MechanicalVentilator-ARDS
MechanicalVentilatorARDS
Description
A male patient with a predicted body weight of 60 kg is mechanically ventilated with varying severities of ARDS. These are the data sources:
- Resistance: Rinsp is assumed equal to Rexp, taken from Arnal et al [1] (Table 3).
- Compliance: All compliances were taken from Maj et al [8] (Table 1) derived as tidal volume (ie, mL/kg x PBW calcualted with ARDS equation for males) divided by driving pressure. Mild ARDS was mean minus 1 standard deviatio; moderate ARDS was the mean value; severe ARDS was mean plus 1 standard deviation.
- Dead space: VD/VT values were taken from Maj et al [8] (Table 2).
- Shunt: Values for QS/QT were a compromise between Maj et al [8] (Table 2, venous admixture) and Torres et al [13] (Table 3) to give realistic PO2 results for the simulated ventilator settings.
- Ventilator Settings: All ventilator settings were takeng from Arnal et al [1] (Table 2) for a male patient aged 73 years and predicted body weight of 60 kg. Note that the mode for simulation is PC-CMV, which is equivalent to the mode used by Arnal et [1] for passive pateints. Equivalent settings for tidal volume, rate, and inspiratory time can be used for volume control simulations.
- Blood Gas Values: Expected blood gas value for outputs of Pulse simulator were taken from the most complete source: Arnal et al [1] (Table 2). FiO2 values for moderate and severe ARDS were adjusted upward to give the expected P/F ratios for the given PaO2 ranges. Expected values for SpO2 were calculated from PaO2 using the equation from Gadrey et al [4].
Segment Validation
Segment 1
Diagnosis: Mild ARDS (severity = 0.3).
Ventilator settings are (VT Target = 6.9 mL/kg (ideal)):
Mode | VT (mL) | PIP (cmH2O) | Flow (L/min) | I:E | TI (s) | RR (bpm) | PEEP (cmH2O) | FiO2 |
---|---|---|---|---|---|---|---|---|
PC-CMV | 414 | Adjust | NA | 0.83 | 1.3 | 21 | 10 | 0.31 |
Property Name | Validation | Engine Value | Percent Error | Percent Change | Notes |
---|---|---|---|---|---|
InspiratoryRespiratoryResistance(cmH2O_s/L) | EqualTo (12.0) [1] | 11.6 | 3.17% | Rinsp | |
ExpiratoryRespiratoryResistance(cmH2O_s/L) | EqualTo (12.0) [1] | 11.6 | 3.18% | Rexp | |
RespiratoryCompliance(mL/cmH2O) | EqualTo (40.0) [8] | 40.9 | 2.20% | C | |
ApparentPhysiologicDeadSpaceTidalVolumeRatio | EqualTo (0.540) [8] | 0.545 | 0.925% | VD/VT (determined from blood gas values) | |
ApparentShuntFraction | EqualTo (0.200) [8] [13] | 0.151 | 27.9% | QS/QT (determined from blood gas values) | |
MechanicalVentilator-TidalVolume(mL) | EqualTo (414) [1] | 422 | 1.82% | VT (measured) | |
BloodPH | [7.28,7.40] [1] | 7.37 | 0.00% | pH | |
Aorta-Oxygen-PartialPressure(mmHg) | [72.0,88.0] [1] | 107 | 19.8% | PaO2 | |
Aorta-CarbonDioxide-PartialPressure(mmHg) | [37.0,46.0] [1] | 44.4 | 0.00% | PaCO2 | |
OxygenSaturation | [0.940,0.970] [4] | 0.982 | 1.24% | SpO2 | |
HorowitzIndex(mmHg) | [232,284] [1] | 347 | 20.0% | PaO2/FiO2 | |
HorowitzIndex(mmHg) | [200,300] [3] | 347 | 14.5% | PaO2/FiO2 |
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Property Name | Engine Value |
---|---|
Patient-Height(in) | 64.3 |
Patient-IdealBodyWeight(kg) | 60.0 |
InspiratoryRespiratoryResistance(cmH2O_s/L) | 11.6 |
