Estimation Of Lower Airway Resistance
In Expiratory Flow Limitation
During Mechanical Ventilation
Author(s)
P. Barbini, G. Cevenini & M. R. Massai
Abstract
Determining the level of expiratory flow limitation (EFL) in critical
mechanically ventilated patients is of clinical relevance for choosing appropriate
respiratory treatment and/or pharmacological therapy. In many respiratory
diseases, EFL arises from pathological changes in the mechanical properties of
the bronchial tree. These properties cannot be evaluated using common
lumped-parameter models or conventional estimation approaches based on
measured mouth pressure and flow data, because during EFL expiratory flow no
longer depends on the difference between alveolar and mouth pressure (Starling
resistor effect). Starting from simulation data obtained by a dynamic non linear
lumped-parameter model recently proposed for interpreting the main effects of
EFL, we developed a two-step procedure which analyses inspiration and
expiration separately in mechanically-ventilated flow-limited patients, thus
enabling total resistance of deeper airway generations influencing the onset of
EFL to be estimated. The negative expiratory pressure method was used to detect
the presence of flow limitation during expiration. The model-to-model approach
showed that lung and chest wall elastances and resistance of the lower bronchial
tree could be estimated with reasonable accuracy from mouth flow and mouth
and pleural pressure data. The estimated values are consistent with the
mechanical properties of the lower generations of the bronchial tree described by
the forward model. On the basis of these estimated parameters, the
end-expiratory occlusion technique also allows the end-expiratory lung volume
to be determined.
Keywords: respiratory system, breathing mechanics model, expiratory flow
limitation, mechanical ventilation, parameter identification, resistance.
Keywords
respiratory system, breathing mechanics model, expiratory flow
limitation, mechanical ventilation, parameter identification, resistance.
Related Book
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