Harmonic excitation of linear respiratory mechanics for physiological dual controlled ventilation
Author(s)
Francesco Montecchia*
ABSTRACT
The theoretical approach along with the rationale of harmonic excitation modality (HEM) applied as optimal dual controlled ventilation (DCV) to anaesthetized or severe brain injured patients, whose respiretory mechanics can be properly assumed steady and linear, are presented and discussed. The design criteria of an improved version of the Advanced Lung Ventilation System (ALVS), including HEM in its functional features, are described in details. In particular, the elimination of any undesiderable artificial distortion affecting the respiratory and ventilation pattern waveforms is achieved by maintaining continuous forever the airflow inside the ventilation circuit, ensuring also the highest level of safety for patient in any condition. In such a way, the full-time compatibility of controlled breathings with spontaneous breathing activity of patient during continuous positive airways pressure (CPAP) or bilevel positive airways pressure (BiPAP) ventilation modalities and during assisted/controlled ventilation(A/CV), includeing also synchronized or triggered ventilation modalities, is an intrinsic innovative feature of the system available for clinical application. As expected and according to the clinical requirements, HEM provides for physiological respiratory and ventilation pattern waveforms together with optimal “breath to breath” feedback control of lung volume driven by an improved diagnostic measurement procedure, whose outputs are also vital for adapting all the preset ventilation parameters to the current value of the respiratory parameters of patient. The results produced by software simulations concerning both adult and neonatal patients in different clinical conditions are completely consistent with those obtained by the theoretical treatment, showing that HEM reaches the best performances from both clinical and engineering points of view.
The theoretical approach along with the rationale of harmonic excitation modality (HEM) applied as optimal dual controlled ventilation (DCV) to anaesthetized or severe brain injured patients, whose respiretory mechanics can be properly assumed steady and linear, are presented and discussed. The design criteria of an improved version of the Advanced Lung Ventilation System (ALVS), including HEM in its functional features, are described in details. In particular, the elimination of any undesiderable artificial distortion affecting the respiratory and ventilation pattern waveforms is achieved by maintaining continuous forever the airflow inside the ventilation circuit, ensuring also the highest level of safety for patient in any condition. In such a way, the full-time compatibility of controlled breathings with spontaneous breathing activity of patient during continuous positive airways pressure (CPAP) or bilevel positive airways pressure (BiPAP) ventilation modalities and during assisted/controlled ventilation(A/CV), includeing also synchronized or triggered ventilation modalities, is an intrinsic innovative feature of the system available for clinical application. As expected and according to the clinical requirements, HEM provides for physiological respiratory and ventilation pattern waveforms together with optimal “breath to breath” feedback control of lung volume driven by an improved diagnostic measurement procedure, whose outputs are also vital for adapting all the preset ventilation parameters to the current value of the respiratory parameters of patient. The results produced by software simulations concerning both adult and neonatal patients in different clinical conditions are completely consistent with those obtained by the theoretical treatment, showing that HEM reaches the best performances from both clinical and engineering points of view.
Cite this paper
Montecchia, F. (2012) Harmonic excitation of linear respiratory mechanics for physiological dual controlled ventilation. Journal of Biomedical Science and Engineering, 5, 678-695. doi: 10.4236/jbise.2012.511085.
Montecchia, F. (2012) Harmonic excitation of linear respiratory mechanics for physiological dual controlled ventilation. Journal of Biomedical Science and Engineering, 5, 678-695. doi: 10.4236/jbise.2012.511085.
