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 |
| 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 |
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| 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 |
| 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 |
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| 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 |
| 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 |
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| 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
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