Dynamic versus static respiratory mechanics in acute lung injury and acute respiratory distress syndrome

Stahl, C; Möller, Knut; Schumann, Stefan; Kuhlen, Ralf; Sydow, M.; Putensen, Christian; Guttmann, J.

doi:10.1097/01.ccm.0000227220.67613.0d

Cited by 142 publications

(115 citation statements)

References 62 publications

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“…The module measures dynamic compliance, which is the ratio of change in volume to the change in pressure during inspiration. Dynamic compliance is calculated using the least squares fitting method of the flow, volume, and raw pressure waveform [16][17][18]. Blood pressure was measured with an automated NIBP device (Philips Intellivue MP70).…”

Section: Methodsmentioning

confidence: 99%

Cardiorespiratory Effects of Derotational Casting during Anesthesia for Children with Early Onset Scoliosis

Jensen¹,

Stasic²,

Kishan³

et al. 2014

OJAnes

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Study Design: A prospective, observational case series of eighteen children with early onset scoliosis undergo spine manipulation and casting. Objective: Determine if respiratory system compliance decreases during casting warrants tracheal intubation in all Derotational casting procedures. Background: Children with early onset scoliosis with a Cobb angle greater than 25 degrees will have significant progression of their scoliosis. Surgical techniques cannot result in spine fusion as growth retardation will ensue. Serial thoracolumbar casting may correct the scoliosis or delay the need for surgery. The cast, however, is highly restrictive until the cast is appropriately cut. Does respiratory system compliance decrease a significant degree to require tracheal intubation in all Derotational casting procedures? Methods: Eighteen children (mean age: 4.5 years, mean weight: 16.9 kg) undergoing initial scoliosis casting were enrolled. Anesthesia was induced with sevoflurane in oxygen, an intravenous catheter was inserted, intravenous propofol administered and tracheal intubation performed. Baseline measurements of heart rate, blood pressure, SpO 2 , peak inspiratory pressure (PIP), and pulmonary compliance were made before casting, immediately after casting, and after cast cut-out. Results: PIP increased from 15.8 cm H 2 O to 42.6 after cast application and decreased to 20.2 after cast cut-out. Compliance decreased from 1.08 ml/cm H 2 O/kg to 0.21 after cast application and increased to 0.61 after cast cut-out. There were no clinically significant changes in heart rate, blood pressure, or SpO 2 . Conclusion: The thoracolumbar cast applied for scoliosis treatment causes severe restriction of chest wall movement and subsequent deterioration of pulmonary function. The time of severe restriction of chest wall motion is short and is relieved once cast cut-outs are performed. The marked increase in PIP and decrease in compliance that occurs during the casting process necessitates tracheal intubation.

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Section: Methodsmentioning

confidence: 99%

Cardiorespiratory Effects of Derotational Casting during Anesthesia for Children with Early Onset Scoliosis

Jensen¹,

Stasic²,

Kishan³

et al. 2014

OJAnes

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“…Both patient studies (ARDS group, control group) were approved by the local ethics committees (details in Stahl et al [12] and Ganzert et al [20]) and provide flow, volume and pressure data.…”

Section: Datamentioning

confidence: 99%

“…This study used the McREM clinical data (full details are available at Stahl et al [12]). In this dataset different respiratory maneuvers were carried out on 28 mechanical ventilated ARDS patients.…”

Section: Datamentioning

confidence: 99%

What Does a First Order Model Tell Us about PEEP Wave Maneuvers?

Laufer¹,

Kretschmer²,

Docherty³

et al. 2017

JBiSE

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Patients with acute respiratory distress syndrome (ARDS) are currently treated with a lung protective ventilation strategy and the application of positive end-expiratory pressure (PEEP), sometimes in combination with recruitment maneuvers. In this study, the respiratory system elastance and airway resistance of each breath before, during and after a specific recruitment maneuver (PEEP wave maneuver) were analyzed in two patient groups, ARDS and control group. A reduction of elastance after the maneuver was observed in ARDS patients. In addition, only healthy lungs exhibited a reduction of the elastance during the course of the maneuver, while the lungs of ARDS patients didn't show that reduction of elastance. The capability of PEEP wave maneuvers to improve lung ventilation was shown and the dynamic behavior of the elastance after the maneuver was illustrated. Healthy lungs adapt faster to changes in mechanical ventilation than the lungs of ARDS patients.

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“…Patients were mechanically ventilated with low-flow (LF) manoeuvres performed using a Evita4Lab-System (Stahl et al 2006). During the LF-Manoeuvre, the lung is inflated by an extremely low constant gas flow of 35 mL/s over 55 s, yielding a quasi-static pressure/volume curve.…”

Section: Subject and Clinical Protocolmentioning

confidence: 99%

Traversing the Fuzzy Valley: Problems Caused by Reliance on Default Simulation and Parameter Identification Programs for Discontinuous Models

Docherty

Schranz

Chase

et al. 2012

IFAC Proceedings Volumes

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The Levenberg-Marquardt parameter identification method is often used in tandem with numerical Runge-Kutta model simulation to find optimal model parameter values to match measured data. However, these methods can potentially find erroneous parameter values. The problem is exacerbated when discontinuous models are analyzed.A highly parameterized respiratory mechanics model defines a pressure-volume response to a low flow experiment in an acute respiratory distress syndrome patient. Levenberg-Marquardt parameter identification is used with various starting values and either a typical numerical integration model simulation or a novel error-stepping method.Model parameter values from the error-stepping method were consistently located close to the error minima (median deviation: 0.4%). In contrast, model values from numerical integration were erratic and distinct from the error minima (median deviation: 1.4%).The comparative failure of Runge-Kutta model simulation was due to the method's poor handling of model discontinuities and the resultant lack of smoothness in the error surface. As the Leven-bergMarquardt identification system is an error gradient decent method, it depends on accurate measurement of the model-to-measured data error surface. Hence, the method failed to converge accurately due to poorly defined error surfaces.When the error surface is imprecisely identified, the parameter identification process can produce suboptimal results. Particular care must be used when gradient decent methods are used in conjunction with numerical integration model simulation methods and discontinuous models.

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Dynamic versus static respiratory mechanics in acute lung injury and acute respiratory distress syndrome

Cited by 142 publications

References 62 publications

Cardiorespiratory Effects of Derotational Casting during Anesthesia for Children with Early Onset Scoliosis

Cardiorespiratory Effects of Derotational Casting during Anesthesia for Children with Early Onset Scoliosis

What Does a First Order Model Tell Us about PEEP Wave Maneuvers?

Traversing the Fuzzy Valley: Problems Caused by Reliance on Default Simulation and Parameter Identification Programs for Discontinuous Models

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