Clinical application of respiratory elastance (CARE trial) for mechanically ventilated respiratory failure patients: a model-based study

Chiew, Yeong Shiong and Chase, J. Geoffrey and Arunachalam, Ganesaramachandran and Tan, Chee Pin and Loo, Nienloong and Chiew, Yeongwoei and Md Ralib, Azrina and Mat Nor, Mohd Basri (2018) Clinical application of respiratory elastance (CARE trial) for mechanically ventilated respiratory failure patients: a model-based study. IFAC-PapersOnLine, 51 (27). pp. 209-214. ISSN 2405-8963

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Abstract

Mechanical ventilation (MV) is the primary support for respiratory failure patients. MV treatment is difficult to manage due to the variable patient-specific disease state and response to MV treatment. Model-based methods have shown potential in providing unique, personalised information on patient condition for clinicians to guide MV treatment. This study presents a clinical observational trial to investigate the respiratory mechanics and quality of patient ventilator asynchrony conducted in a South-East Asia hospital intensive care unit (ICU). Pilot trial results included 7 study patients. Patient-specific respiratory mechanics Ers and Rrs were median 32.30 cmH2O/l [Interquartile range (IQR): 24.53-43.48] and 7.62 cmH2Os/l [IQR: 4.85-10.34]. The Normalised Area Under the Curve of Time-Varying Elastance (AUC-Edrs) across patients were 27.50 cmH2O/l [IQR: 24.97-28.34]. Patient ventilator interaction is assessed using an asynchrony index (AI), where AI had a median value of 27.0% [(IQR): 21.0-52.7]. Patient-specific respiratory mechanics displayed intra- and inter- patient variability, suggesting patients are different and evolved over time, and thus their MV settings should be patient-specific and time-varying. Model-based methods thus offer unique insight into patient-specific respiratory mechanics and the resulting opportunity to personalize and optimise MV based on evolving patient-specific needs.

Item Type:	Article (Journal)
Additional Information:	3934/70221
Uncontrolled Keywords:	Model-based methods, respiratory mechanics, mechanical ventilation, respiratory failure.
Subjects:	R Medicine > RC Internal medicine R Medicine > RC Internal medicine > RC731 Specialties of Internal Medicine-Diseases of The Respiratory System
Kulliyyahs/Centres/Divisions/Institutes (Can select more than one option. Press CONTROL button):	Kulliyyah of Medicine Kulliyyah of Medicine > Department of Anaesthesiology & Intensive Care
Depositing User:	Prof Azrina Md Ralib
Date Deposited:	28 Jan 2019 11:45
Last Modified:	13 Mar 2019 11:05
URI:	http://irep.iium.edu.my/id/eprint/70221

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