Mild ARDS with Progressive Fall in Oxygenation

Description

A 22 year-old patient was involved in a motor vehicle crash with rollover and ejection from the vehicle. He suffered multiple rib fractures, a right femur fracture, multiple lacerations and pulmonary contusion. He underwent internal fixation of the femur fracture, received 4 units of whole blood, had a chest tube placed for a small hemothorax and returned from the operating room on mechanical ventilation. The patient is sedated and is not currently triggering the ventilator. Intraoperatively 3 L of crystalloids were administered. The patient is 6'2'' tall, weighs 200 lbs and has no known comorbidities or allergies. Chest radiograph demonstrates bi-basilar early consolidation, presence of the chest tube and pulmonary contusion.

Figure 1. Chest radiograph demonstrates bi-basilar early consolidation, presence of the chest tube and pulmonary contusion.

Segment Validation

Segment 1

Learning Objectives:

Identify severity of ARDS
Recognize acceptable ventilator settings

Recommended Actions:

None

Ventilator settings are (VT Target = 7.1 mL/kg (ideal)):

Mode	VT (L)	PIP (cmH2O)	Flow (L/min)	I:E	TI (s)	RR (bpm)	PEEP (cmH2O)	FiO2
VC-AC	0.584	NA	60	NA	0.62	24	5	0.4

Ventilator alarm settings are:

High PIP = 38 cmH2O (~10 cmH2O above the initial value or a max of 40 cmH2O)
Low MVe = 10.4 L/min (~25% below the initial value)
Low VT = 438 mL (~25% below the initial value)
High RR = 34 bpm (~10 bpm above the initial value or a max of 40 bpm)

Table 1. Data request validation results for Segment 1.

Property Name	Validation	Engine Value	Percent Error	Notes
MechanicalVentilator-TidalVolume(mL)	EqualTo 584	578	0.986%	VT (measured)
InspiratoryRespiratoryResistance(cmH2O_s/L)	EqualTo 12 [17]	11.6	3.17%	Rinsp for mild ARDS
ExpiratoryRespiratoryResistance(cmH2O_s/L)	EqualTo 12 [17]	11.6	3.17%	Rexp for mild ARDS
RespiratoryCompliance(mL/cmH2O)	EqualTo 50 [304]	50.2	0.385%	C requested by SME for mild ARDS
PhysiologicDeadSpaceTidalVolumeRatio	EqualTo 0.54 [229]	0.515	4.72%	VD/VT for mild ARDS
ClinicalShuntFraction	[0.200,0.400] [221]	0.191	4.44%	QS/QT for mild ARDS (determined from blood gas values)
HorowitzIndex(mmHg)	[200,300] [115]	198	1.22%	PaO2/FiO2 for mild ARDS

Figure 2. Vitals and ventilator monitors for Segment 1.

Table 2. Data requests for Segment 1.

