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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 [382] that predicts Rexp from measured FEV1. Then Rinsp is calculated as 65% of Rexp (from Officer et al [271]). 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 [17] (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 [113] (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 [365] (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 [17] (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 [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 [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). Expected values for SpO2 were calculated from PaO2 using the equation from Gadrey et al [128].

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
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 [382] [271] 12.4 3.04%   Rinsp
ExpiratoryRespiratoryResistance(cmH2O_s/L) EqualTo 18 [382] 17.8 0.860%   Rexp
RespiratoryCompliance(mL/cmH2O) EqualTo 60 [17] 58.9 1.93%   C
PhysiologicDeadSpaceTidalVolumeRatio EqualTo 0.37 [113] 0.345 6.99%   VD/VT (determined from blood gas values)
ClinicalShuntFraction EqualTo 0.12 [365] 0.128 6.74%   QS/QT (determined from blood gas values)
MechanicalVentilator-TidalVolume(mL) EqualTo 438 [17] 439 0.318%   VT (measured)
BloodPH [7.26,7.40] [17] 7.33 0.00%   pH
Aorta-Oxygen-PartialPressure(mmHg) [67.0,99.0] [17] 88.2 0.00%   PaO2
Aorta-CarbonDioxide-PartialPressure(mmHg) [45.0,55.0] [17] 49.0 0.00%   PaCO2
OxygenSaturation [0.930,0.980] [128] 0.966 0.00%   SpO2


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) 60.0
InspiratoryRespiratoryResistance(cmH2O_s/L) 12.4
ExpiratoryRespiratoryResistance(cmH2O_s/L) 17.8
RespiratoryCompliance(mL/cmH2O) 58.9
ClinicalPhysiologicDeadSpaceTidalVolumeRatio 0.399
ClinicalShuntFraction 0.128
MechanicalVentilator-TidalVolume(L) 0.439
BloodPH 7.33
Aorta-Oxygen-PartialPressure(mmHg) 88.2
Aorta-CarbonDioxide-PartialPressure(mmHg) 49.0
Aorta-Bicarbonate-Molarity(mEq/L) 26.3
OxygenSaturation 0.966
HorowitzIndex(mmHg) 316
IntrinsicPositiveEndExpiratoryPressure(cmH2O) 0.519
MechanicalVentilator-RespirationRate(1/min) 15.0
MechanicalVentilator-MeanAirwayPressure(cmH2O) 7.95
MechanicalVentilator-PeakInspiratoryPressure(cmH2O) 15.0
MechanicalVentilator-PlateauPressure(cmH2O) 13.2
HeartRate(1/min) 72.5
SystolicArterialPressure(mmHg) 113
DiastolicArterialPressure(mmHg) 74.5
MechanicalVentilator-TotalPulmonaryVentilation(L/min) 6.59
MechanicalVentilator-InspiratoryResistance(cmH2O_s/L) 12.4
MechanicalVentilator-ExpiratoryResistance(cmH2O_s/L) 17.9
MechanicalVentilator-StaticRespiratoryCompliance(mL/cmH2O) 57.0
MechanicalVentilator-DynamicRespiratoryCompliance(mL/cmH2O) 44.0
MechanicalVentilator-EndTidalCarbonDioxidePressure(mmHg) 42.7
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 0.00
MechanicalVentilator-IntrinsicPositiveEndExpiratoryPressure(cmH2O) 0.494
MechanicalVentilator-ExtrinsicPositiveEndExpiratoryPressure(cmH2O) 5.00
MechanicalVentilator-TotalPositiveEndExpiratoryPressure(cmH2O) 5.49
PhysiologicDeadSpaceTidalVolumeRatio 0.345
PhysiologicShuntFraction 0.132
TotalRespiratoryModelInspiratoryResistance(cmH2O_s/L) 12.3
TotalRespiratoryModelExpiratoryResistance(cmH2O_s/L) 17.9
TotalRespiratoryModelCompliance(mL/cmH2O) 69.0
ExtrinsicPositiveEndExpiratoryPressure(cmH2O) 5.00
TotalPositiveEndExpiratoryPressure(cmH2O) 5.52
EndTidalCarbonDioxidePressure(mmHg) 45.1
PhysiologicDeadSpace(mL) 145
AlveolarArterialGradient(mmHg) 71.1
AlveolarDeadSpace(mL) 24.9
AnatomicDeadSpace(mL) 120
ChestWallCompliance(L/cmH2O) 0.159
FractionOfInspiredOxygen 0.279
LungCompliance(L/cmH2O) 0.0954
VentilationPerfusionRatio 1.27
HeartStrokeVolume(mL) 73.9
HeartEjectionFraction 0.560
BloodVolume(L) 4.21
MeanArterialPressure(mmHg) 95.2
PulsePressure(mmHg) 39.0
CardiacOutput(L/min) 5.35
CarbonDioxideSaturation 0.314
RespiratoryExchangeRatio 0.826
SystemicVascularResistance(mmHg_s/mL) 1.01
OxygenConsumptionRate(mL/min) 195
CarbonDioxideProductionRate(mL/min) 161
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) 0.434
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
Table 3. Data request validation results for Segment 2.
Property Name Validation Engine Value Percent Error Percent Change Notes
InspiratoryRespiratoryResistance(cmH2O_s/L) EqualTo 24 [382] [271] 23.7 1.25%   Rinsp
ExpiratoryRespiratoryResistance(cmH2O_s/L) EqualTo 36 [382] 37.1 2.87%   Rexp
RespiratoryCompliance(mL/cmH2O) EqualTo 68 [17] 68.1 0.216%   C
PhysiologicDeadSpaceTidalVolumeRatio EqualTo 0.49 [113] 0.478 2.52%   VD/VT (determined from blood gas values)
ClinicalShuntFraction EqualTo 0.19 [365] 0.183 3.63%   QS/QT (determined from blood gas values)
MechanicalVentilator-TidalVolume(mL) EqualTo 534 [17] 532 0.450%   VT (measured)
BloodPH [7.26,7.40] [17] 7.34 0.00%   pH
Aorta-Oxygen-PartialPressure(mmHg) [67.0,99.0] [17] 77.1 0.00%   PaO2
Aorta-CarbonDioxide-PartialPressure(mmHg) [45.0,55.0] [17] 47.8 0.00%   PaCO2
OxygenSaturation [0.930,0.980] [128] 0.953 0.00%   SpO2