ExpiratoryRespiratoryResistance(cmH2O_s/L) | 11.6 |
RespiratoryCompliance(mL/cmH2O) | 40.9 |
ApparentPhysiologicDeadSpaceTidalVolumeRatio | 0.545 |
ApparentShuntFraction | 0.151 |
MechanicalVentilator-TidalVolume(L) | 0.422 |
BloodPH | 7.37 |
Aorta-Oxygen-PartialPressure(mmHg) | 107 |
Aorta-CarbonDioxide-PartialPressure(mmHg) | 44.4 |
Aorta-Bicarbonate-Molarity(mEq/L) | 26.1 |
OxygenSaturation | 0.982 |
HorowitzIndex(mmHg) | 347 |
IntrinsicPositiveEndExpiratoryPressure(cmH2O) | 0.385 |
MechanicalVentilator-RespirationRate(1/min) | 21.0 |
MechanicalVentilator-MeanAirwayPressure(cmH2O) | 15.1 |
MechanicalVentilator-PeakInspiratoryPressure(cmH2O) | 21.5 |
MechanicalVentilator-PlateauPressure(cmH2O) | 20.8 |
HeartRate(1/min) | 69.9 |
SystolicArterialPressure(mmHg) | 115 |
DiastolicArterialPressure(mmHg) | 72.9 |
MechanicalVentilator-TotalPulmonaryVentilation(L/min) | 8.84 |
MechanicalVentilator-InspiratoryResistance(cmH2O_s/L) | 11.6 |
MechanicalVentilator-ExpiratoryResistance(cmH2O_s/L) | 11.6 |
MechanicalVentilator-StaticRespiratoryCompliance(mL/cmH2O) | 40.5 |
MechanicalVentilator-DynamicRespiratoryCompliance(mL/cmH2O) | 36.7 |
MechanicalVentilator-EndTidalCarbonDioxidePressure(mmHg) | 34.4 |
MechanicalVentilator-EndTidalOxygenPressure(mmHg) | 196 |
MechanicalVentilator-ExpiratoryTidalVolume(L) | 0.422 |
MechanicalVentilator-InspiratoryExpiratoryRatio | 0.833 |
MechanicalVentilator-InspiratoryTidalVolume(L) | 0.422 |
MechanicalVentilator-PeakExpiratoryFlow(L/s) | 0.750 |
MechanicalVentilator-LeakFraction | 7.27e-14 |
MechanicalVentilator-IntrinsicPositiveEndExpiratoryPressure(cmH2O) | 0.379 |
MechanicalVentilator-ExtrinsicPositiveEndExpiratoryPressure(cmH2O) | 10.0 |
MechanicalVentilator-TotalPositiveEndExpiratoryPressure(cmH2O) | 10.4 |
PhysiologicDeadSpaceTidalVolumeRatio | 0.516 |
ShuntFraction | 0.0902 |
TotalRespiratoryModelInspiratoryResistance(cmH2O_s/L) | 11.6 |
TotalRespiratoryModelExpiratoryResistance(cmH2O_s/L) | 11.6 |
TotalRespiratoryModelCompliance(mL/cmH2O) | 47.6 |
ExtrinsicPositiveEndExpiratoryPressure(cmH2O) | 10.0 |
TotalPositiveEndExpiratoryPressure(cmH2O) | 10.4 |
EndTidalCarbonDioxidePressure(mmHg) | 37.7 |
PhysiologicDeadSpace(mL) | 217 |
AlveolarArterialGradient(mmHg) | 81.0 |
AlveolarDeadSpace(mL) | 96.6 |
AnatomicDeadSpace(mL) | 120 |
ChestWallCompliance(L/cmH2O) | 0.142 |
FractionOfInspiredOxygen | 0.309 |
LungCompliance(L/cmH2O) | 0.0585 |
VentilationPerfusionRatio | 1.73 |
HeartStrokeVolume(mL) | 80.5 |
HeartEjectionFraction | 0.578 |
BloodVolume(L) | 4.15 |
MeanArterialPressure(mmHg) | 95.4 |
PulsePressure(mmHg) | 42.2 |
CardiacOutput(L/min) | 5.62 |
CarbonDioxideSaturation | 0.134 |
RespiratoryExchangeRatio | 0.827 |
SystemicVascularResistance(mmHg_s/mL) | 0.969 |
OxygenConsumptionRate(mL/min) | 195 |
CarbonDioxideProductionRate(mL/min) | 162 |
Patient-AlveoliSurfaceArea(m^2) | 27.2 |
Patient-ExpiratoryReserveVolume(L) | 0.687 |
Patient-FunctionalResidualCapacity(L) | 1.28 |
Patient-InspiratoryCapacity(L) | 2.45 |
Patient-InspiratoryReserveVolume(L) | 2.02 |
Patient-ResidualVolume(L) | 0.594 |
Patient-TidalVolumeBaseline(L) | 0.435 |
Patient-TotalLungCapacity(L) | 3.73 |
Patient-VitalCapacity(L) | 3.14 |
Segment 2
Diagnosis: Moderate ARDS (severity = 0.6).