Property Name	Engine Value
Patient-Height(in)	74.0
Patient-IdealBodyWeight(kg)	82.2
InspiratoryRespiratoryResistance(cmH2O_s/L)	11.6
ExpiratoryRespiratoryResistance(cmH2O_s/L)	11.6
RespiratoryCompliance(mL/cmH2O)	50.2
ClinicalPhysiologicDeadSpaceTidalVolumeRatio	0.491
ClinicalShuntFraction	0.191
MechanicalVentilator-TidalVolume(L)	0.578
BloodPH	7.39
Aorta-Oxygen-PartialPressure(mmHg)	79.0
Aorta-CarbonDioxide-PartialPressure(mmHg)	42.7
Aorta-Bicarbonate-Molarity(mEq/L)	26.0
OxygenSaturation	0.961
HorowitzIndex(mmHg)	198
IntrinsicPositiveEndExpiratoryPressure(cmH2O)	0.503
MechanicalVentilator-RespirationRate(1/min)	24.0
MechanicalVentilator-MeanAirwayPressure(cmH2O)	9.37
MechanicalVentilator-PeakInspiratoryPressure(cmH2O)	28.1
MechanicalVentilator-PlateauPressure(cmH2O)	17.0
HeartRate(1/min)	71.7
SystolicArterialPressure(mmHg)	114
DiastolicArterialPressure(mmHg)	74.1
MechanicalVentilator-TotalPulmonaryVentilation(L/min)	13.9
MechanicalVentilator-InspiratoryResistance(cmH2O_s/L)	11.6
MechanicalVentilator-ExpiratoryResistance(cmH2O_s/L)	11.6
MechanicalVentilator-StaticRespiratoryCompliance(mL/cmH2O)	50.0
MechanicalVentilator-DynamicRespiratoryCompliance(mL/cmH2O)	25.1
MechanicalVentilator-EndTidalCarbonDioxidePressure(mmHg)	30.4
MechanicalVentilator-EndTidalOxygenPressure(mmHg)	270
MechanicalVentilator-ExpiratoryTidalVolume(L)	0.578
MechanicalVentilator-InspiratoryExpiratoryRatio	0.330
MechanicalVentilator-InspiratoryTidalVolume(L)	0.578
MechanicalVentilator-PeakExpiratoryFlow(L/s)	0.843
MechanicalVentilator-LeakFraction	1.12e-13
MechanicalVentilator-IntrinsicPositiveEndExpiratoryPressure(cmH2O)	0.456
MechanicalVentilator-ExtrinsicPositiveEndExpiratoryPressure(cmH2O)	5.00
MechanicalVentilator-TotalPositiveEndExpiratoryPressure(cmH2O)	5.46
PhysiologicDeadSpaceTidalVolumeRatio	0.515
PhysiologicShuntFraction	0.194
TotalRespiratoryModelInspiratoryResistance(cmH2O_s/L)	11.6
TotalRespiratoryModelExpiratoryResistance(cmH2O_s/L)	11.6
TotalRespiratoryModelCompliance(mL/cmH2O)	60.5
ExtrinsicPositiveEndExpiratoryPressure(cmH2O)	5.00
TotalPositiveEndExpiratoryPressure(cmH2O)	5.51
EndTidalCarbonDioxidePressure(mmHg)	32.4
PhysiologicDeadSpace(mL)	296
AlveolarArterialGradient(mmHg)	188
AlveolarDeadSpace(mL)	132
AnatomicDeadSpace(mL)	164
ChestWallCompliance(L/cmH2O)	0.146
FractionOfInspiredOxygen	0.400
LungCompliance(L/cmH2O)	0.0790
VentilationPerfusionRatio	2.42
HeartStrokeVolume(mL)	82.1
HeartEjectionFraction	0.562
BloodVolume(L)	6.51
MeanArterialPressure(mmHg)	95.4
PulsePressure(mmHg)	39.8
CardiacOutput(L/min)	5.89
CarbonDioxideSaturation	0.0353
RespiratoryExchangeRatio	0.812
SystemicVascularResistance(mmHg_s/mL)	0.924
OxygenConsumptionRate(mL/min)	290
CarbonDioxideProductionRate(mL/min)	235
Patient-AlveoliSurfaceArea(m^2)	37.3
Patient-ExpiratoryReserveVolume(L)	0.984
Patient-FunctionalResidualCapacity(L)	1.85
Patient-InspiratoryCapacity(L)	3.52
Patient-InspiratoryReserveVolume(L)	2.94
Patient-ResidualVolume(L)	0.863
Patient-TidalVolumeBaseline(L)	0.580
Patient-TotalLungCapacity(L)	5.36
Patient-VitalCapacity(L)	4.50

Segment 2

The patient is loaded in the aircraft for transport to trauma center care. Twenty minutes into the transport, SpO2 falls and both PIP and Pplat are increased.

Learning Objectives:

Recognize worsening ARDS
Adjust vent settings for safety

Recommended Actions:

Increase FiO2 to 0.5
Decrease VT to get acceptable DeltaP
Increase RR to get same MVe

Table 3. Data request validation results for Segment 2.

