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 [17] (Table 3).
  • Compliance: All compliances were taken from Maj et al [229] (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 [229] (Table 2).
  • Shunt: Values for QS/QT were a compromise between Maj et al [229] (Table 2, venous admixture) and Torres et al [364] (Table 3) to give realistic PO2 results for the simulated ventilator settings.
  • Ventilator Settings: All ventilator settings were takeng from Arnal et al [17] (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 [17] 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 [17] (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 [128].

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
Table 1. Data request validation results for Segment 1.
Property Name Validation Engine Value Percent Error Percent Change Notes
InspiratoryRespiratoryResistance(cmH2O_s/L) EqualTo 12 [17] 11.62 3.2%   Rinsp
ExpiratoryRespiratoryResistance(cmH2O_s/L) EqualTo 12 [17] 11.63 3.2%   Rexp
RespiratoryCompliance(mL/cmH2O) EqualTo 40 [229] 41.82 4.4%   C
PhysiologicDeadSpaceTidalVolumeRatio EqualTo 0.54 [229] 0.5158 4.6%   VD/VT
ShuntFraction EqualTo 0.2 [229] [364] 0.2179 8.6%   QS/QT
MechanicalVentilator-TidalVolume(mL) EqualTo 414 [17] 421.6 1.8%   VT (measured)
BloodPH [7.28,7.4] [17] 7.373 0.0%   pH
Aorta-Oxygen-PartialPressure(mmHg) [72,88] [17] 77.29 0.0%   PaO2
Aorta-CarbonDioxide-PartialPressure(mmHg) [37,46] [17] 44.38 0.0%   PaCO2
OxygenSaturation [0.94,0.97] [128] 0.9576 0.0%   SpO2
HorowitzIndex(mmHg) [232,284] [17] 249.9 0.0%   PaO2/FiO2
HorowitzIndex(mmHg) [200,300] [115] 249.9 0.0%   PaO2/FiO2


Figure 1. Vitals and ventilator monitors for Segment 1.


