Minimization of Ventilator-Induced Lung Injury in ARDS Patients – Part I: Complex Model of Mechanically Ventilated ARDS Lungs

• Autorzy: Glapiński J. , Jabłoński I.

Identyfikatory

DOI

10.1515/mms-2017-0053

• Języki publikacji: EN

Abstrakty

EN

A complex model of mechanically ventilated ARDS lungs is proposed in the paper. This analogue is based on a combination of four components that describe breathing mechanics: morphology, mechanical properties of surfactant, tissue and chest wall characteristics. Physical-mathematical formulas attained from experimental data have been translated into their electrical equivalents and implemented in MultiSim software. To examine the adequacy of the forward model to the properties and behaviour of mechanically ventilated lungs in patients with ARDS symptoms, several computer simulations have been performed and reported in the paper. Inhomogeneous characteristics observed in the physical properties of ARDS lungs were mapped in a multi-lobe model and the measured outputs were compared with the data from physiological reports. In this way clinicians and scientists can obtain the knowledge on the moment of airway zone reopening/closure expressed as a function of pressure, volume or even time. In the paper, these trends were assessed for inhomogeneous distributions (proper for ARDS) of surfactant properties and airway geometry in consecutive lung lobes. The proposed model enables monitoring of temporal alveolar dynamics in successive lobes as well as those occurring at a higher level of lung structure organization, i.e. in a point P₀ which can be used for collection of respiratory data during indirect management of recruitment/de-recruitment processes in ARDS lungs. The complex model and synthetic data generated for various parametrization scenarios make possible prospective studies on designing an indirect mode of alveolar zone management, i.e. with a minimized risk of repeated alveolar recruitment/de-recruitment and mechanical overstraining of lung tissues.

Słowa kluczowe

EN

lung alveolar surfactant; respiratory mechanics; mathematical modelling; medical decision support; lung protective ventilation

• Wydawca: Komitet Metrologii i Aparatury Naukowej PAN
• Czasopismo: Metrology and Measurement Systems
• Rocznik: 2017
• Tom: Vol. 24, nr 4
• Strony: 685--699
• Opis fizyczny: Bibliogr. 47 poz., rys., wykr., wzory

Twórcy

autor

Glapiński J.

• Wrocław University of Science and Technology, Faculty of Electronics, Wybrzeże Wyspiańskiego 27, 50-370 Wrocław, Poland

autor

Jabłoński I.

• Wrocław University of Science and Technology, Faculty of Electronics, Wybrzeże Wyspiańskiego 27, 50-370 Wrocław, Poland

