Abstract
BackgroundComputer simulation models could play a key role in developing novel therapeutic strategies for patients with chronic obstructive pulmonary disease (COPD) if they can be shown to accurately represent the pathophysiological characteristics of individual patients.MethodsWe evaluated the capability of a computational simulator to reproduce the heterogeneous effects of COPD on alveolar mechanics as captured in a number of different patient datasets.ResultsOur results show that accurately representing the pathophysiology of individual COPD patients necessitates the use of simulation models with large numbers (up to 200) of compartments for gas exchange. The tuning of such complex simulation models ‘by hand’ to match patient data is not feasible, and thus we present an automated approach based on the use of global optimization algorithms and high-performance computing. Using this approach, we are able to achieve extremely close matches between the simulator and a range of patient data including PaO2, PaCO2, pulmonary deadspace fraction, pulmonary shunt fraction, and ventilation/perfusion (V̇/Q) curves. Using the simulator, we computed combinations of ventilator settings that optimally manage the trade-off between ensuring adequate gas exchange and minimizing the risk of ventilator-associated lung injury for an individual COPD patient.ConclusionsOur results significantly strengthen the credibility of computer simulation models as research tools for the development of novel management protocols in COPD and other pulmonary disease states.Electronic supplementary materialThe online version of this article (doi:10.1186/s40635-014-0023-0) contains supplementary material, which is available to authorized users.
Highlights
Computer simulation models could play a key role in developing novel therapeutic strategies for patients with chronic obstructive pulmonary disease (COPD) if they can be shown to accurately represent the pathophysiological characteristics of individual patients
Many researchers have worked on the development of physiological simulators, and various types of mathematical models have been proposed in the literature (e.g., [4,5,6,7,8,9,10,11]). These models generally employed only a very small number of compartments for gas exchange - in this paper, we show that such model cannot provide an accurate representation of the particular heterogeneous effects of COPD on alveolar mechanics
Besides the use of a rather simplistic model, the study suffered from the use of only two parameters to represent V /Q mismatching; this is a significant limitation, since gas exchange in COPD patients is often characterized by different V /Q patterns with two or three modes [12]
Summary
Computer simulation models could play a key role in developing novel therapeutic strategies for patients with chronic obstructive pulmonary disease (COPD) if they can be shown to accurately represent the pathophysiological characteristics of individual patients. Computer simulators that can accurately represent the particular disease state of an individual COPD patient could be an extremely valuable research tool for investigating the respiratory pathophysiology of COPD and predicting the effects of specific MV settings on the patient. Many researchers have worked on the development of physiological simulators, and various types of mathematical models have been proposed in the literature (e.g., [4,5,6,7,8,9,10,11]) These models generally employed only a very small number of compartments for gas exchange - in this paper, we show that such model cannot provide an accurate representation of the particular heterogeneous effects of COPD on alveolar mechanics. It is obvious that manual matching is only practical for relatively simple models with a small set of adjustable parameters and a limited set of patient data for matching
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