Property Name	Validation	Engine Value	Percent Error	Percent Change	Notes
MechanicalVentilator-TidalVolume(mL)	EqualTo 567	579	2.09%		VT (measured)
InspiratoryRespiratoryResistance(cmH2O_s/L)	EqualTo 12 [17]	12.4	3.08%		Rinsp for moderate ARDS
ExpiratoryRespiratoryResistance(cmH2O_s/L)	EqualTo 12 [17]	12.4	3.08%		Rexp for moderate ARDS
RespiratoryCompliance(mL/cmH2O)	EqualTo 40 [304]	39.2	1.98%		C requested by SME for moderate ARDS
PhysiologicDeadSpaceTidalVolumeRatio	EqualTo 0.57 [229]	0.553	3.02%		VD/VT for moderate ARDS
ClinicalShuntFraction	[0.300,0.500] [221]	0.360	0.00%		QS/QT for moderate ARDS (determined from blood gas values)
HorowitzIndex(mmHg)	[100,200] [115]	135	0.00%		PaO2/FiO2 for moderate ARDS
MechanicalVentilator-PeakInspiratoryPressure(cmH2O)	GreaterThan Segment1 (28.1) [304]	31.7		13.0%	PIP
MechanicalVentilator-PlateauPressure(cmH2O)	GreaterThan Segment1 (17.0) [304]	20.2		18.7%	Pplat
OxygenSaturation	LessThan Segment1 (0.961) [304] [308]	0.896		-6.76%	SpO2

Figure 3. Vitals and ventilator monitors for Segment 2.

Table 4. Data requests for Segment 2.

Property Name	Engine Value
Patient-Height(in)	74.0
Patient-IdealBodyWeight(kg)	82.2
InspiratoryRespiratoryResistance(cmH2O_s/L)	12.4
ExpiratoryRespiratoryResistance(cmH2O_s/L)	12.4
RespiratoryCompliance(mL/cmH2O)	39.2
ClinicalPhysiologicDeadSpaceTidalVolumeRatio	0.510
ClinicalShuntFraction	0.360
MechanicalVentilator-TidalVolume(L)	0.579
BloodPH	7.38
Aorta-Oxygen-PartialPressure(mmHg)	54.0
Aorta-CarbonDioxide-PartialPressure(mmHg)	43.4
Aorta-Bicarbonate-Molarity(mEq/L)	26.0
OxygenSaturation	0.896
HorowitzIndex(mmHg)	135
IntrinsicPositiveEndExpiratoryPressure(cmH2O)	0.321
MechanicalVentilator-RespirationRate(1/min)	24.0
MechanicalVentilator-MeanAirwayPressure(cmH2O)	9.91
MechanicalVentilator-PeakInspiratoryPressure(cmH2O)	31.7
MechanicalVentilator-PlateauPressure(cmH2O)	20.2
HeartRate(1/min)	118
SystolicArterialPressure(mmHg)	109
DiastolicArterialPressure(mmHg)	82.1
MechanicalVentilator-TotalPulmonaryVentilation(L/min)	13.9
MechanicalVentilator-InspiratoryResistance(cmH2O_s/L)	12.4
MechanicalVentilator-ExpiratoryResistance(cmH2O_s/L)	12.4
MechanicalVentilator-StaticRespiratoryCompliance(mL/cmH2O)	38.9
MechanicalVentilator-DynamicRespiratoryCompliance(mL/cmH2O)	21.7
MechanicalVentilator-EndTidalCarbonDioxidePressure(mmHg)	28.8
MechanicalVentilator-EndTidalOxygenPressure(mmHg)	272
MechanicalVentilator-ExpiratoryTidalVolume(L)	0.579
MechanicalVentilator-InspiratoryExpiratoryRatio	0.330
MechanicalVentilator-InspiratoryTidalVolume(L)	0.579
MechanicalVentilator-PeakExpiratoryFlow(L/s)	0.969
MechanicalVentilator-LeakFraction	0.00
MechanicalVentilator-IntrinsicPositiveEndExpiratoryPressure(cmH2O)	0.299
MechanicalVentilator-ExtrinsicPositiveEndExpiratoryPressure(cmH2O)	5.00
MechanicalVentilator-TotalPositiveEndExpiratoryPressure(cmH2O)	5.30
PhysiologicDeadSpaceTidalVolumeRatio	0.553
PhysiologicShuntFraction	0.365
TotalRespiratoryModelInspiratoryResistance(cmH2O_s/L)	12.4
TotalRespiratoryModelExpiratoryResistance(cmH2O_s/L)	12.4
TotalRespiratoryModelCompliance(mL/cmH2O)	47.7
ExtrinsicPositiveEndExpiratoryPressure(cmH2O)	5.00
TotalPositiveEndExpiratoryPressure(cmH2O)	5.32
EndTidalCarbonDioxidePressure(mmHg)	30.9
PhysiologicDeadSpace(mL)	318
AlveolarArterialGradient(mmHg)	215
AlveolarDeadSpace(mL)	154
AnatomicDeadSpace(mL)	164
ChestWallCompliance(L/cmH2O)	0.122
FractionOfInspiredOxygen	0.400
LungCompliance(L/cmH2O)	0.0594
VentilationPerfusionRatio	2.19
HeartStrokeVolume(mL)	55.4
HeartEjectionFraction	0.458
BloodVolume(L)	6.52
MeanArterialPressure(mmHg)	96.0
PulsePressure(mmHg)	27.3
CardiacOutput(L/min)	6.51
CarbonDioxideSaturation	0.0824
RespiratoryExchangeRatio	0.808
SystemicVascularResistance(mmHg_s/mL)	0.840
OxygenConsumptionRate(mL/min)	279
CarbonDioxideProductionRate(mL/min)	225
Patient-AlveoliSurfaceArea(m^2)	14.9
Patient-ExpiratoryReserveVolume(L)	0.943
Patient-FunctionalResidualCapacity(L)	1.39
Patient-InspiratoryCapacity(L)	3.37
Patient-InspiratoryReserveVolume(L)	2.79
Patient-ResidualVolume(L)	0.444
Patient-TidalVolumeBaseline(L)	0.580
Patient-TotalLungCapacity(L)	4.75
Patient-VitalCapacity(L)	4.31

