MechanicalVentilator-COPD
MechanicalVentilatorCOPD
Description
A male patient with a predicted body weight of 60 kg is mechanically ventilated with varying severities of COPD. These are the data sources:
- Resistance: A regression equation was derived from the data of van den Berg et al [14] that predicts Rexp from measured FEV1. Then Rinsp is calculated as 65% of Rexp (from Officer et al [10]). Using the FEV1 calculator, the Rinsp value for mild COPD was based on predicted FEV1 of a 25 year old male, which showed that it was not different from healthy or ARDS patients. The Rexp value for moderate COPD was based on 60 year old male with 41% pred FEV1 = Gold Stage 3. The Rexp value for severe COPD was based on a 60 year old male with 28% pred FEV1 = Gold Stage 4.
- Compliance: All compliances were taken from Arnal et al [1] (Table 3). Mild COPD was approximately the mean value (so as to be higher than normal); moderate COPD was the average of the mean and the high end of the range (60,75), and severe COPD was the highest value of the range.
- Dead space: VD/VT values were taken from Farah et al [2] (Table 1). Mild COPD was mean minus 1 standard deviation; moderate COPD was the mean value; severe COPD was mean plus 2 standard deviations.
- Shunt: QS/QT values were taken from Torres et al [13] (Table 3). Mild COPD was mean minus 2 standard deviations; moderate COPD was the mean value; for severe COPD, values for FiO2 and PaO2 were taken from Arnal et al [1] (Table 2) and used with various prediction equations for iso-shunt lines to get a match at about PaO2 = 69, FiO2 = 0.4 and shunt = 0.20 .
- 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 alv [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). Expected values for SpO2 were calculated from PaO2 using the equation from Gadrey et al [4].
Segment Validation
Segment 1
Diagnosis: Mild COPD (severity = 0.3).
Ventilator settings are (VT Target = 7.3 mL/kg (ideal)):
| Mode | VT (mL) | PIP (cmH2O) | Flow (L/min) | I:E | TI (s) | RR (bpm) | PEEP (cmH2O) | FiO2 |
|---|---|---|---|---|---|---|---|---|
| PC-CMV | 438 | Adjust | NA | 0.32 | 1.2 | 15 | 5 | 0.32 |
| Property Name | Validation | Engine Value | Percent Error | Percent Change | Notes |
|---|---|---|---|---|---|
| InspiratoryRespiratoryResistance(cmH2O_s/L) | EqualTo 12 [14] [10] | 12.3 | 2.5% | Rinsp | |
| ExpiratoryRespiratoryResistance(cmH2O_s/L) | EqualTo 18 [14] | 17.93 | 0.4% | Rexp | |
| RespiratoryCompliance(mL/cmH2O) | EqualTo 60 [1] | 59.59 | 0.7% | C | |
| PhysiologicDeadSpaceTidalVolumeRatio | EqualTo 0.37 [2] | 0.345 | 7.0% | VD/VT | |
| ShuntFraction | EqualTo 0.12 [13] | 0.1138 | 5.3% | QS/QT | |
| MechanicalVentilator-TidalVolume(mL) | EqualTo 438 [1] | 439.4 | 0.3% | VT (measured) | |
| BloodPH | [7.26,7.4] [1] | 7.36 | 0.0% | pH | |
| Aorta-Oxygen-PartialPressure(mmHg) | [67,99] [1] | 89.83 | 0.0% | PaO2 | |
| Aorta-CarbonDioxide-PartialPressure(mmHg) | [45,55] [1] | 45.78 | 0.0% | PaCO2 | |
| OxygenSaturation | [0.93,0.98] [4] | 0.9702 | 0.0% | SpO2 |
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| Property Name | Engine Value |
|---|---|
| Patient-Height(in) | 64.3 |
