Assessing mechanical ventilation asynchrony through iterative airway pressure reconstruction. (April 2018)

• Record Type: Journal Article
• Authors: Chiew, Yeong Shiong; Tan, Chee Pin; Chase, J. Geoffrey; Chiew, Yeong Woei; Desaive, Thomas; Ralib, Azrina Md; Mat Nor, Mohd Basri
• Is Part Of: Computer methods and programs in biomedicine. Volume 157(2018)
• Page Start: 217
• Page End: 224
• Publication Date: 2018-04
• Subjects: Mechanical ventilation -- Asynchrony -- Respiratory mechanics -- Asynchronous magnitude; Medicine -- Computer programs -- Periodicals; Biology -- Computer programs -- Periodicals; Computers -- Periodicals; Medicine -- Periodicals; Médecine -- Logiciels -- Périodiques; Biologie -- Logiciels -- Périodiques; Biology -- Computer programs; Medicine -- Computer programs; Periodicals; Electronic journals; 610.28
• DOI: 10.1016/j.cmpb.2018.02.007
• Languages: English
• ISSNs: 0169-2607

Abstract

Highlights: Application of model-based method is limited during mechanical ventilation asynchrony. Respiratory mechanics estimation is less reliable during asynchrony. Iterative pressure reconstruction method is presented to monitor and reconstruct asynchronous airway pressure. Reconstructed airway pressure is free from 'asynchrony' and enables more consistent respiratory mechanics estimation. Iterative Pressure Reconstruction also provide unique metric to quantify the magnitude of asynchrony of a breathing cycle. Abstract: Background and objective: Respiratory mechanics estimation can be used to guide mechanical ventilation (MV) but is severely compromised when asynchronous breathing occurs. In addition, asynchrony during MV is often not monitored and little is known about the impact or magnitude of asynchronous breathing towards recovery. Thus, it is important to monitor and quantify asynchronous breathing over every breath in an automated fashion, enabling the ability to overcome the limitations of model-based respiratory mechanics estimation during asynchronous breathing ventilation. Methods: An iterative airway pressure reconstruction (IPR) method is used to reconstruct asynchronous airway pressure waveforms to better match passive breathing airway waveforms using a single compartment model. The reconstructed pressure enables estimation of respiratory mechanics of airway pressure waveform essentially free from asynchrony. Reconstruction enables real-time breath-to-breath monitoring and quantification of the magnitude of the asynchrony ( MAsyn ). Results and discussion: Over 100, 000 breathing cycles from MV patients with known asynchronous breathing were analyzed. The IPR was able to reconstruct different types of asynchronous breathing. The resulting respiratory mechanics estimated using pressure reconstruction were more consistent with smaller interquartile range (IQR) compared to respiratory mechanics estimated using asynchronous pressure. Comparing reconstructed pressure with asynchronous pressure waveforms quantifies the magnitude of asynchronous breathing, which has a median value MAsyn for the entire dataset of 3.8%. Conclusion: The iterative pressure reconstruction method is capable of identifying asynchronous breaths and improving respiratory mechanics estimation consistency compared to conventional model-based methods. It provides an opportunity to automate real-time quantification of asynchronous breathing frequency and magnitude that was previously limited to invasively method only.