References
[1] Mushin, W.W., Rendell-Backer, L., Thompson, P.W. and Mapleson, W.W. (1980) Automatic ventilation of the lungs. Backwell, Oxford. [2] MacIntyre, N.R. and Branson, R.D. (2001) Mechanical ventilation. WB Saunders, Philadelphia. [3] Tobin, M.J. (2006) Principles and practice of mechanical ventilation. 2nd Edition, McGraw Hill, New York. [4] Chatburn, R.L. (2007) Classification of ventilator modes: Update and proposal for implementation. Respiratory Care, 52, 301-323. [5] Grianti, F., Montecchia, F., Di Bari, L., Baldassarri, M. (1996) A versatile mechanical ventilator (DIGIT) with high flow stability and a programmable inspiratory phase flow pattern. IEEE Transactions on Biomedical Engineering, 43, 1062-1072. doi:10.1109/10.541248 [6] Montecchia, F., Guerrisi, M., Canichella, A. (2007) Advanced lung ventilation system (ALVS) with linear respiratory mechanics assumption for waveform optimization of dual-controlled ventilation. Medical Engineering & Physics, 29, 259-276. doi:10.1016/j.medengphy.2006.03.006 [7] Montecchia, F. (2011) Theoretical modeling of airways pressure waveform for dual-controlled ventilation with physiological pattern and linear respiratory mechanics. Journal of Biomedical Science and Engineering, 4, 318-338. doi:10.4236/jbise.2011.44042 [8] Branson, R.D. and Davis, K., Jr. (2001) Dual control modes: Combining volume and pressure breaths. Respiratory Care Clinics of North America, 7, 397-408. doi:10.1016/S1078-5337(05)70041-1 [9] Hasan, R.A. and Patel, V. (2004) Pressure-controlled ventilation. Pediatric Critical Care Medicine, 5, 501. doi:10.1097/01.PCC.0000137985.37061.0E [10] ] Campbell, R.S. and Davis, B.R. (2002) Pressure-controlled versus volume-controlled ventilation: Does it matter? Respiratory Care, 47, 416-424. [11] Taylor, A.E., Render, K.R., Hyatt, R.E. and Parker, J.C. (1989) Clinical respiratory physiology. W. B. Saunders Company, Orlando. [12] Hess, D.R. (2005) Ventilator waveform and the physiology of pressure support ventilation. Respiratory Care, 50, 166-186. [13] Branson, R.D. and MacIntyre, N.R. (1996) Dual-control modes of mechanical ventilation. Respiratory Care, 41, 294-305. [14] Branson, R.D. and Johannigman, J.A. (2005) The role of ventilator graphics when setting dual-controlled modes. Respiratory Care, 50, 187-201. [15] Laubscher, T.P., Heinrichs, W., Weiler, N., Hartmann, G. and Brunner, J.X. (1994) An adaptive lung ventilation controller. IEEE Transactions on Biomedical Engineering, 41, 51-59. doi:10.1109/10.277271 [16] Brunner, J.X. (2001) Principles and history of closed-loop controlled ventilation. Respiratory Care Clinics of North America, 7, 341-362. doi:10.1016/S1078-5337(05)70040-X [17] Anderson, J.R. and East, T.D. (2002) A closed-loop controller for mechanical ventilation of patients with ARDS. Biomedical Sciences Instrumentation, 38, 289-294. [18] Tehrani, F.T., Rogers, M., Lo, T., Malinowski, T., Afu-wape, S., Lum, M., Grundl, B. and Terry, M. (2004) A dual closed-loop control system for mechanical ventilation. Journal of Clinical Monitoring and Computing, 18, 111-129. doi:10.1023/B:JOCM.0000032744.99885.38 [19] Chatburn, R.L. (2004) Computer control of mechanical ventilation. Respiratory Care, 49, 507-515. [20] Tehrani, F.T. (2008) Automatic control of mechanical ventilation. Part 1: Theory and history of the technology. Journal of Clinical Monitoring and Computing, 22, 409-415. doi:10.1007/s10877-008-9150-z [21] Bates, J.H., Hunter, L.W., Sly, P.D., Okubo, S., Filiatrault, S. and Milic-Emili, J. (1987) Effect of valve closure time on the determination of respiratory resistance by flow interruption. Medical and Biological