Table 2. Data requests for Segment 1.
Property Name Engine Value
Patient-Height(in) 64.3
Patient-IdealBodyWeight(kg) 60
InspiratoryRespiratoryResistance(cmH2O_s/L) 11.6
ExpiratoryRespiratoryResistance(cmH2O_s/L) 11.6
RespiratoryCompliance(mL/cmH2O) 41.8
PhysiologicDeadSpaceTidalVolumeRatio 0.516
ShuntFraction 0.218
MechanicalVentilator-TidalVolume(L) 0.422
BloodPH 7.37
Aorta-Oxygen-PartialPressure(mmHg) 77.3
Aorta-CarbonDioxide-PartialPressure(mmHg) 44.4
Aorta-Bicarbonate-Molarity(mEq/L) 26.1
OxygenSaturation 0.958
HorowitzIndex(mmHg) 250
IntrinsicPositiveEndExpiratoryPressure(cmH2O) 0.385
MechanicalVentilator-RespirationRate(1/min) 21
MechanicalVentilator-MeanAirwayPressure(cmH2O) 15.1
MechanicalVentilator-PeakInspiratoryPressure(cmH2O) 21.5
MechanicalVentilator-PlateauPressure(cmH2O) 20.9
HeartRate(1/min) 69.8
SystolicArterialPressure(mmHg) 115
DiastolicArterialPressure(mmHg) 72.7
MechanicalVentilator-TotalPulmonaryVentilation(L/min) 8.84
MechanicalVentilator-InspiratoryResistance(cmH2O_s/L) 11.6
MechanicalVentilator-ExpiratoryResistance(cmH2O_s/L) 11.6
MechanicalVentilator-StaticRespiratoryCompliance(mL/cmH2O) 40.2
MechanicalVentilator-DynamicRespiratoryCompliance(mL/cmH2O) 36.7
MechanicalVentilator-EndTidalCarbonDioxidePressure(mmHg) 34.1
MechanicalVentilator-EndTidalOxygenPressure(mmHg) 197
MechanicalVentilator-ExpiratoryTidalVolume(L) 0.422
MechanicalVentilator-InspiratoryExpiratoryRatio 0.833
MechanicalVentilator-InspiratoryTidalVolume(L) 0.422
MechanicalVentilator-PeakExpiratoryFlow(L/s) 0.75
MechanicalVentilator-LeakFraction 0
MechanicalVentilator-IntrinsicPositiveEndExpiratoryPressure(cmH2O) 0.373
MechanicalVentilator-ExtrinsicPositiveEndExpiratoryPressure(cmH2O) 10
MechanicalVentilator-TotalPositiveEndExpiratoryPressure(cmH2O) 10.4
ExtrinsicPositiveEndExpiratoryPressure(cmH2O) 10
TotalPositiveEndExpiratoryPressure(cmH2O) 10.4
EndTidalCarbonDioxidePressure(mmHg) 37.4
PhysiologicDeadSpace(mL) 217
AlveolarArterialGradient(mmHg) 111
AlveolarDeadSpace(mL) 96.6
AnatomicDeadSpace(mL) 120
ChestWallCompliance(L/cmH2O) 0.153
FractionOfInspiredOxygen 0.309
LungCompliance(L/cmH2O) 0.0585
VentilationPerfusionRatio 1.99
HeartStrokeVolume(mL) 81.5
HeartEjectionFraction 0.581
BloodVolume(L) 4.16
MeanArterialPressure(mmHg) 95.5
PulsePressure(mmHg) 42.6
CardiacOutput(L/min) 5.69
CarbonDioxideSaturation 0.133
RespiratoryExchangeRatio 0.824
SystemicVascularResistance(mmHg_s/mL) 0.959
OxygenConsumptionRate(mL/min) 192
CarbonDioxideProductionRate(mL/min) 158
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
Table 3. Data request validation results for Segment 2.
Property Name Validation Engine Value Percent Error Percent Change Notes
InspiratoryRespiratoryResistance(cmH2O_s/L) EqualTo 12 [17] 12.37 3.1%   Rinsp
ExpiratoryRespiratoryResistance(cmH2O_s/L) EqualTo 12 [17] 12.38 3.1%   Rexp
RespiratoryCompliance(mL/cmH2O) EqualTo 35 [229] 35.55 1.6%   C
PhysiologicDeadSpaceTidalVolumeRatio EqualTo 0.57 [229] 0.5537 2.9%   VD/VT
ShuntFraction EqualTo 0.3 [229] [364] 0.3047 1.5%   QS/QT
MechanicalVentilator-TidalVolume(mL) EqualTo 396 [17] 404.8 2.2%   VT (measured)
BloodPH [7.26,7.41] [17] 7.365 0.0%   pH
Aorta-Oxygen-PartialPressure(mmHg) [70,94] [17] 74.6 0.0%   PaO2
Aorta-CarbonDioxide-PartialPressure(mmHg) [39,50] [17] 45.28 0.0%   PaCO2
OxygenSaturation [0.94,0.97] [128] 0.9525 0.0%   SpO2
HorowitzIndex(mmHg) [140,188] [17] 149.5 0.0%   PaO2/FiO2
HorowitzIndex(mmHg) [100,200] [115] 149.5 0.0%   PaO2/FiO2


Figure 2. Vitals and ventilator monitors for Segment 2.