Ventilator settings are (VT Target = 6.6 mL/kg (ideal)):
Mode | VT (mL) | PIP (cmH2O) | Flow (L/min) | I:E | TI (s) | RR (bpm) | PEEP (cmH2O) | FiO2 |
---|---|---|---|---|---|---|---|---|
PC-CMV | 396 | Adjust | NA | 0.91 | 1.2 | 23 | 12 | 0.50 |
Property Name | Validation | Engine Value | Percent Error | Percent Change | Notes |
---|---|---|---|---|---|
InspiratoryRespiratoryResistance(cmH2O_s/L) | EqualTo (12.0) [1] | 12.4 | 3.08% | Rinsp | |
ExpiratoryRespiratoryResistance(cmH2O_s/L) | EqualTo (12.0) [1] | 12.4 | 3.09% | Rexp | |
RespiratoryCompliance(mL/cmH2O) | EqualTo (35.0) [8] | 35.6 | 1.79% | C | |
ApparentPhysiologicDeadSpaceTidalVolumeRatio | EqualTo (0.570) [8] | 0.578 | 1.40% | VD/VT (determined from blood gas values) | |
ApparentShuntFraction | EqualTo (0.300) [8] [13] | 0.307 | 2.31% | QS/QT (determined from blood gas values) | |
MechanicalVentilator-TidalVolume(mL) | EqualTo (396) [1] | 405 | 2.19% | VT (measured) | |
BloodPH | [7.26,7.41] [1] | 7.36 | 0.00% | pH | |
Aorta-Oxygen-PartialPressure(mmHg) | [70.0,94.0] [1] | 83.6 | 0.00% | PaO2 | |
Aorta-CarbonDioxide-PartialPressure(mmHg) | [39.0,50.0] [1] | 45.4 | 0.00% | PaCO2 | |
OxygenSaturation | [0.940,0.970] [4] | 0.965 | 0.00% | SpO2 | |
HorowitzIndex(mmHg) | [140,188] [1] | 167 | 0.00% | PaO2/FiO2 | |
HorowitzIndex(mmHg) | [100,200] [3] | 167 | 0.00% | PaO2/FiO2 |
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Property Name | Engine Value |
---|---|
Patient-Height(in) | 64.3 |
Patient-IdealBodyWeight(kg) | 60.0 |
InspiratoryRespiratoryResistance(cmH2O_s/L) | 12.4 |
ExpiratoryRespiratoryResistance(cmH2O_s/L) | 12.4 |
RespiratoryCompliance(mL/cmH2O) | 35.6 |
ApparentPhysiologicDeadSpaceTidalVolumeRatio | 0.578 |
ApparentShuntFraction | 0.307 |
MechanicalVentilator-TidalVolume(L) | 0.405 |
BloodPH | 7.36 |
Aorta-Oxygen-PartialPressure(mmHg) | 83.6 |
Aorta-CarbonDioxide-PartialPressure(mmHg) | 45.4 |
Aorta-Bicarbonate-Molarity(mEq/L) | 26.2 |
OxygenSaturation | 0.965 |
HorowitzIndex(mmHg) | 167 |
IntrinsicPositiveEndExpiratoryPressure(cmH2O) | 0.465 |
MechanicalVentilator-RespirationRate(1/min) | 22.9 |
MechanicalVentilator-MeanAirwayPressure(cmH2O) | 17.7 |
MechanicalVentilator-PeakInspiratoryPressure(cmH2O) | 24.7 |
MechanicalVentilator-PlateauPressure(cmH2O) | 23.9 |
HeartRate(1/min) | 67.4 |
SystolicArterialPressure(mmHg) | 116 |
DiastolicArterialPressure(mmHg) | 72.2 |
