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

• Main Authors: Chiew, Yeong Shiong, Chase, J. Geoffrey, Arunachalam, Ganesaramachandran, Tan, Chee Pin, Loo, Nienloong, Chiew, Yeongwoei, Md Ralib, Azrina, Mat Nor, Mohd Basri
• Format: Article
• Language: English; English
• Published: IFAC Secretariat 2018
• Subjects: RC Internal medicine; RC731 Specialties of Internal Medicine-Diseases of The Respiratory System
• Online Access: http://irep.iium.edu.my/70221/1/70221_Clinical%20Application%20of%20Respiratory%20Elastance%20%28CARE%20Trial%29_article.pdf; http://irep.iium.edu.my/70221/2/70221_Clinical%20Application%20of%20Respiratory%20Elastance%20%28CARE%20Trial%29_scopus.pdf; http://irep.iium.edu.my/70221/; https://reader.elsevier.com/reader/sd/pii/S2405896318333573?token=C4CD13051CD1110A46D5AFCEAEE9E989328A5A1A4A7F550EFD8F521EC8D3E568B494FBF5112BC5C6C918722C718277D6

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.