Journal article
Computationally-directed mechanical ventilation in a porcine model of ARDS
Frontiers in physiology, Vol.16, 1602578
11/01/2025
DOI: 10.3389/fphys.2025.1602578
PMCID: PMC12689400
PMID: 41384246
Abstract
BackgroundDespite the implementation of protective mechanical ventilation, ventilator-induced lung injury remains a significant driver of ARDS-associated morbidity and mortality. Mechanical ventilation must be personalized and adaptive for the patient and evolving disease course to achieve sustained improvements in patient outcomes. In this study, we modified a military-grade transport ventilator to deliver the airway pressure release ventilation (APRV) modality. We developed a computationally-directed (CD) method of adjusting the expiratory duration (TLow) during APRV using physiologic feedback to reduce alveolar derecruitment and tested this modality in a porcine model of moderate-to-severe ARDS.MethodsFemale Yorkshire-cross pigs (n = 27) were ventilated using a ZOLL EMV+® 731 Series ventilator during general anesthesia and subjected to a heterogeneous Tween lung injury followed by injurious mechanical ventilation. Animals were subsequently ventilated for 6 hours under general anesthesia after randomization to one of three groups: VT6 (n = 9) with a tidal volume (VT) of 6 mL/kg and stepwise adjustments in PEEP and FiO2; VT10 (n = 9) with VT of 10 mL/kg and PEEP of 5 cmH2O; CD-APRV group (n = 9) with computationally-directed adjustments in TLow based on a nonlinear equation of motion to describe respiratory mechanics. Results are reported as median [interquartile range].ResultsAll groups developed moderate-to-severe ARDS and had similar recovery in lung injury, with all demonstrating final PaO2:FiO2 > 300 mmHg (VT6: 415.5 [383.0–443.4], VT10: 353.3 [297.3–397.7], CD-APRV: 316.6 [269.8–362.4]; p = 0.12). PaCO2 was significantly higher in the VT6 group compared with the CD-APRV group (59.3 [52.3–60.1] mmHg vs. 38.5 [32.7–52.2] mmHg, p = 0.04) but not significantly different from the VT10 group (47.5 [45.3–54.4] mmHg; p = 0.32 vs. VT6) despite having a significantly higher respiratory rate (30.0 [30.0–32.0] breaths/min) compared with VT10 (12.0 [12.0–15.0] breaths/min, p = 0.001) and CD-APRV (14.0 [14.0–14.0] breaths/min, p < 0.001) groups at the study end.ConclusionWe successfully implemented a computationally directed APRV modality on a transport ventilator, adjusting TLow based on respiratory mechanics. This study demonstrated that CD-APRV can be safely used, with the advantage of guiding expiratory duration adjustments based on physiologic feedback from the lungs.
Details
- Title: Subtitle
- Computationally-directed mechanical ventilation in a porcine model of ARDS
- Creators
- Michaela Kollisch-Singule - University of Arkansas Medical CenterAndrea F. Cruz - University of Iowa, AnesthesiaJacob Herrmann - University of IowaJoshua Satalin - SUNY Upstate Medical UniversitySarah Satalin - SUNY Upstate Medical UniversityBrian P. Harvey - ZOLL Medical CorporationDorian LeCroy - ZOLL Medical CorporationGeorge Beck - ZSX MedicalMark Lutz - SUNY Upstate Medical UniversityJacob Charlamb - SUNY Upstate Medical UniversityJoshua Kenna - SUNY Upstate Medical UniversityMark Baker - State University of New York at OswegoGary F. Nieman - SUNY Upstate Medical UniversityDavid W. Kaczka - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Frontiers in physiology, Vol.16, 1602578
- DOI
- 10.3389/fphys.2025.1602578
- PMID
- 41384246
- PMCID
- PMC12689400
- NLM abbreviation
- Front Physiol
- ISSN
- 1664-042X
- eISSN
- 1664-042X
- Publisher
- Frontiers Media S.A
- Grant note
- Office of the Assistant Secretary of Defense for Health Affairs, Peer Reviewed Medical Research Program: W81XWH-20-1-0696, W81XWH-21-1-0507 NIH: R01HL142702
The authors declare that financial support was received for the research and/or publication of this article. This project was supported by the Office of the Assistant Secretary of Defense for Health Affairs, Peer Reviewed Medical Research Program, Awards W81XWH-20-1-0696 and W81XWH-21-1-0507. Opinions, interpretations, conclusions, and recommendations are those of the authors, and are not necessarily endorsed by the Department of Defense. This work was also supported by NIH grant R01HL142702.
- Language
- English
- Date published
- 11/01/2025
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Radiology; Anesthesia
- Record Identifier
- 9985089134002771
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