Evaluation of the accuracy of established patient inspiratory effort estimation methods during mechanical support ventilation
There is a clinical need for monitoring inspiratory effort to prevent lung- and diaphragm injury in patients who receive supportive mechanical ventilation in an Intensive Care Unit. Different pressure-based techniques are available to estimate this inspiratory effort at the bedside, but the accuracy...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-02-01
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| Series: | Heliyon |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405844023008174 |
| _version_ | 1811161698152742912 |
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| author | A. van Diepen T.H.G.F. Bakkes A.J.R. De Bie S. Turco R.A. Bouwman P.H. Woerlee M. Mischi |
| author_facet | A. van Diepen T.H.G.F. Bakkes A.J.R. De Bie S. Turco R.A. Bouwman P.H. Woerlee M. Mischi |
| author_sort | A. van Diepen |
| collection | DOAJ |
| description | There is a clinical need for monitoring inspiratory effort to prevent lung- and diaphragm injury in patients who receive supportive mechanical ventilation in an Intensive Care Unit. Different pressure-based techniques are available to estimate this inspiratory effort at the bedside, but the accuracy of their effort estimation is uncertain since they are all based on a simplified linear model of the respiratory system, which omits gas compressibility of air, and the viscoelasticity and nonlinearities of the respiratory system. The aim of this in-silico study was to provide an overview of the pressure-based estimation techniques and to evaluate their accuracy using a more sophisticated model of the respiratory system and ventilator.The influence of the following parameters on the accuracy of the pressure-based estimation techniques was evaluated using the in-silico model: 1) the patient's respiratory mechanics 2) PEEP and the inspiratory pressure of the ventilator 3) gas compressibility of air 4) viscoelasticity of the respiratory system 5) the strength of the inspiratory effort.The best-performing technique in terms of accuracy was the whole breath occlusion. The average error and maximum error were the lowest for all patient archetypes. We found that the error was related to the expansion of gas in the breathing set and lungs and respiratory compliance. However, concerns exist that other factors not included in the model, such as a changed muscle-force relation during an occlusion, might influence the true accuracy. The estimation techniques based on the esophageal pressure showed an error related to the viscoelastic element in the model which leads to a higher error than the occlusion. The error of the esophageal pressure-based techniques is therefore highly dependent on the pathology of the patient and the settings of the ventilator and might change over time while a patient recovers or becomes more ill. |
| first_indexed | 2024-04-10T06:19:34Z |
| format | Article |
| id | doaj.art-79723b2a56b04d7aa6df4a0724c34084 |
| institution | Directory Open Access Journal |
| issn | 2405-8440 |
| language | English |
| last_indexed | 2024-04-10T06:19:34Z |
| publishDate | 2023-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Heliyon |
| spelling | doaj.art-79723b2a56b04d7aa6df4a0724c340842023-03-02T05:02:15ZengElsevierHeliyon2405-84402023-02-0192e13610Evaluation of the accuracy of established patient inspiratory effort estimation methods during mechanical support ventilationA. van Diepen0T.H.G.F. Bakkes1A.J.R. De Bie2S. Turco3R.A. Bouwman4P.H. Woerlee5M. Mischi6Department of Electrical Engineering, Technische Universiteit Eindhoven, De Zaale, Eindhoven, 5612AZ, Noord-Brabant, the Netherlands; Corresponding author.Department of Electrical Engineering, Technische Universiteit Eindhoven, De Zaale, Eindhoven, 5612AZ, Noord-Brabant, the NetherlandsCatharina Hospital, Michelangelolaan 2, Eindhoven, 5623 EJ, Noord-Brabant, the NetherlandsDepartment of Electrical Engineering, Technische Universiteit Eindhoven, De Zaale, Eindhoven, 5612AZ, Noord-Brabant, the NetherlandsDepartment of Electrical Engineering, Technische Universiteit Eindhoven, De Zaale, Eindhoven, 5612AZ, Noord-Brabant, the Netherlands; Catharina Hospital, Michelangelolaan 2, Eindhoven, 5623 EJ, Noord-Brabant, the NetherlandsDepartment of Electrical Engineering, Technische Universiteit Eindhoven, De Zaale, Eindhoven, 5612AZ, Noord-Brabant, the NetherlandsDepartment of Electrical Engineering, Technische Universiteit Eindhoven, De Zaale, Eindhoven, 5612AZ, Noord-Brabant, the NetherlandsThere is a clinical need for monitoring inspiratory effort to prevent lung- and diaphragm injury in patients who receive supportive mechanical ventilation in an Intensive Care Unit. Different pressure-based techniques are available to estimate this inspiratory effort at the bedside, but the accuracy of their effort estimation is uncertain since they are all based on a simplified linear model of the respiratory system, which omits gas compressibility of air, and the viscoelasticity and nonlinearities of the respiratory system. The aim of this in-silico study was to provide an overview of the pressure-based estimation techniques and to evaluate their accuracy using a more sophisticated model of the respiratory system and ventilator.The influence of the following parameters on the accuracy of the pressure-based estimation techniques was evaluated using the in-silico model: 1) the patient's respiratory mechanics 2) PEEP and the inspiratory pressure of the ventilator 3) gas compressibility of air 4) viscoelasticity of the respiratory system 5) the strength of the inspiratory effort.The best-performing technique in terms of accuracy was the whole breath occlusion. The average error and maximum error were the lowest for all patient archetypes. We found that the error was related to the expansion of gas in the breathing set and lungs and respiratory compliance. However, concerns exist that other factors not included in the model, such as a changed muscle-force relation during an occlusion, might influence the true accuracy. The estimation techniques based on the esophageal pressure showed an error related to the viscoelastic element in the model which leads to a higher error than the occlusion. The error of the esophageal pressure-based techniques is therefore highly dependent on the pathology of the patient and the settings of the ventilator and might change over time while a patient recovers or becomes more ill.http://www.sciencedirect.com/science/article/pii/S2405844023008174Pressure support ventilationWork of breathingPressure-time productInspiratory effort |
| spellingShingle | A. van Diepen T.H.G.F. Bakkes A.J.R. De Bie S. Turco R.A. Bouwman P.H. Woerlee M. Mischi Evaluation of the accuracy of established patient inspiratory effort estimation methods during mechanical support ventilation Heliyon Pressure support ventilation Work of breathing Pressure-time product Inspiratory effort |
| title | Evaluation of the accuracy of established patient inspiratory effort estimation methods during mechanical support ventilation |
| title_full | Evaluation of the accuracy of established patient inspiratory effort estimation methods during mechanical support ventilation |
| title_fullStr | Evaluation of the accuracy of established patient inspiratory effort estimation methods during mechanical support ventilation |
| title_full_unstemmed | Evaluation of the accuracy of established patient inspiratory effort estimation methods during mechanical support ventilation |
| title_short | Evaluation of the accuracy of established patient inspiratory effort estimation methods during mechanical support ventilation |
| title_sort | evaluation of the accuracy of established patient inspiratory effort estimation methods during mechanical support ventilation |
| topic | Pressure support ventilation Work of breathing Pressure-time product Inspiratory effort |
| url | http://www.sciencedirect.com/science/article/pii/S2405844023008174 |
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