MechanicalVentilator-TotalPulmonaryVentilation(L/min) | 9.27 |
MechanicalVentilator-InspiratoryResistance(cmH2O_s/L) | 12.4 |
MechanicalVentilator-ExpiratoryResistance(cmH2O_s/L) | 12.4 |
MechanicalVentilator-StaticRespiratoryCompliance(mL/cmH2O) | 35.5 |
MechanicalVentilator-DynamicRespiratoryCompliance(mL/cmH2O) | 31.9 |
MechanicalVentilator-EndTidalCarbonDioxidePressure(mmHg) | 32.3 |
MechanicalVentilator-EndTidalOxygenPressure(mmHg) | 347 |
MechanicalVentilator-ExpiratoryTidalVolume(L) | 0.405 |
MechanicalVentilator-InspiratoryExpiratoryRatio | 0.845 |
MechanicalVentilator-InspiratoryTidalVolume(L) | 0.405 |
MechanicalVentilator-PeakExpiratoryFlow(L/s) | 0.768 |
MechanicalVentilator-LeakFraction | 1.25e-13 |
MechanicalVentilator-IntrinsicPositiveEndExpiratoryPressure(cmH2O) | 0.450 |
MechanicalVentilator-ExtrinsicPositiveEndExpiratoryPressure(cmH2O) | 12.0 |
MechanicalVentilator-TotalPositiveEndExpiratoryPressure(cmH2O) | 12.4 |
PhysiologicDeadSpaceTidalVolumeRatio | 0.554 |
ShuntFraction | 0.263 |
TotalRespiratoryModelInspiratoryResistance(cmH2O_s/L) | 12.4 |
TotalRespiratoryModelExpiratoryResistance(cmH2O_s/L) | 12.4 |
TotalRespiratoryModelCompliance(mL/cmH2O) | 39.5 |
ExtrinsicPositiveEndExpiratoryPressure(cmH2O) | 12.0 |
TotalPositiveEndExpiratoryPressure(cmH2O) | 12.5 |
EndTidalCarbonDioxidePressure(mmHg) | 35.8 |
PhysiologicDeadSpace(mL) | 233 |
AlveolarArterialGradient(mmHg) | 250 |
AlveolarDeadSpace(mL) | 113 |
AnatomicDeadSpace(mL) | 120 |
ChestWallCompliance(L/cmH2O) | 0.134 |
FractionOfInspiredOxygen | 0.499 |
LungCompliance(L/cmH2O) | 0.0495 |
VentilationPerfusionRatio | 2.22 |
HeartStrokeVolume(mL) | 83.7 |
HeartEjectionFraction | 0.588 |
BloodVolume(L) | 4.18 |
MeanArterialPressure(mmHg) | 95.4 |
PulsePressure(mmHg) | 43.5 |
CardiacOutput(L/min) | 5.64 |
CarbonDioxideSaturation | 0.182 |
RespiratoryExchangeRatio | 0.831 |
SystemicVascularResistance(mmHg_s/mL) | 0.965 |
OxygenConsumptionRate(mL/min) | 198 |
CarbonDioxideProductionRate(mL/min) | 164 |
Patient-AlveoliSurfaceArea(m^2) | 10.9 |
Patient-ExpiratoryReserveVolume(L) | 0.671 |
Patient-FunctionalResidualCapacity(L) | 0.976 |
Patient-InspiratoryCapacity(L) | 2.40 |
Patient-InspiratoryReserveVolume(L) | 1.96 |
Patient-ResidualVolume(L) | 0.305 |
Patient-TidalVolumeBaseline(L) | 0.435 |
Patient-TotalLungCapacity(L) | 3.37 |
Patient-VitalCapacity(L) | 3.07 |
Segment 3
Diagnosis: Severe ARDS (severity = 0.9).
