Ventilation inhomogeneity in CDH infants – A new attitude within a simulation study

• Autorzy: Stankiewicz Barbara , Mierzewska-Schmidt Magdalena , Górczyńska Krystyna , Pałko Krzysztof J. , Baranowski Artur , Kozarski Maciej , Darowski Marek

Identyfikatory

DOI

10.1016/j.bbe.2021.08.002

• Języki publikacji: EN

Abstrakty

EN

Congenital Diaphragmatic Hernia (CDH) is a serious newborn defect requiring mechanical ventilation. Initial ventilation settings should take into account the severity of lungs inhomogeneity (LI), but it is not assessed in everyday clinical practice. We present a new LI index that can be easily determined at the bedside. It is based on a comparison of resistive-elastic properties of lungs and defined as a ratio of time constants T₁ T₂^_1 of gas flows in both lungs (T₁ = R₁∙C₁, T₂ = R₂∙C₂). We hypothesised that T₁ T₂^_1 index increase causes a rise of lungs impedance (Z) and requires elevation of peak inspiratory pressure (PIP), mean airway pressure (MAP), and work of breathing (WOB). Infant hybrid (numerical-physical) respiratory simulator and a ventilator were used to simulate conventional ventilation of homogeneous and inhomogeneous lungs, and to measure PIP, MAP and WOB. A high correlation was found between Z, WOB, PIP, MAP and the T₁T₂^_1 index (r = 0.9, P < 0.001). The increase of T₁T₂^_1 index from 1 to 20 resulted in significant rise of WOB, PIP and MAP, e.g. at RR = 60 bpm, the WOB (1.05 → 1.49∙J^_l), PIP (15.2 →20.5 cmH₂O) and MAP (6.8 → 8.4 cmH₂O), P < 0.005. It seems that T₁T₂^_1 index could be used for prediction of PIP and MAP required to achieve effective ventilation in CDH infants; it also may affect the choice of ventilation strategy (CMV or HFV) as well as ventilator settings on CMV. We show how the relationships between WOB, PIP, MAP and the T₁T₂^_1

Słowa kluczowe

EN

infant; congenital diaphragmatic hernia; lung inhomogeneity; mechanical ventilation settings; ventilator-induced lung injury; VILI; hybrid simulation

PL

niemowlę; przepuklina przeponowa; wentylacja mechaniczna; VILI; symulacja hybrydowa

• Wydawca: Nałęcz Institute of Biocybernetics and Biomedical Engineering of the Polish Academy of Sciences ; Elsevier
• Czasopismo: Biocybernetics and Biomedical Engineering
• Rocznik: 2021
• Tom: Vol. 41, no. 4
• Strony: 1378--1389
• Opis fizyczny: Bibliogr. 58 poz., rys., tab., wykr.

Twórcy

autor

Stankiewicz Barbara

• Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 4 Ks. Trojdena 4, 02-109 Warsaw, Poland

autor

Mierzewska-Schmidt Magdalena

• Department of Paediatric Anaesthesiology and Intensive Therapy, Medical University of Warsaw, Warsaw, Poland

autor

Górczyńska Krystyna

• Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland

autor

Pałko Krzysztof J.

• Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland

autor

Baranowski Artur

• Department of Paediatric Anaesthesiology and Intensive Therapy, Medical University of Warsaw, Warsaw, Poland

autor

Kozarski Maciej

• Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland

autor

Darowski Marek

• Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland

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