Intracycle power and ventilation mode as potential contributors to ventilator-induced lung injury

Abstract Background High rates of inflation energy delivery coupled with transpulmonary tidal pressures of sufficient magnitude may augment the risk of damage to vulnerable, stress-focused units within a mechanically heterogeneous lung. Apart from flow amplitude, the clinician-selected flow waveform...

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Autores principales:	John J. Marini, Philip S. Crooke, Pierre Tawfik, Robert L. Chatburn, David J. Dries, Luciano Gattinoni
Formato:	article
Lenguaje:	EN
Publicado:	SpringerOpen 2021
Materias:	Mechanical ventilation Mathematical model Ventilator-induced lung injury VILI Power Intracycle power Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
Acceso en línea:	https://doaj.org/article/66c4350c2ab34582be860ad6775d8cfa
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spelling	oai:doaj.org-article:66c4350c2ab34582be860ad6775d8cfa2021-11-08T10:57:59ZIntracycle power and ventilation mode as potential contributors to ventilator-induced lung injury10.1186/s40635-021-00420-92197-425Xhttps://doaj.org/article/66c4350c2ab34582be860ad6775d8cfa2021-11-01T00:00:00Zhttps://doi.org/10.1186/s40635-021-00420-9https://doaj.org/toc/2197-425XAbstract Background High rates of inflation energy delivery coupled with transpulmonary tidal pressures of sufficient magnitude may augment the risk of damage to vulnerable, stress-focused units within a mechanically heterogeneous lung. Apart from flow amplitude, the clinician-selected flow waveform, a relatively neglected dimension of inflation power, may distribute inflation energy of each inflation cycle non-uniformly among alveoli with different mechanical properties over the domains of time and space. In this initial step in modeling intracycle power distribution, our primary objective was to develop a mathematical model of global intracycle inflation power that uses clinician-measurable inputs to allow comparisons of instantaneous ICP profiles among the flow modes commonly encountered in clinical practice: constant, linearly decelerating, exponentially decelerating (pressure control), and spontaneous (sinusoidal). Methods We first tested the predictions of our mathematical model of passive inflation with the actual physical performance of a mechanical ventilator–lung system that simulated ventilation to three types of patients: normal, severe ARDS, and severe airflow obstruction. After verification, model predictions were then generated for 5000 ‘virtual ARDS patients’. Holding constant the tidal volume and inflation time between modes, the validated model then varied the flow profile and quantitated the resulting intensity and timing of potentially damaging ‘elastic’ energy and intracycle power (pressure–flow product) developed in response to random combinations of machine settings and severity levels for ARDS. Results Our modeling indicates that while the varied flow patterns ultimately deliver similar total amounts of alveolar energy during each breath, they differ profoundly regarding the potentially damaging pattern with which that energy distributes over time during inflation. Pressure control imposed relatively high maximal intracycle power. Conclusions Flow amplitude and waveform may be relatively neglected and modifiable determinants of VILI risk when ventilating ARDS.John J. MariniPhilip S. CrookePierre TawfikRobert L. ChatburnDavid J. DriesLuciano GattinoniSpringerOpenarticleMechanical ventilationMathematical modelVentilator-induced lung injuryVILIPowerIntracycle powerMedical emergencies. Critical care. Intensive care. First aidRC86-88.9ENIntensive Care Medicine Experimental, Vol 9, Iss 1, Pp 1-14 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Mechanical ventilation Mathematical model Ventilator-induced lung injury VILI Power Intracycle power Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
spellingShingle	Mechanical ventilation Mathematical model Ventilator-induced lung injury VILI Power Intracycle power Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 John J. Marini Philip S. Crooke Pierre Tawfik Robert L. Chatburn David J. Dries Luciano Gattinoni Intracycle power and ventilation mode as potential contributors to ventilator-induced lung injury
description	Abstract Background High rates of inflation energy delivery coupled with transpulmonary tidal pressures of sufficient magnitude may augment the risk of damage to vulnerable, stress-focused units within a mechanically heterogeneous lung. Apart from flow amplitude, the clinician-selected flow waveform, a relatively neglected dimension of inflation power, may distribute inflation energy of each inflation cycle non-uniformly among alveoli with different mechanical properties over the domains of time and space. In this initial step in modeling intracycle power distribution, our primary objective was to develop a mathematical model of global intracycle inflation power that uses clinician-measurable inputs to allow comparisons of instantaneous ICP profiles among the flow modes commonly encountered in clinical practice: constant, linearly decelerating, exponentially decelerating (pressure control), and spontaneous (sinusoidal). Methods We first tested the predictions of our mathematical model of passive inflation with the actual physical performance of a mechanical ventilator–lung system that simulated ventilation to three types of patients: normal, severe ARDS, and severe airflow obstruction. After verification, model predictions were then generated for 5000 ‘virtual ARDS patients’. Holding constant the tidal volume and inflation time between modes, the validated model then varied the flow profile and quantitated the resulting intensity and timing of potentially damaging ‘elastic’ energy and intracycle power (pressure–flow product) developed in response to random combinations of machine settings and severity levels for ARDS. Results Our modeling indicates that while the varied flow patterns ultimately deliver similar total amounts of alveolar energy during each breath, they differ profoundly regarding the potentially damaging pattern with which that energy distributes over time during inflation. Pressure control imposed relatively high maximal intracycle power. Conclusions Flow amplitude and waveform may be relatively neglected and modifiable determinants of VILI risk when ventilating ARDS.
format	article
author	John J. Marini Philip S. Crooke Pierre Tawfik Robert L. Chatburn David J. Dries Luciano Gattinoni
author_facet	John J. Marini Philip S. Crooke Pierre Tawfik Robert L. Chatburn David J. Dries Luciano Gattinoni
author_sort	John J. Marini
title	Intracycle power and ventilation mode as potential contributors to ventilator-induced lung injury
title_short	Intracycle power and ventilation mode as potential contributors to ventilator-induced lung injury
title_full	Intracycle power and ventilation mode as potential contributors to ventilator-induced lung injury
title_fullStr	Intracycle power and ventilation mode as potential contributors to ventilator-induced lung injury
title_full_unstemmed	Intracycle power and ventilation mode as potential contributors to ventilator-induced lung injury
title_sort	intracycle power and ventilation mode as potential contributors to ventilator-induced lung injury
publisher	SpringerOpen
publishDate	2021
url	https://doaj.org/article/66c4350c2ab34582be860ad6775d8cfa
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Intracycle power and ventilation mode as potential contributors to ventilator-induced lung injury

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