State-of-the-Art Mechanical Ventilation

Karcz, Marcin; Vitkus, Alisa; Papadakos, Peter J.; Schwaiberger, David; Lachmann, Burkhard

doi:10.1053/j.jvca.2011.03.010

Cited by 27 publications

(32 citation statements)

References 201 publications

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“…In addition, deep knowledge about the breathing pattern during increased ventilatory needs and its relationship with WOB is an interesting issue in mechanical ventilation and therapy of respiratory disorders [44,45,46]. In these situations, forecasting tools based on computationally-driven systems and suitable approaches to quantify WOB could be applied in order to improve patient treatments [47,48] …”

Section: Respiratory Control System Modelingmentioning

confidence: 99%

Novel Modeling of Work of Breathing for Its Optimization During Increased Respiratory Efforts

Higuita

Mañanas

Sánchez

et al. 2016

IEEE Systems Journal

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One of the most complex physiological systems whose modeling is still an open study is the respiratory control system where different models have been proposed based on the criterion of minimizing the work of breathing (WOB). The aim of this study is twofold: to compare two known models of the respiratory control system which set the breathing pattern based on quantifying the respiratory work; and to assess the influence of using direct-search or evolutionary optimization algorithms on adjustment of model parameters. This study was carried out using experimental data from a group of healthy volunteers under CO 2 incremental inhalation, which were used to adjust the model parameters and to evaluate how much the equations of WOB follow a real breathing pattern. This breathing pattern was characterized by the following variables: tidal volume, inspiratory and expiratory time duration and total minute ventilation. Different optimization algorithms were considered to determine the most appropriate model from physiological viewpoint. Algorithms were used for a double optimization: firstly, to minimize the WOB and secondly to adjust model parameters. The performance of optimization algorithms was also evaluated in terms of convergence rate, solution accuracy and precision. Results showed strong differences in the performance of opti- mization algorithms according to constraints and topological features of the function to be optimized. In breathing pattern optimization, the sequential quadratic programming technique (SQP) showed the best performance and convergence speed when respiratory work was low. In addition, SQP allowed to implement multiple non-linear constraints through mathematical expressions in the easiest way. Regarding parameter adjustment of the model to experimental data, the evolutionary strategy with covariance matrix and adaptation (CMA-ES) provided the best quality solutions with fast convergence and the best accuracy and precision in both models. CMAES reached the best adjustment because of its good performance on noise and multi-peaked fitness functions. Although one of the studied models has been much more commonly used to simulate respiratory response to CO 2 inhalation, results showed that an alternative model has a more appropriate cost function to minimize WOB from a physiological viewpoint according to experimental data.

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Section: Respiratory Control System Modelingmentioning

confidence: 99%

Novel Modeling of Work of Breathing for Its Optimization During Increased Respiratory Efforts

Higuita

Mañanas

Sánchez

et al. 2016

IEEE Systems Journal

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“…Based on the assumption that a lower inflection point (LIP) represents alveolar recruitment, it is the LIP on the total respiratory system pressure-volume curve that is used extensively to set the PEEP in patients with acute respiratory failure (22). This means that the LIP on the pressurevolume curve reflects the average critical pressure needed to reopen those regions of the lung that close during expiration (22).…”

Section: Optimal Positive End-expiratory Pressure Selectionmentioning

confidence: 99%

“…This means that the LIP on the pressurevolume curve reflects the average critical pressure needed to reopen those regions of the lung that close during expiration (22).…”

Section: Optimal Positive End-expiratory Pressure Selectionmentioning

confidence: 99%

“…The lower inflection point on the pressure-volume curve should therefore not be used as the method of choice to calculate the level of PEEP as recruitment occurs along the entire volume-pressure curve, independent of lower and upper inflection points (22). It would therefore seem Arch Crit Care Med.…”

Section: Optimal Positive End-expiratory Pressure Selectionmentioning

confidence: 99%

“…Amato et al (15) were one of the first groups to use in mode in combination with alveolar recruitment higher and showed an improved weaning rate as well as 28-day. The use of PCV allows one to control the ventilatory pressure throughout the ventilator cycle in order to generate the appropriate pressure necessary to expand the collapsed alveoli during a recruitment maneuver (2,3,22,39). This is especially important in patients with severe chest trauma in whom the pressure needed for alveolar recruitment may reach values as high as 60 to 70 cmH 2 O after which the peak inspiratory pressure is adjusted to the lowest level necessary to maintain an open lung.…”

Section: Recruitment Techniques: Review Of the Literaturementioning

confidence: 99%

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Lung Recruitment in Trauma Patients

Karcz¹,

Schwaiberger²,

Haitsma³

et al. 2015

Arch Crit Care Med

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The ventilatory management of trauma patients can present significant challenges. Its main aims focus on the reduction of the work of breathing, facilitation of an improvement in gaseous exchange, and on the avoidance of ventilation-induced lung injury (VILI). VILI is a pathophysiologic process consisting of several changes seen in ventilated lungs that have been attributed to the ventilation strategy employed subsequent to the traumatic lung injury. In order to avoid the major components of VILI, both maximal alveolar aeration and recruitment are needed to minimize the shear stresses in the injured lung tissue. Alveolar recruitment maneuvers have become the major goals of mechanical ventilatory support for patients with severe trauma over the last few decades. The importance of early lung recruitment with an 'open lung' approach has been well documented in several studies and its application has been shown to preserve lung mechanics, attenuate lung mechanotrauma, and thereby reduce mortality during ventilation. Controversies nonetheless exist regarding the most appropriate form of their use in patients with pulmonary injuries as recruitment maneuvers may have several adverse effects. The main concerns center on exploiting high airway pressures during the recruitment process and its potential harmful consequences, such as barotrauma and hemodynamic compromise. The purpose of this article is to review the major concepts in the mechanical ventilation literature that outline the principles for the use of the open lung management strategy in patients that have been subjected to significant trauma and to delineate both the major techniques of lung recruitment as well as their potential complications.

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What Happens to the Lung During Mechanical Ventilation and One-Lung Ventilation?

Hedenstierna

2017

Postoperative Care in Thoracic Surgery

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State-of-the-Art Mechanical Ventilation

Cited by 27 publications

References 201 publications

Novel Modeling of Work of Breathing for Its Optimization During Increased Respiratory Efforts

Novel Modeling of Work of Breathing for Its Optimization During Increased Respiratory Efforts

Lung Recruitment in Trauma Patients

What Happens to the Lung During Mechanical Ventilation and One-Lung Ventilation?

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