Analysis of different model-based approaches for estimating dFRC for real-time application.
BACKGROUND
Acute Respiratory Distress Syndrome (ARDS) is characterized by inflammation, filling of the lung with fluid and the collapse of lung units. Mechanical ventilation (MV) is used to treat ARDS using positive end expiratory pressure (PEEP) to recruit and retain lung units, thus increasing pulmonary volume and dynamic functional residual capacity (dFRC) at the end of expiration. However, simple, non-invasive methods to estimate dFRC do not exist.


METHODS
Four model-based methods for estimating dFRC are compared based on their performance on two separate clinical data cohorts. The methods are derived from either stress-strain theory or a single compartment lung model, and use commonly controlled or measured parameters (lung compliance, plateau airway pressure, pressure-volume (PV) data). Population constants are determined for the stress-strain approach, which is implemented using data at both single and multiple PEEP levels. Estimated values are compared to clinically measured values to assess the reliability of each method for each cohort individually and combined.


RESULTS
The stress-strain multiple breath (at multiple PEEP levels) method produced an overall correlation coefficient R2 = 0.966. The stress-strain single breath method produced R2 = 0.530. The single compartment single breath method produced R2 = 0.415. A combined method at single and multiple PEEP levels produced R2 = 0.963.


CONCLUSIONS
The results suggest that model-based, single breath and non-invasive approaches to estimating dFRC may be viable in a clinical scenario, ensuring no interruption to MV. The models provide a means of estimating dFRC at any PEEP level. However, model limitations and large estimation errors limit the use of the methods at very low PEEP.
University of Canterbury, Christchurch, 8041, New Zealand. erwin.vandrunen@pg.canterbury.ac.nz
Erwin J
EJ
van Drunen
J Geoffrey
JG
Chase
Yeong Shiong
YS
Chiew
Geoffrey M
GM
Shaw
Thomas
T
Desaive
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005652:Functional Residual Capacity; D006801:Humans; D008168:Lung / Q000503:physiopathology; D008176:Lung Volume Measurements; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D011175:Positive-Pressure Respiration / Q000379:methods; D015203:Reproducibility of Results; D012121:Respiration, Artificial / Q000379:methods; D012128:Respiratory Distress Syndrome / Q000503:physiopathology / Q000628:therapy; D012189:Retrospective Studies; D055815:Young Adult