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) 60.0
InspiratoryRespiratoryResistance(cmH2O_s/L) 23.7
ExpiratoryRespiratoryResistance(cmH2O_s/L) 37.1
RespiratoryCompliance(mL/cmH2O) 68.1
ClinicalPhysiologicDeadSpaceTidalVolumeRatio 0.495
ClinicalShuntFraction 0.183
MechanicalVentilator-TidalVolume(L) 0.532
BloodPH 7.34
Aorta-Oxygen-PartialPressure(mmHg) 77.1
Aorta-CarbonDioxide-PartialPressure(mmHg) 47.8
Aorta-Bicarbonate-Molarity(mEq/L) 26.3
OxygenSaturation 0.953
HorowitzIndex(mmHg) 241
IntrinsicPositiveEndExpiratoryPressure(cmH2O) 3.42
MechanicalVentilator-RespirationRate(1/min) 14.0
MechanicalVentilator-MeanAirwayPressure(cmH2O) 12.4
MechanicalVentilator-PeakInspiratoryPressure(cmH2O) 25.0
MechanicalVentilator-PlateauPressure(cmH2O) 17.2
HeartRate(1/min) 77.2
SystolicArterialPressure(mmHg) 112
DiastolicArterialPressure(mmHg) 75.7
MechanicalVentilator-TotalPulmonaryVentilation(L/min) 7.42
MechanicalVentilator-InspiratoryResistance(cmH2O_s/L) 23.7
MechanicalVentilator-ExpiratoryResistance(cmH2O_s/L) 37.1
MechanicalVentilator-StaticRespiratoryCompliance(mL/cmH2O) 67.8
MechanicalVentilator-DynamicRespiratoryCompliance(mL/cmH2O) 29.6
MechanicalVentilator-EndTidalCarbonDioxidePressure(mmHg) 40.1
MechanicalVentilator-EndTidalOxygenPressure(mmHg) 200
MechanicalVentilator-ExpiratoryTidalVolume(L) 0.532
MechanicalVentilator-InspiratoryExpiratoryRatio 0.433
MechanicalVentilator-InspiratoryTidalVolume(L) 0.532
MechanicalVentilator-PeakExpiratoryFlow(L/s) 0.285
MechanicalVentilator-LeakFraction 3.13e-14
MechanicalVentilator-IntrinsicPositiveEndExpiratoryPressure(cmH2O) 2.38
MechanicalVentilator-ExtrinsicPositiveEndExpiratoryPressure(cmH2O) 7.00
MechanicalVentilator-TotalPositiveEndExpiratoryPressure(cmH2O) 9.38
PhysiologicDeadSpaceTidalVolumeRatio 0.478
PhysiologicShuntFraction 0.193
TotalRespiratoryModelInspiratoryResistance(cmH2O_s/L) 23.5
TotalRespiratoryModelExpiratoryResistance(cmH2O_s/L) 37.0
TotalRespiratoryModelCompliance(mL/cmH2O) 70.5
ExtrinsicPositiveEndExpiratoryPressure(cmH2O) 7.01
TotalPositiveEndExpiratoryPressure(cmH2O) 10.4
EndTidalCarbonDioxidePressure(mmHg) 42.4
PhysiologicDeadSpace(mL) 201
AlveolarArterialGradient(mmHg) 117
AlveolarDeadSpace(mL) 80.7
AnatomicDeadSpace(mL) 120
ChestWallCompliance(L/cmH2O) 0.232
FractionOfInspiredOxygen 0.320
LungCompliance(L/cmH2O) 0.0972
VentilationPerfusionRatio 1.47
HeartStrokeVolume(mL) 68.5
HeartEjectionFraction 0.543
BloodVolume(L) 4.25
MeanArterialPressure(mmHg) 95.0
PulsePressure(mmHg) 36.4
CardiacOutput(L/min) 5.29
CarbonDioxideSaturation 0.277
RespiratoryExchangeRatio 0.825
SystemicVascularResistance(mmHg_s/mL) 1.02
OxygenConsumptionRate(mL/min) 196
CarbonDioxideProductionRate(mL/min) 162
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) 0.434
Patient-TotalLungCapacity(L) 4.33
Patient-VitalCapacity(L) 3.40

