In silico testing of a non‑invasive, individualised PEEP titration method for optimal lung compliance during pressure support ventilation

R. Warnaar*, E. Oppersma, A. Cornet, D. Donker

*Corresponding author for this work

Research output: Contribution to journalMeeting AbstractAcademic

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Introduction: Comprehensive quantification of respiratory system mechanics during pressure support ventilation (PSV) classically requires invasive measurements or interruptions of spontaneous breathing. This limits broad clinical applicability of these methods for lung compliance optimisation during PSV. Therefore, we present a non-invasive approach for individualised PEEP titration based on dynamic lung compliance measurements at the bedside.
Objectives: This study focuses on the sensitivity of a non-invasive method for bedside quantification of dynamic lung compliance in response to simulated PEEP interventions in patients receiving PSV.
Methods: An individual patient’s respiratory system was modelled in Simulink R2020b (The MathWorks, Inc., MA, USA) as an electrical ana-logue with a pressure dependent lung compliance (Fig. 1a). This in silico patient was ventilated in PSV mode applying 7 different PEEP levels: 0, 2, 4, 6, 8, 10, 12, and 14 cmH2O. Simulations were run during spontaneous breathing at each PEEP level. The expiratory time constant (RC-time = air-way resistance * respiratory system compliance = RAW * CRS) was esti-mated [1]. The airway resistance was determined as the time derivative of the airway pressure divided by the time derivative of the flow, both around zero flow at end-inspiration. CRS was calculated as the RC-time over the median airway resistance over all breaths. The correlation between true, i.e. modelled, and measured compliance was quantified with the Pearson correlation coefficient.Results. Both measured and modelled CRS at each PEEP level are shown in Fig. 1b. The measured compliances correlate well with the modelled compliances (r = 0.85, p < 0.01), although they show a systematic offset. Importantly, individualised titration of PEEP was possible using the pro-posed method, as the PEEP level for maximal lung compliance was iden-tical in both curves.
Conclusion: We demonstrate that this method allows for non-invasive, individualised PEEP titration during PSV ventilation in a modelled clinical case. This approach has great potential for future bedside use, and there-fore deserves further clinical testing, aiming to optimise pressure sup-port ventilation, and promote patient-ventilator synchrony and weaning.
Original languageEnglish
Article number000429
Pages (from-to)120-121
Number of pages2
JournalIntensive Care Medicine Experimental
Issue numberSupplement 1
Publication statusPublished - 29 Sep 2021
EventESICM 34th Annual Congress, LIVES 2021 - Virtual
Duration: 3 Oct 20216 Oct 2021
Conference number: 34


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