Segment 3

Patient transport continues.

Learning Objectives:

Recognize need to increase PEEP to keep on PEEP matrix

Recommended Actions:

Increase PEEP to 8 cmH2O to keep on low PEEP table

Ventilator settings are updated to:

FiO2: 0.4 -> 0.5
RR: 24 -> 28 bpm
VT: 584 -> 490 mL
Flow: 60 -> 50 L/min

Table 5. Data request validation results for Segment 3.

Property Name	Validation	Engine Value	Percent Error	Percent Change	Notes
MechanicalVentilator-TidalVolume(mL)	EqualTo 490	482	1.74%		VT (measured)
Aorta-Oxygen-PartialPressure(mmHg)	GreaterThan Segment2 (54.0) [304] [308]	56.5		4.62%	PaO2
ClinicalShuntFraction	EqualTo Segment2 (0.360) [304] [308]	0.361	0.131%		QS/QT

Figure 4. Vitals and ventilator monitors for Segment 3.

Table 6. Data requests for Segment 3.

Property Name	Engine Value
Patient-Height(in)	74.0
Patient-IdealBodyWeight(kg)	82.2
InspiratoryRespiratoryResistance(cmH2O_s/L)	12.4
ExpiratoryRespiratoryResistance(cmH2O_s/L)	12.4
RespiratoryCompliance(mL/cmH2O)	39.7
ClinicalPhysiologicDeadSpaceTidalVolumeRatio	0.518
ClinicalShuntFraction	0.361
MechanicalVentilator-TidalVolume(L)	0.482
BloodPH	7.37
Aorta-Oxygen-PartialPressure(mmHg)	56.5
Aorta-CarbonDioxide-PartialPressure(mmHg)	44.4
Aorta-Bicarbonate-Molarity(mEq/L)	26.1
OxygenSaturation	0.904
HorowitzIndex(mmHg)	113
IntrinsicPositiveEndExpiratoryPressure(cmH2O)	0.560
MechanicalVentilator-RespirationRate(1/min)	27.8
MechanicalVentilator-MeanAirwayPressure(cmH2O)	9.82
MechanicalVentilator-PeakInspiratoryPressure(cmH2O)	27.7
MechanicalVentilator-PlateauPressure(cmH2O)	17.8
HeartRate(1/min)	106
SystolicArterialPressure(mmHg)	110
DiastolicArterialPressure(mmHg)	81.2
MechanicalVentilator-TotalPulmonaryVentilation(L/min)	13.4
MechanicalVentilator-InspiratoryResistance(cmH2O_s/L)	12.4
MechanicalVentilator-ExpiratoryResistance(cmH2O_s/L)	12.4
MechanicalVentilator-StaticRespiratoryCompliance(mL/cmH2O)	39.1
MechanicalVentilator-DynamicRespiratoryCompliance(mL/cmH2O)	21.2
MechanicalVentilator-EndTidalCarbonDioxidePressure(mmHg)	29.4
MechanicalVentilator-EndTidalOxygenPressure(mmHg)	347
MechanicalVentilator-ExpiratoryTidalVolume(L)	0.482
MechanicalVentilator-InspiratoryExpiratoryRatio	0.403
MechanicalVentilator-InspiratoryTidalVolume(L)	0.482
MechanicalVentilator-PeakExpiratoryFlow(L/s)	0.834
MechanicalVentilator-LeakFraction	4.38e-15
MechanicalVentilator-IntrinsicPositiveEndExpiratoryPressure(cmH2O)	0.510
