Journal article
Intratidal Overdistention and Derecruitment in the Injured Lung: A Simulation Study
IEEE transactions on biomedical engineering, Vol.64(3), pp.681-689
03/2017
DOI: 10.1109/TBME.2016.2572678
PMCID: PMC5218981
PMID: 27244715
Abstract
Goal: Ventilated patients with the acute respiratory distress syndrome (ARDS) are predisposed to cyclic parenchymal overdistention and derecruitment, which may worsen existing injury. We hypothesized that intratidal variations in global mechanics, as assessed at the airway opening, would reflect such distributed processes. Methods: We developed a computational lung model for determining local instantaneous pressure distributions and mechanical impedances continuously during a breath. Based on these distributions and previous literature, we simulated the within-breath variability of airway segment dimensions, parenchymal viscoelasticity, and acinar recruitment in an injured canine lung for tidal volumes(V T ) of 10, 15, and 20 mL · kg -1 and positive end-expiratory pressures (PEEP) of 5, 10, and 15 cm H 2 O. Acini were allowed to transition between recruited and derecruited states when exposed to stochastically determined critical opening and closing pressures, respectively. Results: For conditions of low V T and low PEEP, we observed small intratidal variations in global resistance and elastance, with a small number of cyclically recruited acini. However, with higher V T and PEEP, larger variations in resistance and elastance were observed, and the majority of acini remained open throughout the breath. Changes in intratidal resistance, elastance, and impedance followed well-defined parabolic trajectories with tracheal pressure, achieving minima near 12 to 16 cm H 2 O. Conclusion: Intratidal variations in lung mechanics may allow for optimization of ventilator settings in patients with ARDS, by balancing lung recruitment against parenchymal overdistention. Significance: Titration of airway pressures based on variations in intratidal mechanics may mitigate processes associated with injurious ventilation.
Details
- Title: Subtitle
- Intratidal Overdistention and Derecruitment in the Injured Lung: A Simulation Study
- Creators
- Reza Amini - Beth Israel Deaconess Medical Center and Harvard Medical SchoolJacob Herrmann - University of IowaDavid W Kaczka - University of Iowa, Iowa City, IA, USA
- Resource Type
- Journal article
- Publication Details
- IEEE transactions on biomedical engineering, Vol.64(3), pp.681-689
- DOI
- 10.1109/TBME.2016.2572678
- PMID
- 27244715
- PMCID
- PMC5218981
- NLM abbreviation
- IEEE Trans Biomed Eng
- ISSN
- 0018-9294
- eISSN
- 1558-2531
- Publisher
- IEEE
- Grant note
- HL112547 (RA); HL108724 (DWK) / National Institutes of Health (10.13039/100000002)
- Language
- English
- Date published
- 03/2017
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Radiology; Anesthesia
- Record Identifier
- 9984007168802771
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