Monitoring of total positive end-expiratory pressure during mechanical ventilation by artificial neural networks.

Journal: Journal of clinical monitoring and computing
PMID: 27067075

Abstract

Ventilation treatment of acute lung injury (ALI) requires the application of positive airway pressure at the end of expiration (PEEP) to avoid lung collapse. However, the total pressure exerted on the alveolar walls (PEEP) is the sum of PEEP and intrinsic PEEP (PEEP), a hidden component. To measure PEEP, ventilation must be discontinued with an end-expiratory hold maneuver (EEHM). We hypothesized that artificial neural networks (ANN) could estimate the PEEP from flow and pressure tracings during ongoing mechanical ventilation. Ten pigs were mechanically ventilated, and the time constant of their respiratory system (τ) was measured. We shortened their expiratory time (TE) according to multiples of τ, obtaining different respiratory patterns (R). Pressure (P) and flow (V') at the airway opening during ongoing mechanical ventilation were simultaneously recorded, with and without the addition of external resistance. The last breath of each R included an EEHM, which was used to compute the reference PEEP. The entire protocol was repeated after the induction of ALI with i.v. injection of oleic acid, and 382 tracings were obtained. The ANN had to extract the PEEP, from the tracings without an EEHM. ANN agreement with reference PEEP was assessed with the Bland-Altman method. Bland Altman analysis of estimation error by ANN showed -0.40 ± 2.84 (expressed as bias ± precision) and ±5.58 as limits of agreement (data expressed as cmHO). The ANNs estimated the PEEP well at different levels of PEEP under dynamic conditions, opening up new possibilities in monitoring PEEP in critically ill patients who require ventilator treatment.

Authors

  • Gaetano Perchiazzi
    Department of Emergency and Organ Transplant, Section of Anaesthesia and Intensive Care Medicine, University of Bari, c/o Centro di Rianimazione - Policlinico Hospital, Piazza Giulio Cesare, 11, 70124, Bari, Italy. gaetano.perchiazzi@uniba.it.
  • Christian Rylander
    Department of Anaesthesia and Intensive Care Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.
  • Mariangela Pellegrini
    Department of Emergency and Organ Transplant, Section of Anaesthesia and Intensive Care Medicine, University of Bari, c/o Centro di Rianimazione - Policlinico Hospital, Piazza Giulio Cesare, 11, 70124, Bari, Italy.
  • Anders Larsson
    5 Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
  • Göran Hedenstierna
    Hedenstierna Laboratory, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.

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