Table 4. Data requests for Segment 2.
Property Name Engine Value
Patient-Height(in) 64.3
Patient-IdealBodyWeight(kg) 60
InspiratoryRespiratoryResistance(cmH2O_s/L) 12.4
ExpiratoryRespiratoryResistance(cmH2O_s/L) 12.4
RespiratoryCompliance(mL/cmH2O) 35.5
PhysiologicDeadSpaceTidalVolumeRatio 0.554
ShuntFraction 0.305
MechanicalVentilator-TidalVolume(L) 0.405
BloodPH 7.36
Aorta-Oxygen-PartialPressure(mmHg) 74.6
Aorta-CarbonDioxide-PartialPressure(mmHg) 45.3
Aorta-Bicarbonate-Molarity(mEq/L) 26.1
OxygenSaturation 0.952
HorowitzIndex(mmHg) 149
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) 68.9
SystolicArterialPressure(mmHg) 115
DiastolicArterialPressure(mmHg) 71.6
MechanicalVentilator-TotalPulmonaryVentilation(L/min) 9.27
MechanicalVentilator-InspiratoryResistance(cmH2O_s/L) 12.4
MechanicalVentilator-ExpiratoryResistance(cmH2O_s/L) 12.4
MechanicalVentilator-StaticRespiratoryCompliance(mL/cmH2O) 35.3
MechanicalVentilator-DynamicRespiratoryCompliance(mL/cmH2O) 31.9
MechanicalVentilator-EndTidalCarbonDioxidePressure(mmHg) 32
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 8.61E-14
MechanicalVentilator-IntrinsicPositiveEndExpiratoryPressure(cmH2O) 0.444
MechanicalVentilator-ExtrinsicPositiveEndExpiratoryPressure(cmH2O) 12
MechanicalVentilator-TotalPositiveEndExpiratoryPressure(cmH2O) 12.4
ExtrinsicPositiveEndExpiratoryPressure(cmH2O) 12
TotalPositiveEndExpiratoryPressure(cmH2O) 12.5
EndTidalCarbonDioxidePressure(mmHg) 35.5
PhysiologicDeadSpace(mL) 233
AlveolarArterialGradient(mmHg) 260
AlveolarDeadSpace(mL) 113
AnatomicDeadSpace(mL) 120
ChestWallCompliance(L/cmH2O) 0.131
FractionOfInspiredOxygen 0.499
LungCompliance(L/cmH2O) 0.0495
VentilationPerfusionRatio 2.31
HeartStrokeVolume(mL) 83.9
HeartEjectionFraction 0.589
BloodVolume(L) 4.19
MeanArterialPressure(mmHg) 94.9
PulsePressure(mmHg) 43.5
CardiacOutput(L/min) 5.78
CarbonDioxideSaturation 0.178
RespiratoryExchangeRatio 0.828
SystemicVascularResistance(mmHg_s/mL) 0.937
OxygenConsumptionRate(mL/min) 195
CarbonDioxideProductionRate(mL/min) 161
Patient-AlveoliSurfaceArea(m^2) 10.9
Patient-ExpiratoryReserveVolume(L) 0.671
Patient-FunctionalResidualCapacity(L) 0.976
Patient-InspiratoryCapacity(L) 2.4
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
Table 5. Data request validation results for Segment 3.
Property Name Validation Engine Value Percent Error Percent Change Notes
InspiratoryRespiratoryResistance(cmH2O_s/L) EqualTo 12 [17] 13.12 9.0%   Rinsp
ExpiratoryRespiratoryResistance(cmH2O_s/L) EqualTo 12 [17] 13.13 9.0%   Rexp
RespiratoryCompliance(mL/cmH2O) EqualTo 33 [229] 32.55 1.4%   C
PhysiologicDeadSpaceTidalVolumeRatio EqualTo 0.65 [229] 0.6296 3.2%   VD/VT
ShuntFraction EqualTo 0.4 [229] [364] 0.4039 1.0%   QS/QT
MechanicalVentilator-TidalVolume(mL) EqualTo 396 [17] 401.9 1.5%   VT (measured)
BloodPH [7.21,7.34] [17] 7.357 0.2%   pH
Aorta-Oxygen-PartialPressure(mmHg) [68,80] [17] 70.81 0.0%   PaO2
Aorta-CarbonDioxide-PartialPressure(mmHg) [44,56] [17] 46.16 0.0%   PaCO2
OxygenSaturation [0.92,0.95] [128] 0.9446 0.0%   SpO2
HorowitzIndex(mmHg) [85,100] [17] 88.59 0.0%   PaO2/FiO2
HorowitzIndex(mmHg) LessThan 100 [115] 88.59   -11.4% PaO2/FiO2


Figure 3. Vitals and ventilator monitors for Segment 3.