MechanicalVentilator-ExtrinsicPositiveEndExpiratoryPressure(cmH2O)	5.00
MechanicalVentilator-TotalPositiveEndExpiratoryPressure(cmH2O)	5.51
PhysiologicDeadSpaceTidalVolumeRatio	0.553
PhysiologicShuntFraction	0.364
TotalRespiratoryModelInspiratoryResistance(cmH2O_s/L)	12.4
TotalRespiratoryModelExpiratoryResistance(cmH2O_s/L)	12.4
TotalRespiratoryModelCompliance(mL/cmH2O)	46.2
ExtrinsicPositiveEndExpiratoryPressure(cmH2O)	5.00
TotalPositiveEndExpiratoryPressure(cmH2O)	5.56
EndTidalCarbonDioxidePressure(mmHg)	32.4
PhysiologicDeadSpace(mL)	318
AlveolarArterialGradient(mmHg)	280
AlveolarDeadSpace(mL)	154
AnatomicDeadSpace(mL)	164
ChestWallCompliance(L/cmH2O)	0.126
FractionOfInspiredOxygen	0.499
LungCompliance(L/cmH2O)	0.0594
VentilationPerfusionRatio	2.19
HeartStrokeVolume(mL)	59.1
HeartEjectionFraction	0.475
BloodVolume(L)	6.53
MeanArterialPressure(mmHg)	95.9
PulsePressure(mmHg)	28.9
CardiacOutput(L/min)	6.27
CarbonDioxideSaturation	0.139
RespiratoryExchangeRatio	0.810
SystemicVascularResistance(mmHg_s/mL)	0.872
OxygenConsumptionRate(mL/min)	282
CarbonDioxideProductionRate(mL/min)	228
Patient-AlveoliSurfaceArea(m^2)	14.9
Patient-ExpiratoryReserveVolume(L)	0.943
Patient-FunctionalResidualCapacity(L)	1.39
Patient-InspiratoryCapacity(L)	3.37
Patient-InspiratoryReserveVolume(L)	2.79
Patient-ResidualVolume(L)	0.444
Patient-TidalVolumeBaseline(L)	0.580
Patient-TotalLungCapacity(L)	4.75
Patient-VitalCapacity(L)	4.31

Segment 4

Patient transport has ended.

Learning Objectives:

Recognize improvement due to change in vent settings

Recommended Actions:

None

Ventilator settings are updated to:

PEEP: 5 -> 8 cmH2O

Table 7. Data request validation results for Segment 4.

Property Name	Validation	Engine Value	Percent Error	Percent Change	Notes
MechanicalVentilator-TidalVolume(mL)	EqualTo 490	481	1.79%		VT (measured)
RespiratoryCompliance(mL/cmH2O)	GreaterThan Segment3 (39.7) [229]	41.5		4.67%	C
Aorta-CarbonDioxide-PartialPressure(mmHg)	EqualTo Segment3 (44.4) [254]	49.0	9.69%		PaCO2
Aorta-Oxygen-PartialPressure(mmHg)	GreaterThan Segment3 (56.5) [185]	62.6		10.9%	PaO2
HorowitzIndex(mmHg)	GreaterThan Segment3 (113) [185]	125		10.9%	PaO2/FiO2
ClinicalShuntFraction	LessThan Segment3 (0.361) [185]	0.320		-11.4%	QS/QT (determined from blood gas values)

Figure 5. Vitals and ventilator monitors for Segment 4.

Table 8. Data requests for Segment 4.