Ventilator settings are (VT Target = 6.6 mL/kg (ideal)):
Mode | VT (mL) | PIP (cmH2O) | Flow (L/min) | I:E | TI (s) | RR (bpm) | PEEP (cmH2O) | FiO2 |
---|---|---|---|---|---|---|---|---|
PC-CMV | 396 | Adjust | NA | 1.0 | 1.2 | 25 | 12 | 0.80 |
Property Name | Validation | Engine Value | Percent Error | Percent Change | Notes |
---|---|---|---|---|---|
InspiratoryRespiratoryResistance(cmH2O_s/L) | EqualTo (12.0) [1] | 13.1 | 8.95% | Rinsp | |
ExpiratoryRespiratoryResistance(cmH2O_s/L) | EqualTo (12.0) [1] | 13.1 | 8.97% | Rexp | |
RespiratoryCompliance(mL/cmH2O) | EqualTo (33.0) [8] | 33.1 | 0.256% | C | |
ApparentPhysiologicDeadSpaceTidalVolumeRatio | EqualTo (0.650) [8] | 0.708 | 8.50% | VD/VT (determined from blood gas values) | |
ApparentShuntFraction | EqualTo (0.400) [8] [13] | 0.454 | 12.7% | QS/QT (determined from blood gas values) | |
MechanicalVentilator-TidalVolume(mL) | EqualTo (396) [1] | 402 | 1.47% | VT (measured) | |
BloodPH | [7.21,7.34] [1] | 7.24 | 0.00% | pH | |
Aorta-Oxygen-PartialPressure(mmHg) | [68.0,80.0] [1] | 79.2 | 0.00% | PaO2 | |
Aorta-CarbonDioxide-PartialPressure(mmHg) | [44.0,56.0] [1] | 61.9 | 9.95% | PaCO2 | |
OxygenSaturation | [0.920,0.950] [4] | 0.944 | 0.00% | SpO2 | |
HorowitzIndex(mmHg) | [85.0,100] [1] | 99.1 | 0.00% | PaO2/FiO2 | |
HorowitzIndex(mmHg) | LessThan (100) [3] | 99.1 | -0.915% | PaO2/FiO2 |
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Property Name | Engine Value |
---|---|
Patient-Height(in) | 64.3 |
Patient-IdealBodyWeight(kg) | 60.0 |
InspiratoryRespiratoryResistance(cmH2O_s/L) | 13.1 |
ExpiratoryRespiratoryResistance(cmH2O_s/L) | 13.1 |
RespiratoryCompliance(mL/cmH2O) | 33.1 |
ApparentPhysiologicDeadSpaceTidalVolumeRatio | 0.708 |
ApparentShuntFraction | 0.454 |
MechanicalVentilator-TidalVolume(L) | 0.402 |
BloodPH | 7.24 |
Aorta-Oxygen-PartialPressure(mmHg) | 79.2 |
Aorta-CarbonDioxide-PartialPressure(mmHg) | 61.9 |
Aorta-Bicarbonate-Molarity(mEq/L) | 26.9 |
OxygenSaturation | 0.944 |
HorowitzIndex(mmHg) | 99.1 |
IntrinsicPositiveEndExpiratoryPressure(cmH2O) | 0.792 |
MechanicalVentilator-RespirationRate(1/min) | 25.0 |
MechanicalVentilator-MeanAirwayPressure(cmH2O) | 18.9 |
MechanicalVentilator-PeakInspiratoryPressure(cmH2O) | 26.0 |
MechanicalVentilator-PlateauPressure(cmH2O) | 25.0 |
HeartRate(1/min) | 70.2 |
SystolicArterialPressure(mmHg) | 117 |
DiastolicArterialPressure(mmHg) | 72.2 |