Bibliografia

• [1] Rubenfeld, G.D. (2003). Epidemiology of acute lung injury. Crit Care Med., 31, 276-284.
• [2] Dreyfuss, D., Saumon, G. (1998). Ventilator-induced lung injury: lessons from experimental studies. Am J. Resp. Crit. Care Med., 157, 294-323.
• [3] Allen, G.B., Suratt, B.T., Rinaldi, L., Petty, J.M., Bates, J.H. (2006). Choosing the frequency of deep inflation in mice: balancing recruitment against ventilator-induced lung injury. Am J. Physiol. Lung Cell Mol. Physiol., 291, L710-L717.
• [4] Slutsky, A.S. (1999). Lung injury caused by mechanical ventilation. Chest, 116, 9-15.
• [5] Hickling, K.G. (2001). Best compliance during a decremental, but not incremental, positive end-expiratory pressure trial is related to open-lung positive end-expiratory pressure: a mathematical model of acute respiratory distress syndrome lungs. Am J. Respir. Crit. Care Med., 163, 69-78.
• [6] Hickling, K.G. (1998). The pressure-volume curve is greatly modified by recruitment. A mathematical model of ARDS lungs. Am J. Respir. Crit. Care Med., 158, 194-202.
• [7] Pavone, L.A., Albert, S., Carney, D., Gatto, L.A., Halter, J.M., Nieman, G.F. (2007). Injurious mechanical ventilation in the normal lung causes a progressive pathologic change in dynamic alveolar mechanics. Crit. Care, 11, R64.
• [8] Lachmann, B. (1992). Open up the lung and keep the lung open. Intensive Care Med., 18, 319-321
• [9] Amato, M.B., Barbas, C.S., Medeiros, D.M., Magaldi, R.B., Schettino, G.P., Lorenzi-Filho, G., Kairalla, R.A., Deheinzelin, D., Munoz, C., Oliveira, R., Takagaki, T.Y., Carvalho, C.R. (1998). Effect of a protectiveventilation strategy on mortality in the acute respiratory distress syndrome. N. Engl. J. Med., 338, 347-354.
• [10] Alencar, A.M., Buldyrev, S.V., Majumdar, A., Stanley, H.E., Suki, B. (2001). Avalanche dynamics of crackle sound in the lung. Phys. Rev. Lett., 87, 088101.
• [11] Zhao, P., Yang, J., He, Y. (2017). Analysing the therapeutical action of lung recruitment maneuver on patients with acute respiratory distress syndrome by comparing different ventilation strategies. Biomedical Research, 28(4), 1828-1831.
• [12] Bates, J.H., Irvin, C.G. (2002). Time dependence of recruitment and derecruitment in the lung: a theoretical model. J. Appl. Physiol. Respir. Environ. Exercise Physiol., 93, 705-713.
• [13] Brower, R.G., Morris, A., MacIntyre, N., Matthay, M.A., Hayden, D., Thompson, T., Clemmer, T., Lanken, P.N., Schoenfeld, D. (2003). Effects of recruitment maneuvers in patients with acute lung injury and acute respiratory distress syndrome ventilated with high positive end-expiratory pressure. Crit. Care Med., 31, 2592-2597.
• [14] Meade, M.O., Cook, D.J., Guyatt, G.H., Slutsky, A.S., Arabi, Y.M., Cooper, D.J., Davies, A.R., Hand, L.E., Zhou, Q., Thabane, L., Austin, P., Lapinsky, S., Baxter, A., Russell, J., Skrobik, Y., Ronco, J.J., Stewart, T.E. (2008). Ventilation strategy using low tidal volumes, recruitment maneuvers, and high positive end expiratory pressure for acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA, 299, 637-645.
• [15] Albert, P., DiRocco, J., Allen, G.B., Bates, J.H.T., Lafollette, R., Kubiak, B.D., Fischer, J., Maroney, S., Nieman, G.F. (2009). The role of time and pressure on alveolar recruitment. J. Appl. Physiol., 106, 757-765.
• [16] Ma, B., Bates, J.H.T. (2010). Modeling the complex dynamics of derecruitmentin the lung. Ann. Biomed. Eng., 38, 3466-3477.
• [17] Bates, J.H.T., Irvin, C.G. (2002). Time dependence of recruitment and derecruitmentin the lung: A theoretical model. J. Appl. Physiol., 93, 705-713.
• [18] DiRocco, J.D., Carney, D.E., Nieman, G.F. (2007). Correlation between alveolar recruitment/derecruitment and inflection points on the pressurevolumecurve. Intensive Care Med., 33, 1204-11.
• [19] Hickling, K.G. (1998). The pressure-volume curve is greatly modified by recruitment. A mathematical model of ARDS lungs. Amer. J. Respir. Crit.Care Med., 158, 194-202.
• [20] Steimle, K.L., Mogensen, M.L., Karbing, D.S., de la Serna, J.B., Smith, B.W., Vacek, O., Andreassen, S. (2009). A Mathematical Physiological Model of the Pulmonary Ventilation. Proc. of the 7th IFAC Symposium on Modelling and Control in Biomedical Systems Aalborg, Denmark.
• [21] Lutchen, K.R., Costa, K.D. (1990). Physiological interpretations based on lumped element models fit to respiratory impedance data: use of forward-inverse modeling. IEEE Transactions on Biomedical Engineering, 37, 1076-1086.
• [22] Polak, A., Mroczka, J. (2006). Nonlinear model for mechanical ventilation of human lungs. Comp. Biol. Med., 36(1), 41-58.
• [23] Polak, A. (2002). A Morphometric Model of Lung Mechanics for Time-Domain Analysis of Alveolar Pressures during Mechanical Ventilation. Ann. Biomed. Eng., 30(4), 537-45.