Property Name	Engine Value
Patient-Height(in)	74.0
Patient-IdealBodyWeight(kg)	82.2
InspiratoryRespiratoryResistance(cmH2O_s/L)	12.4
ExpiratoryRespiratoryResistance(cmH2O_s/L)	12.4
RespiratoryCompliance(mL/cmH2O)	41.5
ClinicalPhysiologicDeadSpaceTidalVolumeRatio	0.525
ClinicalShuntFraction	0.320
MechanicalVentilator-TidalVolume(L)	0.481
BloodPH	7.33
Aorta-Oxygen-PartialPressure(mmHg)	62.6
Aorta-CarbonDioxide-PartialPressure(mmHg)	49.0
Aorta-Bicarbonate-Molarity(mEq/L)	26.3
OxygenSaturation	0.917
HorowitzIndex(mmHg)	125
IntrinsicPositiveEndExpiratoryPressure(cmH2O)	0.631
MechanicalVentilator-RespirationRate(1/min)	27.8
MechanicalVentilator-MeanAirwayPressure(cmH2O)	12.8
MechanicalVentilator-PeakInspiratoryPressure(cmH2O)	30.3
MechanicalVentilator-PlateauPressure(cmH2O)	20.3
HeartRate(1/min)	81.8
SystolicArterialPressure(mmHg)	113
DiastolicArterialPressure(mmHg)	76.6
MechanicalVentilator-TotalPulmonaryVentilation(L/min)	13.4
MechanicalVentilator-InspiratoryResistance(cmH2O_s/L)	12.4
MechanicalVentilator-ExpiratoryResistance(cmH2O_s/L)	12.4
MechanicalVentilator-StaticRespiratoryCompliance(mL/cmH2O)	41.1
MechanicalVentilator-DynamicRespiratoryCompliance(mL/cmH2O)	21.6
MechanicalVentilator-EndTidalCarbonDioxidePressure(mmHg)	32.2
MechanicalVentilator-EndTidalOxygenPressure(mmHg)	346
MechanicalVentilator-ExpiratoryTidalVolume(L)	0.481
MechanicalVentilator-InspiratoryExpiratoryRatio	0.403
MechanicalVentilator-InspiratoryTidalVolume(L)	0.481
MechanicalVentilator-PeakExpiratoryFlow(L/s)	0.808
MechanicalVentilator-LeakFraction	0.00
MechanicalVentilator-IntrinsicPositiveEndExpiratoryPressure(cmH2O)	0.566
MechanicalVentilator-ExtrinsicPositiveEndExpiratoryPressure(cmH2O)	8.00
MechanicalVentilator-TotalPositiveEndExpiratoryPressure(cmH2O)	8.57
PhysiologicDeadSpaceTidalVolumeRatio	0.553
PhysiologicShuntFraction	0.325
TotalRespiratoryModelInspiratoryResistance(cmH2O_s/L)	12.4
TotalRespiratoryModelExpiratoryResistance(cmH2O_s/L)	12.4
TotalRespiratoryModelCompliance(mL/cmH2O)	46.1
ExtrinsicPositiveEndExpiratoryPressure(cmH2O)	8.01
TotalPositiveEndExpiratoryPressure(cmH2O)	8.64
EndTidalCarbonDioxidePressure(mmHg)	35.4
PhysiologicDeadSpace(mL)	318
AlveolarArterialGradient(mmHg)	271
AlveolarDeadSpace(mL)	154
AnatomicDeadSpace(mL)	164
ChestWallCompliance(L/cmH2O)	0.143
FractionOfInspiredOxygen	0.499
LungCompliance(L/cmH2O)	0.0594
VentilationPerfusionRatio	2.22
HeartStrokeVolume(mL)	75.8
HeartEjectionFraction	0.539
BloodVolume(L)	6.62
MeanArterialPressure(mmHg)	95.8
PulsePressure(mmHg)	36.5
CardiacOutput(L/min)	6.20
CarbonDioxideSaturation	0.315
RespiratoryExchangeRatio	0.814
SystemicVascularResistance(mmHg_s/mL)	0.881
OxygenConsumptionRate(mL/min)	288
CarbonDioxideProductionRate(mL/min)	235
Patient-AlveoliSurfaceArea(m^2)	14.9
Patient-ExpiratoryReserveVolume(L)	0.943
Patient-FunctionalResidualCapacity(L)	1.39
Patient-InspiratoryCapacity(L)	3.37
Patient-InspiratoryReserveVolume(L)	2.79
Patient-ResidualVolume(L)	0.444
Patient-TidalVolumeBaseline(L)	0.580
Patient-TotalLungCapacity(L)	4.75
Patient-VitalCapacity(L)	4.31

Scenario Output Plots

Figure 6. Select outputs from the scenario.