| Patient-IdealBodyWeight(kg) | 60 |
| InspiratoryRespiratoryResistance(cmH2O_s/L) | 12.3 |
| ExpiratoryRespiratoryResistance(cmH2O_s/L) | 17.9 |
| RespiratoryCompliance(mL/cmH2O) | 59.6 |
| PhysiologicDeadSpaceTidalVolumeRatio | 0.345 |
| ShuntFraction | 0.114 |
| MechanicalVentilator-TidalVolume(L) | 0.439 |
| BloodPH | 7.36 |
| Aorta-Oxygen-PartialPressure(mmHg) | 89.8 |
| Aorta-CarbonDioxide-PartialPressure(mmHg) | 45.8 |
| Aorta-Bicarbonate-Molarity(mEq/L) | 26.2 |
| OxygenSaturation | 0.97 |
| HorowitzIndex(mmHg) | 322 |
| IntrinsicPositiveEndExpiratoryPressure(cmH2O) | 0.519 |
| MechanicalVentilator-RespirationRate(1/min) | 15 |
| MechanicalVentilator-MeanAirwayPressure(cmH2O) | 7.95 |
| MechanicalVentilator-PeakInspiratoryPressure(cmH2O) | 15 |
| MechanicalVentilator-PlateauPressure(cmH2O) | 13.3 |
| HeartRate(1/min) | 73.1 |
| SystolicArterialPressure(mmHg) | 113 |
| DiastolicArterialPressure(mmHg) | 74.3 |
| MechanicalVentilator-TotalPulmonaryVentilation(L/min) | 6.59 |
| MechanicalVentilator-InspiratoryResistance(cmH2O_s/L) | 12.3 |
| MechanicalVentilator-ExpiratoryResistance(cmH2O_s/L) | 17.9 |
| MechanicalVentilator-StaticRespiratoryCompliance(mL/cmH2O) | 56.2 |
| MechanicalVentilator-DynamicRespiratoryCompliance(mL/cmH2O) | 44 |
| MechanicalVentilator-EndTidalCarbonDioxidePressure(mmHg) | 40.1 |
| MechanicalVentilator-EndTidalOxygenPressure(mmHg) | 163 |
| MechanicalVentilator-ExpiratoryTidalVolume(L) | 0.439 |
| MechanicalVentilator-InspiratoryExpiratoryRatio | 0.429 |
| MechanicalVentilator-InspiratoryTidalVolume(L) | 0.439 |
| MechanicalVentilator-PeakExpiratoryFlow(L/s) | 0.397 |
| MechanicalVentilator-LeakFraction | 1.7E-13 |
| MechanicalVentilator-IntrinsicPositiveEndExpiratoryPressure(cmH2O) | 0.486 |
| MechanicalVentilator-ExtrinsicPositiveEndExpiratoryPressure(cmH2O) | 5 |
| MechanicalVentilator-TotalPositiveEndExpiratoryPressure(cmH2O) | 5.49 |
| ExtrinsicPositiveEndExpiratoryPressure(cmH2O) | 5 |
| TotalPositiveEndExpiratoryPressure(cmH2O) | 5.52 |
| EndTidalCarbonDioxidePressure(mmHg) | 42.4 |
| PhysiologicDeadSpace(mL) | 145 |
| AlveolarArterialGradient(mmHg) | 68 |
| AlveolarDeadSpace(mL) | 24.9 |
| AnatomicDeadSpace(mL) | 120 |
| ChestWallCompliance(L/cmH2O) | 0.163 |
| FractionOfInspiredOxygen | 0.279 |
| LungCompliance(L/cmH2O) | 0.0954 |
| VentilationPerfusionRatio | 1.37 |
| HeartStrokeVolume(mL) | 73.9 |
| HeartEjectionFraction | 0.56 |
| BloodVolume(L) | 4.17 |
| MeanArterialPressure(mmHg) | 95.1 |
| PulsePressure(mmHg) | 39 |
| CardiacOutput(L/min) | 5.41 |
| CarbonDioxideSaturation | 0.199 |
| RespiratoryExchangeRatio | 0.828 |
| SystemicVascularResistance(mmHg_s/mL) | 1 |
| OxygenConsumptionRate(mL/min) | 199 |
| CarbonDioxideProductionRate(mL/min) | 165 |
| Patient-AlveoliSurfaceArea(m^2) | 27.2 |
| Patient-ExpiratoryReserveVolume(L) | 0.741 |
| Patient-FunctionalResidualCapacity(L) | 1.61 |
| Patient-InspiratoryCapacity(L) | 2.65 |
| Patient-InspiratoryReserveVolume(L) | 2.21 |
| Patient-ResidualVolume(L) | 0.871 |
| Patient-TidalVolumeBaseline(L) | 0.435 |
| Patient-TotalLungCapacity(L) | 4.26 |
| Patient-VitalCapacity(L) | 3.39 |
Segment 2
Diagnosis: Moderate COPD (severity = 0.6).
