title: Coupling of EIT with computational lung modeling for predicting patient-specific ventilatory responses.
abstract: Providing optimal personalized mechanical ventilation for patients with acute or chronic respiratory failure is still a challenge within a clinical setting for each case anew. In this article, we integrate electrical impedance tomography (EIT) monitoring into a powerful patient-specific computational lung model to create an approach for personalizing protective ventilatory treatment. The underlying computational lung model is based on a single computed tomography scan and able to predict global airflow quantities, as well as local tissue aeration and strains for any ventilation maneuver. For validation, a novel "virtual EIT" module is added to our computational lung model, allowing to simulate EIT images based on the patient's thorax geometry and the results of our numerically predicted tissue aeration. Clinically measured EIT images are not used to calibrate the computational model. Thus they provide an independent method to validate the computational predictions at high temporal resolution. The performance of this coupling approach has been tested in an example patient with acute respiratory distress syndrome. The method shows good agreement between computationally predicted and clinically measured airflow data and EIT images. These results imply that the proposed framework can be used for numerical prediction of patient-specific responses to certain therapeutic measures before applying them to an actual patient. In the long run, definition of patient-specific optimal ventilation protocols might be assisted by computational modeling.NEW & NOTEWORTHYIn this work, we present a patient-specific computational lung model that is able to predict global and local ventilatory quantities for a given patient and any selected ventilation protocol. For the first time, such a predictive lung model is equipped with a virtual electrical impedance tomography module allowing real-time validation of the computed results with the patient measurements. First promising results obtained in an acute respiratory distress syndrome patient show the potential of this approach for personalized computationally guided optimization of mechanical ventilation in future.
authors.affiliation: Institute for Computational Mechanics, Technical University of Munich, Munich, Germany; and.
authors.forename: Christian J
authors.initials: CJ
authors.lastname: Roth
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Christian Albrechts University, Kiel, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Becher
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Christian Albrechts University, Kiel, Germany.
authors.forename: Inéz
authors.initials: I
authors.lastname: Frerichs
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Christian Albrechts University, Kiel, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Weiler
authors.affiliation: Institute for Computational Mechanics, Technical University of Munich, Munich, Germany; and wall@lnm.mw.tum.de.
authors.forename: Wolfgang A
authors.identifier: http://orcid.org/0000-0001-7419-3384
authors.initials: WA
authors.lastname: Wall
mesh_terms: D003198:Computer Simulation; D017097:Electric Impedance; D006801:Humans; D008168:Lung / Q000502:physiology*; D012123:Pulmonary Ventilation / Q000502:physiology*; D012119:Respiration; D012121:Respiration, Artificial / Q000379:methods; D012128:Respiratory Distress Syndrome / Q000503:physiopathology; D013909:Thorax / Q000502:physiology; D014054:Tomography / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: EIT; alveolar strain; protective ventilation; reduced-dimensional lung model; ventilation monitoring