Engineering Computing, 25, 136-140. doi:10.1007/BF02442841 [22] Bates, J.H., Baconnier, P. and Milic-Emili, J. (1988) A theoretical analysis of interrupter technique for measuring respiratory mechanics. Journal of Applied Physiology, 64, 2204-2214. [23] Jonson, B., Beydon, L., Brauer, K., Mansson, C., Valind, S. and Grytzell, H. (1993) Mechanics of respiratory system in healthy anesthetized humans with emphasis on viscoelastic properties. Journal of Applied Physiology, 75, 132-140. [24] Crooke, P.S., Hota, S., Marini, J.J. and Hotchkiss, J.R. (2003) Mathematical models of passive, pressure-controlled ventilation with different resistance assumptions. Mathematical and Computer Modelling, 38, 495-502. doi:10.1016/S0895-7177(03)90021-5 [25] Milic-Emili, J., Gottfried, S.B. and Rossi, A. (1987) Non-invasive measurement of respiratory mechanics in ICU patients. International Journal of Clinical Monitoring and Computing, 4, 11-30. doi:10.1007/BF02919570 [26] Baconnier, P.F., Carry, P.Y., Eberhard, A., Perdrix, J.P. and Fargnoli, J.M. (1995) A computer program for automatic measurement of respiratory mechanics in artificially ventilated patients. Computer Methods and Program in Biomedicine, 47, 205-220. doi:10.1016/0169-2607(95)01651-9 [27] Lucangelo, U., Bernabè, F. and Blanch, L. (2005) Respiratory mechanics derived from signals in the ventilator circuit. Respiratory Care, 50, 55-65. [28] Lutchen, K.R., Yang, Y., Kaczka, D.W. and Suki, B. (1993) Optimal ventilation waveforms for estimating low-frequency respiratory impedance. Journal of Applied Physiology, 75, 478-488. [29] Kaczka, D.W., Ingenito, E.P. and Lutchen, K.R. (1999) Technique to determine inspiratory impedance during mechanical ventilation: Implication for flow limited patients. Annals of Biomedical Engineering, 27, 340-355. doi:10.1114/1.146
[1] Mushin, W.W., Rendell-Backer, L., Thompson, P.W. and Mapleson, W.W. (1980) Automatic ventilation of the lungs. Backwell, Oxford. [2] MacIntyre, N.R. and Branson, R.D. (2001) Mechanical ventilation. WB Saunders, Philadelphia. [3] Tobin, M.J. (2006) Principles and practice of mechanical ventilation. 2nd Edition, McGraw Hill, New York. [4] Chatburn, R.L. (2007) Classification of ventilator modes: Update and proposal for implementation. Respiratory Care, 52, 301-323. [5] Grianti, F., Montecchia, F., Di Bari, L., Baldassarri, M. (1996) A versatile mechanical ventilator (DIGIT) with high flow stability and a programmable inspiratory phase flow pattern. IEEE Transactions on Biomedical Engineering, 43, 1062-1072. doi:10.1109/10.541248 [6] Montecchia, F., Guerrisi, M., Canichella, A. (2007) Advanced lung ventilation system (ALVS) with linear respiratory mechanics assumption for waveform optimization of dual-controlled ventilation. Medical Engineering & Physics, 29, 259-276. doi:10.1016/j.medengphy.2006.03.006 [7] Montecchia, F. (2011) Theoretical modeling of airways pressure waveform for dual-controlled ventilation with physiological pattern and linear respiratory mechanics. Journal of Biomedical Science and Engineering, 4, 318-338. doi:10.4236/jbise.2011.44042 [8] Branson, R.D. and Davis, K., Jr. (2001) Dual control modes: Combining volume and pressure breaths. Respiratory Care Clinics of North America, 7, 397-408. doi:10.1016/S1078-5337(05)70041-1 [9] Hasan, R.A. and Patel, V. (2004) Pressure-controlled ventilation. Pediatric Critical Care Medicine, 5, 501. doi:10.1097/01.PCC.0000137985.37061.0E [10] ] Campbell, R.S. and Davis, B.R. (2002) Pressure-controlled versus volume-controlled ventilation: Does it matter? Respiratory Care, 47, 416-424. [11] Taylor, A.E., Render, K.R., Hyatt, R.E. and