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  • Author: Paul D. Docherty x
  • SPRACHE: English x
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Abstract

Mathematical models can be employed to simulate a patient’s individual physiology and can therefore be used to predict reactions to changes in the therapy. To be clinically useful, those models need to be identifiable from data available at the bedside. Gradient based methods to identify the values of the model parameters that represent the recorded data highly depend on the initial estimates. The proposed work implements a previously developed method to overcome those dependencies to identify a three parameter model of gas exchange. The proposed hierarchical method uses models of lower order related to the three parameter model to calculate valid initial estimates for the parameter identification. The presented approach was evaluated using 12 synthetic patients and compared to a traditional direct approach as well as a global search method. Results show that the direct approach is highly dependent on how well the initial estimates are selected, while the hierarchical approach was able to find correct parameter values in all tested patients.

Abstract

For patients with acute respiratory distress syndrome (ARDS), the use of mathematical models to determine patient-specific ventilator settings can reduce ventilator induced lung injury and improve patient outcomes. A non-linear autoregressive model of pulmonary mechanics was used to identify inspiratory and expiratory pressure-dependent elastance (Ei and Ee) as independent variables. The analysis was implemented on 19 data sets of recruitment manoeuvres (RMs) that were performed on 10 mechanically ventilated patients. At pressures p = 15–20 cmH2O the agreement between Ei and Ee was low. However, Ei was a well-matched predictor of Ee for p = 25–40 cmH2O, with R2 ≥ 0.78, and there was no significant bias in the difference between Ei and Ee. Since many other models cannot uniquely identify Ei and Ee, the outcome may provide further insight into the characteristics of ARDS lungs in sedated patients.

Abstract

The risk of ventilator induced lung injury in mechanically ventilated (MV) critically ill patients can be mitigated by patient-specific optimisation of ventilator settings. Recent studies have shown that driving pressure, i.e. the difference between plateau pressure (Pplat) and PEEP, is a strong indicator for survival in MV patients suffering from ARDS. However, to measure Pplat, an extended end-inspiratory pause (EIP) has to be applied, possibly interrupting ventilation therapy. This study presents a method for predicting Pplat from normal breaths in MV patients.

A total of 859 MV breaths with a 5 second EIP were recorded in 27 MV patients with ARDS. Two methods for determining Pplat were tested, one using an exponential fit of the pressure data and the other using a four-parameter viscoelastic model (VEM). Each method was identified using various lengths of data after the peak inspiratory pressure (PIP). Using the identified parameters, both methods were then used to predict the Pplat recorded at 5 seconds.

The exponential method showed a median coefficient of variation (CV) from the real Pplat of 42.9% using data from PIP to 0.5 seconds after PIP, 24.9% using 1 second of data and 15.2% using 1.5 seconds of data. The respective VEM prediction median CVs were of 17.2%, 9.7% and 8.4%. Therefore, the VEM showed a better prediction than the non-physiological exponential model, allowing it to be used to reduce the clinical burden of determining Pplat by reducing the required length of the EIP to 1.5 seconds.

Abstract

Respiratory system modelling can enable patient-specific mechanical ventilator settings to be found, and can thus reduce the incidence of ventilator induced lung injury in the intensive care unit. The resistance of a simple first order model (FOM) of pulmonary mechanics was compared with a flow dependent term of a non-linear autoregressive (NARX) model. Model parameters were identified for consecutive non-overlapping windows of length 20 breaths. The analysis was performed over recruitment manoeuvres for 25 sedated mechanically ventilated patients. The NARX model term, b1, consistently decreased as positive end expiratory pressure (PEEP) increased, while the FOM resistance behaviour varied. Overall the NARX b1 behaviour is more in-line with expected trends in airway resistance as PEEP increases. This work has further verified the physiologically descriptive capability of the NARX model.

Abstract

Compliant phantoms of the human aortic arch can mimic patient specific cardiovascular dysfunctions in vitro. Hence, phantoms may enable elucidation of haemodynamic disturbances caused by aortic dysfunction. This paper describes the fabrication of a thin-walled silicone phantom of the human ascending aorta and brachiocephalic artery. The model geometry was determined via a meta-analysis and modelled in SolidWorks before 3D printing. The solid model surface was smoothed and scanned with a 3D scanner. An offset outer mould was milled from Ebalta S-Model board. The final phantom indicated that ABS was a suitable material for the internal model, the Ebalta S-Model board yielded a rough external surface. Co-location of the moulds during silicone pour was insufficient to enable consistent wall thickness. The resulting phantom was free of air bubbles but did not have the desired wall thickness consistency.