Ventilator settings are (VT Target = 8.9 mL/kg (ideal)):
| Mode | VT (mL) | PIP (cmH2O) | Flow (L/min) | I:E | TI (s) | RR (bpm) | PEEP (cmH2O) | FiO2 |
|---|---|---|---|---|---|---|---|---|
| PC-CMV | 534 | Adjust | NA | 0.43 | 1.3 | 14 | 7 | 0.32 |
| Property Name | Validation | Engine Value | Percent Error | Percent Change | Notes |
|---|---|---|---|---|---|
| InspiratoryRespiratoryResistance(cmH2O_s/L) | EqualTo 24 [14] [10] | 23.55 | 1.9% | Rinsp | |
| ExpiratoryRespiratoryResistance(cmH2O_s/L) | EqualTo 36 [14] | 37.05 | 2.9% | Rexp | |
| RespiratoryCompliance(mL/cmH2O) | EqualTo 68 [1] | 67.15 | 1.3% | C | |
| PhysiologicDeadSpaceTidalVolumeRatio | EqualTo 0.49 [2] | 0.4778 | 2.5% | VD/VT | |
| ShuntFraction | EqualTo 0.19 [13] | 0.2019 | 6.1% | QS/QT | |
| MechanicalVentilator-TidalVolume(mL) | EqualTo 534 [1] | 531.6 | 0.5% | VT (measured) | |
| BloodPH | [7.26,7.4] [1] | 7.361 | 0.0% | pH | |
| Aorta-Oxygen-PartialPressure(mmHg) | [67,99] [1] | 73.37 | 0.0% | PaO2 | |
| Aorta-CarbonDioxide-PartialPressure(mmHg) | [45,55] [1] | 45.71 | 0.0% | PaCO2 | |
| OxygenSaturation | [0.93,0.98] [4] | 0.9496 | 0.0% | SpO2 |
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| Property Name | Engine Value |
|---|---|
| Patient-Height(in) | 64.3 |
| Patient-IdealBodyWeight(kg) | 60 |
| InspiratoryRespiratoryResistance(cmH2O_s/L) | 23.5 |
| ExpiratoryRespiratoryResistance(cmH2O_s/L) | 37.1 |
| RespiratoryCompliance(mL/cmH2O) | 67.1 |
| PhysiologicDeadSpaceTidalVolumeRatio | 0.478 |
| ShuntFraction | 0.202 |
| MechanicalVentilator-TidalVolume(L) | 0.532 |
| BloodPH | 7.36 |
| Aorta-Oxygen-PartialPressure(mmHg) | 73.4 |
| Aorta-CarbonDioxide-PartialPressure(mmHg) | 45.7 |
| Aorta-Bicarbonate-Molarity(mEq/L) | 26.2 |
| OxygenSaturation | 0.95 |
| HorowitzIndex(mmHg) | 229 |
| IntrinsicPositiveEndExpiratoryPressure(cmH2O) | 3.42 |
| MechanicalVentilator-RespirationRate(1/min) | 14 |
| MechanicalVentilator-MeanAirwayPressure(cmH2O) | 12.4 |
| MechanicalVentilator-PeakInspiratoryPressure(cmH2O) | 25 |
| MechanicalVentilator-PlateauPressure(cmH2O) | 17.3 |
| HeartRate(1/min) | 77.8 |
| SystolicArterialPressure(mmHg) | 112 |
| DiastolicArterialPressure(mmHg) | 75 |
| MechanicalVentilator-TotalPulmonaryVentilation(L/min) | 7.42 |
| MechanicalVentilator-InspiratoryResistance(cmH2O_s/L) | 23.6 |
| MechanicalVentilator-ExpiratoryResistance(cmH2O_s/L) | 37 |
| MechanicalVentilator-StaticRespiratoryCompliance(mL/cmH2O) | 67.1 |
| MechanicalVentilator-DynamicRespiratoryCompliance(mL/cmH2O) | 29.6 |
| MechanicalVentilator-EndTidalCarbonDioxidePressure(mmHg) | 38.5 |
| MechanicalVentilator-EndTidalOxygenPressure(mmHg) | 199 |
| MechanicalVentilator-ExpiratoryTidalVolume(L) | 0.532 |
| MechanicalVentilator-InspiratoryExpiratoryRatio | 0.433 |
| MechanicalVentilator-InspiratoryTidalVolume(L) | 0.532 |
| MechanicalVentilator-PeakExpiratoryFlow(L/s) | 0.285 |
| MechanicalVentilator-LeakFraction | 0 |
