Mixed‐integer quadratic programming approach for noninvasive estimation of respiratory effort profile during pressure support ventilation

Victor, Marcus; Máximo, Marcos R. O. A.; Matsumoto, Monica M.; Pereira, S.; Tucci, Mauro R.

doi:10.1002/cnm.3668

Cited by 3 publications

(2 citation statements)

References 37 publications

(107 reference statements)

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“…Under certain conditions, esophageal pressure can be used as a surrogate for pleural pressure (P pl ), allowing the calculation of transpulmonary pressure (P L ), work of breathing (WOB), intrinsic positive end-expiratory pressure (auto-PEEP) and respiratory muscle performance. These parameters, not otherwise measured, can be used to individualize mechanical ventilation settings (Vicario et al 2016, Yoshida et al 2018, Baedorf et al 2018aGattinoni et al 2019, Pasticci et al 2020, Victor et al 2023.…”

Section: Introductionmentioning

confidence: 99%

Esophageal balloon catheter system identification to improve respiratory effort time features and amplitude determination

Xia,

Victor Jr,

Morais

et al. 2024

Physiol. Meas.

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Objective: Understanding the patient's respiratory effort and mechanics is essential to provide individualized care during mechanical ventilation. However, the measurement of transpulmonary pressure (difference between airway and pleural pressures) is not easily performed in practice. While airway pressures are available on most mechanical ventilators, pleural pressures are measured indirectly by an esophageal balloon catheter. Still, in many cases, esophageal pressure readings take other phenomena into account and are not a reliable measure of pleural pressure. Approach: A system identification approach was applied to provide accurate pleural measures from esophageal pressure readings. First, we used a closed pressurized chamber to stimulate an esophageal balloon and model its dynamics. Second, we created a simplified version of an artificial lung and tried the model with different ventilation configurations. For validation, 11 patients' data (5 male and 6 female) were used to estimate respiratory effort profile and patient mechanics. Main results: After correcting the balloon catheter dynamic response, the estimates of resistance and compliance and the correspondent respiratory effort waveform were improved when compared with the adjusted quantities in the test bench. The performance of the estimated model was evaluated using the respiratory pause/occlusion maneuver, demonstrating improved agreement between the airway and esophageal pressure waveforms when using the normalized mean squared error metric. With the corrected muscle pressure waveform, we detected start and peak times 130 ± 50 ms earlier and a peak amplitude 2.04 ± 1.46 cmH2O higher than the correspondent estimates from esophageal catheter readings. Significance: Compensating the acquired measurements with system identification techniques makes the readings more accurate, possibly better portraying the patient's situation for individualizing ventilation therapy.

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Section: Introductionmentioning

confidence: 99%

Esophageal balloon catheter system identification to improve respiratory effort time features and amplitude determination

Xia,

Victor Jr,

Morais

et al. 2024

Physiol. Meas.

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“…17 Due to excess inhalation of inert gas and imbalance in anesthesia, the partial pressure affects the arterial blood as well as the venous blood, which causes impaired gas exchange not only in young people but also in elderly. 14,[19][20][21][22][23] In literature, there are various theoretical studies 5,6,8,9,24,25 on the attempt of suicide by inhalation of an excessive amount of inert gas. In a forensic investigation, it was documented that a 37-year-old male was discovered unresponsive inside his vehicle, with five liquid nitrogen tanks found in the trunk, 4 indicating excessive inhalation of nitrogen gas.…”

Section: Introductionmentioning

confidence: 99%

Analysis of the effect of inert gas on alveolar/venous blood partial pressure by using the operator splitting method

Jyoti,

Kwak,

Ham

et al. 2024

Numer Methods Biomed Eng

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This study aims to investigate how inert gas affects the partial pressure of alveolar and venous blood using a fast and accurate operator splitting method (OSM). Unlike previous complex methods, such as the finite element method (FEM), OSM effectively separates governing equations into smaller sub‐problems, facilitating a better understanding of inert gas transport and exchange between blood capillaries and surrounding tissue. The governing equations were discretized with a fully implicit finite difference method (FDM), which enables the use of larger time steps. The model employed partial differential equations, considering convection‐diffusion in blood and only diffusion in tissue. The study explores the impact of initial arterial pressure, breathing frequency, blood flow velocity, solubility, and diffusivity on the partial pressure of inert gas in blood and tissue. Additionally, the effects of anesthetic inert gas and oxygen on venous blood partial pressure were analyzed. Simulation results demonstrate that the high solubility and diffusivity of anesthetic inert gas lead to its prolonged presence in blood and tissue, resulting in lower partial pressure in venous blood. These findings enhance our understanding of inert gas interaction with alveolar/venous blood, with potential implications for medical diagnostics and therapies.

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Computational physiological models for individualised mechanical ventilation: a systematic literature review focussing on quality, availability, and clinical readiness

et al. 2023

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Background Individualised optimisation of mechanical ventilation (MV) remains cumbersome in modern intensive care medicine. Computerised, model-based support systems could help in tailoring MV settings to the complex interactions between MV and the individual patient's pathophysiology. Therefore, we critically appraised the current literature on computational physiological models (CPMs) for individualised MV in the ICU with a focus on quality, availability, and clinical readiness. Methods A systematic literature search was conducted on 13 February 2023 in MEDLINE ALL, Embase, Scopus and Web of Science to identify original research articles describing CPMs for individualised MV in the ICU. The modelled physiological phenomena, clinical applications, and level of readiness were extracted. The quality of model design reporting and validation was assessed based on American Society of Mechanical Engineers (ASME) standards. Results Out of 6,333 unique publications, 149 publications were included. CPMs emerged since the 1970s with increasing levels of readiness. A total of 131 articles (88%) modelled lung mechanics, mainly for lung-protective ventilation. Gas exchange (n = 38, 26%) and gas homeostasis (n = 36, 24%) models had mainly applications in controlling oxygenation and ventilation. Respiratory muscle function models for diaphragm-protective ventilation emerged recently (n = 3, 2%). Three randomised controlled trials were initiated, applying the Beacon and CURE Soft models for gas exchange and PEEP optimisation. Overall, model design and quality were reported unsatisfactory in 93% and 21% of the articles, respectively. Conclusion CPMs are advancing towards clinical application as an explainable tool to optimise individualised MV. To promote clinical application, dedicated standards for quality assessment and model reporting are essential. Trial registration number PROSPERO—CRD42022301715. Registered 05 February, 2022.

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Mixed‐integer quadratic programming approach for noninvasive estimation of respiratory effort profile during pressure support ventilation

Cited by 3 publications

References 37 publications

Esophageal balloon catheter system identification to improve respiratory effort time features and amplitude determination

Esophageal balloon catheter system identification to improve respiratory effort time features and amplitude determination

Analysis of the effect of inert gas on alveolar/venous blood partial pressure by using the operator splitting method

Computational physiological models for individualised mechanical ventilation: a systematic literature review focussing on quality, availability, and clinical readiness

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