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
Table 5. Data request validation results for Segment 3.
Property Name Validation Engine Value Percent Error Percent Change Notes
InspiratoryRespiratoryResistance(cmH2O_s/L) EqualTo 34 [382] [271] 32.9 3.16%   Rinsp
ExpiratoryRespiratoryResistance(cmH2O_s/L) EqualTo 51 [382] 50.5 0.976%   Rexp
RespiratoryCompliance(mL/cmH2O) EqualTo 75 [17] 74.8 0.236%   C
PhysiologicDeadSpaceTidalVolumeRatio EqualTo 0.73 [113] 0.743 1.82%   VD/VT
ClinicalShuntFraction EqualTo 0.2 [17] 0.215 7.34%   QS/QT (determined from blood gas values)
MechanicalVentilator-TidalVolume(mL) EqualTo 600 [17] 616 2.67%   VT (measured)
BloodPH [7.26,7.40] [17] 7.35 0.00%   pH
Aorta-Oxygen-PartialPressure(mmHg) [67.0,99.0] [17] 74.5 0.00%   PaO2
Aorta-CarbonDioxide-PartialPressure(mmHg) [45.0,55.0] [17] 47.0 0.00%   PaCO2
OxygenSaturation [0.930,0.980] [128] 0.950 0.00%   SpO2


