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.
Highlights
Real-time patient respiratory mechanics estimation can be used to guide mechanical ventilation settings, positive end-expiratory pressure (PEEP)
Graphic user interface and main user function Clinical utilisation of respiratory elastance (CURE) Soft can be used in two modes of operation: 1) Online: This mode acquires data from the ventilator in real-time and calculates the respiratory mechanic parameters in real-time to aid clinical decision making
To validate the CURE Soft application in clinical settings, a clinical trial is being carried out to investigate the potential of using respiratory mechanics to optimise PEEP in mechanical ventilation (MV) in Christchurch Hospital, New Zealand (Australian New Zealand Trial Registry Number: ACTRN12613001006730)
Summary
CURE Soft trial and general observations At the start of the clinical trial, CURE Soft is initiated to calculate respiratory system stiffness. This result suggested that the patient started to regain spontaneous breathing effort This fluctuation of respiratory stiffness corresponds to the ‘entrainment’ of breathing on MV as shown in Figure 4 (Right Column) where the shape of the airway pressure is altered by the patients breathing effort [21,22]. Limitations and future works CURE Soft was able to calculate patient-specific respiratory mechanics for every breath using the airway pressure and flow information from the ventilator. The application of CURE Soft, is a system necessary to test this hypothesis at scale without clinically intensive and infrequent interventions
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