-positive end expiratory pressure (PEEP) has the effect of a sudden change in the level of recruitment (ΔdFRC) once the PEEP becomes greater than the auto-PEEP, as shown in Figure 7 for an auto-PEEP of 7cmH2O
Summary
Acute Respiratory Distress Syndrome (ARDS) is characterized by inflammation, filling of the lung with fluid and the collapse of lung units. Mechanical ventilation (MV) is used to treat ARDS using positive end expiratory pressure (PEEP) to recruit and retain lung units, increasing pulmonary volume and dynamic functional residual capacity (dFRC) at the end of expiration. Patients suffering from severe respiratory insufficiency such as Acute Respiratory Distress Syndrome (ARDS) (mild, moderate, severe) [1] are admitted to the intensive care unit (ICU) and require mechanical ventilation (MV) for breathing support. ARDS is associated with lung inflammation and fluid filling causing a loss of functional lung units resulting in a stiffer lung with reduced intrapulmonary gas volume known as the “baby lung” [2]. A PaO2/FiO2 value less than 300mmHg implies the patient has mild ARDS, while less than 200mmHg is moderate ARDS and less than 100mmHg is characterised as severe ARDS [1]
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