MechanicalVentilator-TotalPulmonaryVentilation(L/min) | 10.0 |
MechanicalVentilator-InspiratoryResistance(cmH2O_s/L) | 13.1 |
MechanicalVentilator-ExpiratoryResistance(cmH2O_s/L) | 13.1 |
MechanicalVentilator-StaticRespiratoryCompliance(mL/cmH2O) | 32.7 |
MechanicalVentilator-DynamicRespiratoryCompliance(mL/cmH2O) | 28.7 |
MechanicalVentilator-EndTidalCarbonDioxidePressure(mmHg) | 32.5 |
MechanicalVentilator-EndTidalOxygenPressure(mmHg) | 581 |
MechanicalVentilator-ExpiratoryTidalVolume(L) | 0.402 |
MechanicalVentilator-InspiratoryExpiratoryRatio | 1.00 |
MechanicalVentilator-InspiratoryTidalVolume(L) | 0.402 |
MechanicalVentilator-PeakExpiratoryFlow(L/s) | 0.803 |
MechanicalVentilator-LeakFraction | 0.00 |
MechanicalVentilator-IntrinsicPositiveEndExpiratoryPressure(cmH2O) | 0.750 |
MechanicalVentilator-ExtrinsicPositiveEndExpiratoryPressure(cmH2O) | 12.0 |
MechanicalVentilator-TotalPositiveEndExpiratoryPressure(cmH2O) | 12.8 |
PhysiologicDeadSpaceTidalVolumeRatio | 0.630 |
ShuntFraction | 0.401 |
TotalRespiratoryModelInspiratoryResistance(cmH2O_s/L) | 13.1 |
TotalRespiratoryModelExpiratoryResistance(cmH2O_s/L) | 13.1 |
TotalRespiratoryModelCompliance(mL/cmH2O) | 36.7 |
ExtrinsicPositiveEndExpiratoryPressure(cmH2O) | 12.0 |
TotalPositiveEndExpiratoryPressure(cmH2O) | 12.8 |
EndTidalCarbonDioxidePressure(mmHg) | 36.3 |
PhysiologicDeadSpace(mL) | 264 |
AlveolarArterialGradient(mmHg) | 491 |
AlveolarDeadSpace(mL) | 144 |
AnatomicDeadSpace(mL) | 120 |
ChestWallCompliance(L/cmH2O) | 0.132 |
FractionOfInspiredOxygen | 0.799 |
LungCompliance(L/cmH2O) | 0.0450 |
VentilationPerfusionRatio | 2.72 |
HeartStrokeVolume(mL) | 88.3 |
HeartEjectionFraction | 0.596 |
BloodVolume(L) | 4.34 |
MeanArterialPressure(mmHg) | 96.0 |
PulsePressure(mmHg) | 45.1 |
CardiacOutput(L/min) | 6.20 |
CarbonDioxideSaturation | 0.193 |
RespiratoryExchangeRatio | 0.831 |
SystemicVascularResistance(mmHg_s/mL) | 0.881 |
OxygenConsumptionRate(mL/min) | 197 |
CarbonDioxideProductionRate(mL/min) | 163 |
Patient-AlveoliSurfaceArea(m^2) | 5.45 |
Patient-ExpiratoryReserveVolume(L) | 0.663 |
Patient-FunctionalResidualCapacity(L) | 0.703 |
Patient-InspiratoryCapacity(L) | 2.37 |
Patient-InspiratoryReserveVolume(L) | 1.93 |
Patient-ResidualVolume(L) | 0.0404 |
Patient-TidalVolumeBaseline(L) | 0.435 |
Patient-TotalLungCapacity(L) | 3.07 |
Patient-VitalCapacity(L) | 3.03 |
Scenario Output Plots
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