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) 60.0
InspiratoryRespiratoryResistance(cmH2O_s/L) 32.9
ExpiratoryRespiratoryResistance(cmH2O_s/L) 50.5
RespiratoryCompliance(mL/cmH2O) 74.8
ClinicalPhysiologicDeadSpaceTidalVolumeRatio 0.571
ClinicalShuntFraction 0.215
MechanicalVentilator-TidalVolume(L) 0.616
BloodPH 7.35
Aorta-Oxygen-PartialPressure(mmHg) 74.5
Aorta-CarbonDioxide-PartialPressure(mmHg) 47.0
Aorta-Bicarbonate-Molarity(mEq/L) 26.2
OxygenSaturation 0.950
HorowitzIndex(mmHg) 177
IntrinsicPositiveEndExpiratoryPressure(cmH2O) 6.28
MechanicalVentilator-RespirationRate(1/min) 14.0
MechanicalVentilator-MeanAirwayPressure(cmH2O) 17.5
MechanicalVentilator-PeakInspiratoryPressure(cmH2O) 40.0
MechanicalVentilator-PlateauPressure(cmH2O) 21.8
HeartRate(1/min) 81.7
SystolicArterialPressure(mmHg) 111
DiastolicArterialPressure(mmHg) 76.9
MechanicalVentilator-TotalPulmonaryVentilation(L/min) 8.60
MechanicalVentilator-InspiratoryResistance(cmH2O_s/L) 32.8
MechanicalVentilator-ExpiratoryResistance(cmH2O_s/L) 50.5
MechanicalVentilator-StaticRespiratoryCompliance(mL/cmH2O) 74.9
MechanicalVentilator-DynamicRespiratoryCompliance(mL/cmH2O) 20.6
MechanicalVentilator-EndTidalCarbonDioxidePressure(mmHg) 34.5
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 0.00
MechanicalVentilator-IntrinsicPositiveEndExpiratoryPressure(cmH2O) 3.53
MechanicalVentilator-ExtrinsicPositiveEndExpiratoryPressure(cmH2O) 10.0
MechanicalVentilator-TotalPositiveEndExpiratoryPressure(cmH2O) 13.5
PhysiologicDeadSpaceTidalVolumeRatio 0.743
PhysiologicShuntFraction 0.226
TotalRespiratoryModelInspiratoryResistance(cmH2O_s/L) 32.5
TotalRespiratoryModelExpiratoryResistance(cmH2O_s/L) 50.5
TotalRespiratoryModelCompliance(mL/cmH2O) 74.9
ExtrinsicPositiveEndExpiratoryPressure(cmH2O) 10.0
TotalPositiveEndExpiratoryPressure(cmH2O) 16.3
EndTidalCarbonDioxidePressure(mmHg) 37.0
PhysiologicDeadSpace(mL) 312
AlveolarArterialGradient(mmHg) 203
AlveolarDeadSpace(mL) 192
AnatomicDeadSpace(mL) 120
ChestWallCompliance(L/cmH2O) 0.320
FractionOfInspiredOxygen 0.420
LungCompliance(L/cmH2O) 0.0981
VentilationPerfusionRatio 1.77
HeartStrokeVolume(mL) 63.3
HeartEjectionFraction 0.525
BloodVolume(L) 4.27
MeanArterialPressure(mmHg) 94.9
PulsePressure(mmHg) 34.0
CardiacOutput(L/min) 5.18
CarbonDioxideSaturation 0.250
RespiratoryExchangeRatio 0.822
SystemicVascularResistance(mmHg_s/mL) 1.04
OxygenConsumptionRate(mL/min) 197
CarbonDioxideProductionRate(mL/min) 162
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) 0.434
Patient-TotalLungCapacity(L) 4.44
Patient-VitalCapacity(L) 3.40

Scenario Output Plots


Figure 4. Select outputs from the scenario.


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