| MechanicalVentilator-IntrinsicPositiveEndExpiratoryPressure(cmH2O) | 2.37 |
| MechanicalVentilator-ExtrinsicPositiveEndExpiratoryPressure(cmH2O) | 7 |
| MechanicalVentilator-TotalPositiveEndExpiratoryPressure(cmH2O) | 9.37 |
| ExtrinsicPositiveEndExpiratoryPressure(cmH2O) | 7.01 |
| TotalPositiveEndExpiratoryPressure(cmH2O) | 10.4 |
| EndTidalCarbonDioxidePressure(mmHg) | 40.8 |
| PhysiologicDeadSpace(mL) | 201 |
| AlveolarArterialGradient(mmHg) | 122 |
| AlveolarDeadSpace(mL) | 80.7 |
| AnatomicDeadSpace(mL) | 120 |
| ChestWallCompliance(L/cmH2O) | 0.22 |
| FractionOfInspiredOxygen | 0.32 |
| LungCompliance(L/cmH2O) | 0.0972 |
| VentilationPerfusionRatio | 1.73 |
| HeartStrokeVolume(mL) | 69.6 |
| HeartEjectionFraction | 0.547 |
| BloodVolume(L) | 4.2 |
| MeanArterialPressure(mmHg) | 94.7 |
| PulsePressure(mmHg) | 37 |
| CardiacOutput(L/min) | 5.41 |
| CarbonDioxideSaturation | 0.197 |
| RespiratoryExchangeRatio | 0.829 |
| SystemicVascularResistance(mmHg_s/mL) | 0.998 |
| OxygenConsumptionRate(mL/min) | 200 |
| CarbonDioxideProductionRate(mL/min) | 166 |
| Patient-AlveoliSurfaceArea(m^2) | 10.9 |
| Patient-ExpiratoryReserveVolume(L) | 0.743 |
| Patient-FunctionalResidualCapacity(L) | 1.67 |
| Patient-InspiratoryCapacity(L) | 2.65 |
| Patient-InspiratoryReserveVolume(L) | 2.22 |
| Patient-ResidualVolume(L) | 0.929 |
| Patient-TidalVolumeBaseline(L) | 0.435 |
| Patient-TotalLungCapacity(L) | 4.33 |
| Patient-VitalCapacity(L) | 3.4 |
Segment 3
Diagnosis: Severe COPD (severity = 0.9).
Ventilator settings are (VT Target = 10.0 mL/kg (ideal)):
| Mode | VT (mL) | PIP (cmH2O) | Flow (L/min) | I:E | TI (s) | RR (bpm) | PEEP (cmH2O) | FiO2 |
|---|---|---|---|---|---|---|---|---|
| PC-CMV | 600 | Adjust | NA | 0.5 | 1.1 | 14 | 10 | 0.42 |
| Property Name | Validation | Engine Value | Percent Error | Percent Change | Notes |
|---|---|---|---|---|---|
| InspiratoryRespiratoryResistance(cmH2O_s/L) | EqualTo 34 [14] [10] | 32.55 | 4.4% | Rinsp | |
| ExpiratoryRespiratoryResistance(cmH2O_s/L) | EqualTo 51 [14] | 50.55 | 0.9% | Rexp | |
| RespiratoryCompliance(mL/cmH2O) | EqualTo 75 [1] | 74.6 | 0.5% | C | |
| PhysiologicDeadSpaceTidalVolumeRatio | EqualTo 0.73 [2] | 0.7434 | 1.8% | VD/VT | |
| ShuntFraction | EqualTo 0.2 [1] | 0.2044 | 2.2% | QS/QT | |
| MechanicalVentilator-TidalVolume(mL) | EqualTo 600 [1] | 616.3 | 2.7% | VT (measured) | |
| BloodPH | [7.26,7.4] [1] | 7.36 | 0.0% | pH | |
| Aorta-Oxygen-PartialPressure(mmHg) | [67,99] [1] | 75.25 | 0.0% | PaO2 | |
| Aorta-CarbonDioxide-PartialPressure(mmHg) | [45,55] [1] | 45.78 | 0.0% | PaCO2 | |
| OxygenSaturation | [0.93,0.98] [4] | 0.9526 | 0.0% | SpO2 |
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| Property Name | Engine Value |
|---|---|
| Patient-Height(in) | 64.3 |
| Patient-IdealBodyWeight(kg) | 60 |
| InspiratoryRespiratoryResistance(cmH2O_s/L) | 32.6 |
| ExpiratoryRespiratoryResistance(cmH2O_s/L) | 50.6 |
| RespiratoryCompliance(mL/cmH2O) | 74.6 |
| PhysiologicDeadSpaceTidalVolumeRatio | 0.743 |