Table 6. Data requests for Segment 3.
Property Name Engine Value
Patient-Height(in) 64.3
Patient-IdealBodyWeight(kg) 60
InspiratoryRespiratoryResistance(cmH2O_s/L) 13.1
ExpiratoryRespiratoryResistance(cmH2O_s/L) 13.1
RespiratoryCompliance(mL/cmH2O) 32.6
PhysiologicDeadSpaceTidalVolumeRatio 0.63
ShuntFraction 0.404
MechanicalVentilator-TidalVolume(L) 0.402
BloodPH 7.36
Aorta-Oxygen-PartialPressure(mmHg) 70.8
Aorta-CarbonDioxide-PartialPressure(mmHg) 46.2
Aorta-Bicarbonate-Molarity(mEq/L) 26.2
OxygenSaturation 0.945
HorowitzIndex(mmHg) 88.6
IntrinsicPositiveEndExpiratoryPressure(cmH2O) 0.792
MechanicalVentilator-RespirationRate(1/min) 25
MechanicalVentilator-MeanAirwayPressure(cmH2O) 18.9
MechanicalVentilator-PeakInspiratoryPressure(cmH2O) 26
MechanicalVentilator-PlateauPressure(cmH2O) 25.1
HeartRate(1/min) 69.9
SystolicArterialPressure(mmHg) 116
DiastolicArterialPressure(mmHg) 72.5
MechanicalVentilator-TotalPulmonaryVentilation(L/min) 10
MechanicalVentilator-InspiratoryResistance(cmH2O_s/L) 13.1
MechanicalVentilator-ExpiratoryResistance(cmH2O_s/L) 13.1
MechanicalVentilator-StaticRespiratoryCompliance(mL/cmH2O) 32.6
MechanicalVentilator-DynamicRespiratoryCompliance(mL/cmH2O) 28.7
MechanicalVentilator-EndTidalCarbonDioxidePressure(mmHg) 29.3
MechanicalVentilator-EndTidalOxygenPressure(mmHg) 583
MechanicalVentilator-ExpiratoryTidalVolume(L) 0.402
MechanicalVentilator-InspiratoryExpiratoryRatio 1
MechanicalVentilator-InspiratoryTidalVolume(L) 0.402
MechanicalVentilator-PeakExpiratoryFlow(L/s) 0.803
MechanicalVentilator-LeakFraction 3.73E-15
MechanicalVentilator-IntrinsicPositiveEndExpiratoryPressure(cmH2O) 0.745
MechanicalVentilator-ExtrinsicPositiveEndExpiratoryPressure(cmH2O) 12
MechanicalVentilator-TotalPositiveEndExpiratoryPressure(cmH2O) 12.7
ExtrinsicPositiveEndExpiratoryPressure(cmH2O) 12
TotalPositiveEndExpiratoryPressure(cmH2O) 12.8
EndTidalCarbonDioxidePressure(mmHg) 32.7
PhysiologicDeadSpace(mL) 264
AlveolarArterialGradient(mmHg) 499
AlveolarDeadSpace(mL) 144
AnatomicDeadSpace(mL) 120
ChestWallCompliance(L/cmH2O) 0.123
FractionOfInspiredOxygen 0.799
LungCompliance(L/cmH2O) 0.045
VentilationPerfusionRatio 2.86
HeartStrokeVolume(mL) 84.3
HeartEjectionFraction 0.587
BloodVolume(L) 4.21
MeanArterialPressure(mmHg) 95.7
PulsePressure(mmHg) 43.6
CardiacOutput(L/min) 5.89
CarbonDioxideSaturation 0.216
RespiratoryExchangeRatio 0.83
SystemicVascularResistance(mmHg_s/mL) 0.927
OxygenConsumptionRate(mL/min) 196
CarbonDioxideProductionRate(mL/min) 162
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


Figure 4. Select outputs from the scenario.


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