Parker, J.C. (1989) Clinical respiratory physiology. W. B. Saunders Company, Orlando. [12] Hess, D.R. (2005) Ventilator waveform and the physiology of pressure support ventilation. Respiratory Care, 50, 166-186. [13] Branson, R.D. and MacIntyre, N.R. (1996) Dual-control modes of mechanical ventilation. Respiratory Care, 41, 294-305. [14] Branson, R.D. and Johannigman, J.A. (2005) The role of ventilator graphics when setting dual-controlled modes. Respiratory Care, 50, 187-201. [15] Laubscher, T.P., Heinrichs, W., Weiler, N., Hartmann, G. and Brunner, J.X. (1994) An adaptive lung ventilation controller. IEEE Transactions on Biomedical Engineering, 41, 51-59. doi:10.1109/10.277271 [16] Brunner, J.X. (2001) Principles and history of closed-loop controlled ventilation. Respiratory Care Clinics of North America, 7, 341-362. doi:10.1016/S1078-5337(05)70040-X [17] Anderson, J.R. and East, T.D. (2002) A closed-loop controller for mechanical ventilation of patients with ARDS. Biomedical Sciences Instrumentation, 38, 289-294. [18] Tehrani, F.T., Rogers, M., Lo, T., Malinowski, T., Afu-wape, S., Lum, M., Grundl, B. and Terry, M. (2004) A dual closed-loop control system for mechanical ventilation. Journal of Clinical Monitoring and Computing, 18, 111-129. doi:10.1023/B:JOCM.0000032744.99885.38 [19] Chatburn, R.L. (2004) Computer control of mechanical ventilation. Respiratory Care, 49, 507-515. [20] Tehrani, F.T. (2008) Automatic control of mechanical ventilation. Part 1: Theory and history of the technology. Journal of Clinical Monitoring and Computing, 22, 409-415. doi:10.1007/s10877-008-9150-z [21] Bates, J.H., Hunter, L.W., Sly, P.D., Okubo, S., Filiatrault, S. and Milic-Emili, J. (1987) Effect of valve closure time on the determination of respiratory resistance by flow interruption. Medical and Biological Engineering Computing, 25, 136-140. doi:10.1007/BF02442841 [22] Bates, J.H., Baconnier, P. and Milic-Emili, J. (1988) A theoretical analysis of interrupter technique for measuring respiratory mechanics. Journal of Applied Physiology, 64, 2204-2214. [23] Jonson, B., Beydon, L., Brauer, K., Mansson, C., Valind, S. and Grytzell, H. (1993) Mechanics of respiratory system in healthy anesthetized humans with emphasis on viscoelastic properties. Journal of Applied Physiology, 75, 132-140. [24] Crooke, P.S., Hota, S., Marini, J.J. and Hotchkiss, J.R. (2003) Mathematical models of passive, pressure-controlled ventilation with different resistance assumptions. Mathematical and Computer Modelling, 38, 495-502. doi:10.1016/S0895-7177(03)90021-5 [25] Milic-Emili, J., Gottfried, S.B. and Rossi, A. (1987) Non-invasive measurement of respiratory mechanics in ICU patients. International Journal of Clinical Monitoring and Computing, 4, 11-30. doi:10.1007/BF02919570 [26] Baconnier, P.F., Carry, P.Y., Eberhard, A., Perdrix, J.P. and Fargnoli, J.M. (1995) A computer program for automatic measurement of respiratory mechanics in artificially ventilated patients. Computer Methods and Program in Biomedicine, 47, 205-220. doi:10.1016/0169-2607(95)01651-9 [27] Lucangelo, U., Bernabè, F. and Blanch, L. (2005) Respiratory mechanics derived from signals in the ventilator circuit. Respiratory Care, 50, 55-65. [28] Lutchen, K.R., Yang, Y., Kaczka, D.W. and Suki, B. (1993) Optimal ventilation waveforms for estimating low-frequency respiratory impedance. Journal of Applied Physiology, 75, 478-488. [29] Kaczka, D.W., Ingenito, E.P. and Lutchen, K.R. (1999) Technique to determine inspiratory impedance during mechanical ventilation: Implication for flow limited patients. Annals of Biomedical Engineering, 27, 340-355. doi:10.1114/1.146