| ShuntFraction | 0.204 |
| MechanicalVentilator-TidalVolume(L) | 0.616 |
| BloodPH | 7.36 |
| Aorta-Oxygen-PartialPressure(mmHg) | 75.2 |
| Aorta-CarbonDioxide-PartialPressure(mmHg) | 45.8 |
| Aorta-Bicarbonate-Molarity(mEq/L) | 26.2 |
| OxygenSaturation | 0.953 |
| HorowitzIndex(mmHg) | 179 |
| IntrinsicPositiveEndExpiratoryPressure(cmH2O) | 6.28 |
| MechanicalVentilator-RespirationRate(1/min) | 14 |
| MechanicalVentilator-MeanAirwayPressure(cmH2O) | 17.5 |
| MechanicalVentilator-PeakInspiratoryPressure(cmH2O) | 40 |
| MechanicalVentilator-PlateauPressure(cmH2O) | 21.8 |
| HeartRate(1/min) | 79.4 |
| SystolicArterialPressure(mmHg) | 112 |
| DiastolicArterialPressure(mmHg) | 76.3 |
| MechanicalVentilator-TotalPulmonaryVentilation(L/min) | 8.6 |
| MechanicalVentilator-InspiratoryResistance(cmH2O_s/L) | 32.6 |
| MechanicalVentilator-ExpiratoryResistance(cmH2O_s/L) | 50.5 |
| MechanicalVentilator-StaticRespiratoryCompliance(mL/cmH2O) | 74.7 |
| MechanicalVentilator-DynamicRespiratoryCompliance(mL/cmH2O) | 20.6 |
| MechanicalVentilator-EndTidalCarbonDioxidePressure(mmHg) | 33.8 |
| MechanicalVentilator-EndTidalOxygenPressure(mmHg) | 284 |
| MechanicalVentilator-ExpiratoryTidalVolume(L) | 0.616 |
| MechanicalVentilator-InspiratoryExpiratoryRatio | 0.344 |
| MechanicalVentilator-InspiratoryTidalVolume(L) | 0.616 |
| MechanicalVentilator-PeakExpiratoryFlow(L/s) | 0.275 |
| MechanicalVentilator-LeakFraction | 0 |
| MechanicalVentilator-IntrinsicPositiveEndExpiratoryPressure(cmH2O) | 3.53 |
| MechanicalVentilator-ExtrinsicPositiveEndExpiratoryPressure(cmH2O) | 10 |
| MechanicalVentilator-TotalPositiveEndExpiratoryPressure(cmH2O) | 13.5 |
| ExtrinsicPositiveEndExpiratoryPressure(cmH2O) | 10 |
| TotalPositiveEndExpiratoryPressure(cmH2O) | 16.3 |
| EndTidalCarbonDioxidePressure(mmHg) | 36.2 |
| PhysiologicDeadSpace(mL) | 312 |
| AlveolarArterialGradient(mmHg) | 202 |
| AlveolarDeadSpace(mL) | 192 |
| AnatomicDeadSpace(mL) | 120 |
| ChestWallCompliance(L/cmH2O) | 0.316 |
| FractionOfInspiredOxygen | 0.42 |
| LungCompliance(L/cmH2O) | 0.0981 |
| VentilationPerfusionRatio | 2.07 |
| HeartStrokeVolume(mL) | 66.2 |
| HeartEjectionFraction | 0.535 |
| BloodVolume(L) | 4.22 |
| MeanArterialPressure(mmHg) | 95 |
| PulsePressure(mmHg) | 35.4 |
| CardiacOutput(L/min) | 5.26 |
| CarbonDioxideSaturation | 0.199 |
| RespiratoryExchangeRatio | 0.829 |
| SystemicVascularResistance(mmHg_s/mL) | 1.03 |
| OxygenConsumptionRate(mL/min) | 203 |
| CarbonDioxideProductionRate(mL/min) | 169 |
| Patient-AlveoliSurfaceArea(m^2) | 5.45 |
| Patient-ExpiratoryReserveVolume(L) | 0.744 |
| Patient-FunctionalResidualCapacity(L) | 1.79 |
| Patient-InspiratoryCapacity(L) | 2.66 |
| Patient-InspiratoryReserveVolume(L) | 2.22 |
| Patient-ResidualVolume(L) | 1.04 |
| Patient-TidalVolumeBaseline(L) | 0.435 |
| Patient-TotalLungCapacity(L) | 4.44 |
| Patient-VitalCapacity(L) | 3.4 |
Scenario Output Plots
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