• [24] Jabłoński, I., Mroczka, J. (2009). Frequency-domain identification of the respiratory system model during the interrupter experiment. Measurement, 42(3), 390-398.
• [25] Valberg, P.A., Brain, J.D. (1977). Lung surface tension and air space dimensions from multiple pressurevoume curves. J. Appl. Physiol., 43, 730-738.
• [26] Sturm, R. (2015). A computer model for the simulation of nanoparticle deposition in the alveolar structures of the human lungs. Annals of Translational Medicine, 3(19).
• [27] Reifenrath, R. (1975). The significance of alveolar geometry and surface tension in the respiratory mechanics of the lung. Respiration Physiology, 24(2), 115-137.
• [28] Clements, J.A., Hustead, R.F., Johnson, R.P., Gribetz, I. (1961). Pulmonary surface tension and alveolar stability. Journal of Applied Physiology, 16(3), 444-450.
• [29] Lu, J.Y., Distefano, J., Philips, K., Chen, A.W. (1999). Neumann Effect of the compression ratio on properties of lung surfactant (bovine lipid extract surfactant) films. Respiration Physiology, 115, 55-71.
• [30] Sharp, J.T., Johnson, F.N., Goldberg, N.B., Van Lith, P. (1967). Hysteresis and stress adaptation in the human respiratory system. J. Appl. Physiol., 23(4), 487-97.
• [31] Smith, J.C., Stamenovic, D. (1986). Surface forces in lungs. I. Alveolar surface tension-lung volume elationships. J. Appl. Physiol., 60, 1351-1350.
• [32] Steimle, K.L., Mogensen, M.L., Karbing, D.S., Bernardino de la Serna, J., Andreassen, S. (2010). A model of ventilation of the healthy human lung. Comput. Methods Programs Biomed., 101(2), 144-155.
• [33] Konno, K., Mead, J. (1968). Static volume-pressure characteristics of the rib cage and abdomen. J. Appl. Physiol., 24(4), 544-548.
• [34] Goldman, M.D., Mead, J. (1973). Mechanical interaction between the diaphragm and rib cage. Journal of Applied Physiology Published, 35(2), 197-204.
• [35] Steimle, K.L., Mogensen, M.L., Karbing, D.S., Bernardino de la Serna, J., Andreassen, S. (2010). A model of ventilation of the healthy human lung. Comput Methods Programs Biomed., 101(2), 144−55.
• [36] Jabłoński, I., Polak, A.G., Mroczka, J. (2011). A preliminary study on the accuracy of respiratory input interrupter measurement using the interrupter technique. Computer Methods & Programs in Biomedicine, 101(2), 115-125.
• [37] Jabłoński, I. (2013). Computer assessment of indirect insight during airflow interrupter maneuver of breathing. Computer Methods & Programs in Biomedicine, 110(3), 320-332.
• [38] Kretschmer, J., Wahl, A., Moller, K. (2011). Dynamically generated models for medical decision support systems. Computers in Biology and Medicine, 41, 899-907.
• [39] Malarkkan, N., Snook, N.J., Lumb, A.B. (2003). New aspects of ventilation in acute lung injury. Anaesthesia, 58(7), 627-728.
• [40] Amato, M.B., Barbas, C.S., Medeiros, D.M., Magaldi, R.B., Schettino, G.P., Lorenzi-Filho, G., Kairalla, R.A., Deheinzelin, D., Munoz, C., Oliveira, R., Takagaki, T.Y., Carvalho, C.R. (1998). Effect of a protectiveventilation strategy on mortality in the acute respiratory distress syndrome. N. Engl. J. Med., 338, 347-354.
• [41] Putensen, C., Zech, S., Wrigge, H., Zinserling, J., Stuber, F., Spirgel, T., Mutz, N. (2001). Long-Term Effects of Spontaneous Breathing During Ventilatory Support in Patients with Acute Lung Injury. Am J. of Resp. and Critical Care Med., 164(1).
• [42] Harris, R.S.M. (2005). Pressure-Volume Curves of the Respiratory System. Respiratory Care January, 50(1).
• [43] Schoel, W., Schürch, S., Goerke, J. (1994). The captive bubble method for the evaluation of pulmonary surfactant: surface tension, area, and volume calculations. Biochimica et Biophysica Acta (BBA) − General Subjects, 1200(3), 281-290.
• [44] Schürch, S. (1982). Surface tension at low lung volumes: Dependence on time and alveolar size. Respiration Physiology, 48(3), 339-355.
• [45] Boker, A., Haberman, C.J., Girling, L., Guzman, R.P., Louridas, G., Tanner, J.R., Cheang, M., Maycher, B.W., Bell, D.D., Doak, G.J. (2004). Variable ventilation improves perioperative lung function in patients undergoing abdominal aortic aneurysmectomy. Anesthesiology, 100(3), 608-616.
• [46] Spieth, P., Carvalho, A., Pelosi, P., Hoehn, C., Meissner, C., Kasper, M., Hübler, M., von Neindorff, M., Dassow, C., Barrenschee, M., Uhlig, S., Koch, T., de Abreu, M.G. (2009). Variable Tidal Volumes Improve Lung Protective Ventilation Strategies in Experimental Lung Injury. American Journal of Respiratory and Critical Care Medicine, 179(8).
• [47] Mroczka, J., Szczuczyński, D. (2009). Inverse problems formulated in terms of first-kind fredholm integral equations in indirect measurements. Metrol. Meas. Syst., 16(3), 333-357.

Uwagi

EN

This work was supported by the National Science Centre under decision DEC-2013-11-BST7-01173.

PL

Opracowanie ze środków MNiSW w ramach umowy 812/P-DUN/2016 na działalność upowszechniającą naukę (zadania 2017).