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 |
| Property Name | Validation | Engine Value | Percent Error | Percent Change | Notes |
|---|---|---|---|---|---|
| InspiratoryRespiratoryResistance(cmH2O_s/L) | EqualTo 12 [382] [271] | 12.3 | 2.47% | Rinsp | |
| ExpiratoryRespiratoryResistance(cmH2O_s/L) | EqualTo 18 [382] | 17.9 | 0.413% | Rexp | |
| RespiratoryCompliance(mL/cmH2O) | EqualTo 60 [17] | 58.9 | 1.79% | C | |
| PhysiologicDeadSpaceTidalVolumeRatio | EqualTo 0.37 [113] | 0.345 | 6.99% | VD/VT (determined from blood gas values) | |
| ClinicalShuntFraction | EqualTo 0.12 [365] | 0.116 | 3.69% | 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] | 92.0 | 0.00% | PaO2 | |
| Aorta-CarbonDioxide-PartialPressure(mmHg) | [45.0,55.0] [17] | 49.1 | 0.00% | PaCO2 | |
| OxygenSaturation | [0.930,0.980] [128] | 0.970 | 0.00% | SpO2 |
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| Property Name | Engine Value |
|---|---|
| Patient-Height(in) | 64.3 |
| Patient-IdealBodyWeight(kg) | 60.0 |
| InspiratoryRespiratoryResistance(cmH2O_s/L) | 12.3 |
| ExpiratoryRespiratoryResistance(cmH2O_s/L) | 17.9 |
| RespiratoryCompliance(mL/cmH2O) | 58.9 |
| ClinicalPhysiologicDeadSpaceTidalVolumeRatio | 0.398 |
| ClinicalShuntFraction | 0.116 |
| MechanicalVentilator-TidalVolume(L) | 0.439 |
| BloodPH | 7.33 |
| Aorta-Oxygen-PartialPressure(mmHg) | 92.0 |
| Aorta-CarbonDioxide-PartialPressure(mmHg) | 49.1 |
| Aorta-Bicarbonate-Molarity(mEq/L) | 26.3 |
| OxygenSaturation | 0.970 |
| HorowitzIndex(mmHg) | 329 |
| 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) | 71.5 |
| SystolicArterialPressure(mmHg) | 114 |
| DiastolicArterialPressure(mmHg) | 73.9 |
| MechanicalVentilator-TotalPulmonaryVentilation(L/min) | 6.59 |
| MechanicalVentilator-InspiratoryResistance(cmH2O_s/L) | 12.3 |
| 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) | 0.498 |
| MechanicalVentilator-ExtrinsicPositiveEndExpiratoryPressure(cmH2O) | 5.00 |
| MechanicalVentilator-TotalPositiveEndExpiratoryPressure(cmH2O) | 5.50 |
| PhysiologicDeadSpaceTidalVolumeRatio | 0.345 |
| ShuntFraction | 0.114 |
| TotalRespiratoryModelInspiratoryResistance(cmH2O_s/L) | 12.3 |
| TotalRespiratoryModelExpiratoryResistance(cmH2O_s/L) | 17.9 |
| TotalRespiratoryModelCompliance(mL/cmH2O) | 67.9 |
| ExtrinsicPositiveEndExpiratoryPressure(cmH2O) | 5.00 |
| TotalPositiveEndExpiratoryPressure(cmH2O) | 5.52 |
| EndTidalCarbonDioxidePressure(mmHg) | 45.2 |
| PhysiologicDeadSpace(mL) | 145 |
| AlveolarArterialGradient(mmHg) | 66.6 |
| AlveolarDeadSpace(mL) | 24.9 |
| AnatomicDeadSpace(mL) | 120 |
| ChestWallCompliance(L/cmH2O) | 0.160 |
| FractionOfInspiredOxygen | 0.279 |
| LungCompliance(L/cmH2O) | 0.0954 |
| VentilationPerfusionRatio | 1.36 |
| HeartStrokeVolume(mL) | 76.2 |
| HeartEjectionFraction | 0.567 |
| BloodVolume(L) | 4.21 |
| MeanArterialPressure(mmHg) | 95.2 |
| PulsePressure(mmHg) | 40.0 |
| CardiacOutput(L/min) | 5.45 |
| CarbonDioxideSaturation | 0.314 |
| RespiratoryExchangeRatio | 0.828 |
| SystemicVascularResistance(mmHg_s/mL) | 0.996 |
| OxygenConsumptionRate(mL/min) | 197 |
| CarbonDioxideProductionRate(mL/min) | 163 |
| 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 |
| Property Name | Validation | Engine Value | Percent Error | Percent Change | Notes |
|---|---|---|---|---|---|
| InspiratoryRespiratoryResistance(cmH2O_s/L) | EqualTo 24 [382] [271] | 23.6 | 1.88% | Rinsp | |
| ExpiratoryRespiratoryResistance(cmH2O_s/L) | EqualTo 36 [382] | 37.0 | 2.87% | Rexp | |
| RespiratoryCompliance(mL/cmH2O) | EqualTo 68 [17] | 68.5 | 0.734% | C | |
| PhysiologicDeadSpaceTidalVolumeRatio | EqualTo 0.49 [113] | 0.478 | 2.52% | VD/VT (determined from blood gas values) | |
| ClinicalShuntFraction | EqualTo 0.19 [365] | 0.205 | 7.65% | 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] | 75.5 | 0.00% | PaO2 | |
| Aorta-CarbonDioxide-PartialPressure(mmHg) | [45.0,55.0] [17] | 47.7 | 0.00% | PaCO2 | |
| OxygenSaturation | [0.930,0.980] [128] | 0.951 | 0.00% | SpO2 |
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| Property Name | Engine Value |
|---|---|
| Patient-Height(in) | 64.3 |
| Patient-IdealBodyWeight(kg) | 60.0 |
| InspiratoryRespiratoryResistance(cmH2O_s/L) | 23.6 |
| ExpiratoryRespiratoryResistance(cmH2O_s/L) | 37.0 |
| RespiratoryCompliance(mL/cmH2O) | 68.5 |
| ClinicalPhysiologicDeadSpaceTidalVolumeRatio | 0.495 |
| ClinicalShuntFraction | 0.205 |
| MechanicalVentilator-TidalVolume(L) | 0.532 |
| BloodPH | 7.34 |
| Aorta-Oxygen-PartialPressure(mmHg) | 75.5 |
| Aorta-CarbonDioxide-PartialPressure(mmHg) | 47.7 |
| Aorta-Bicarbonate-Molarity(mEq/L) | 26.3 |
| OxygenSaturation | 0.951 |
| HorowitzIndex(mmHg) | 236 |
| 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) | 74.9 |
| SystolicArterialPressure(mmHg) | 113 |
| DiastolicArterialPressure(mmHg) | 74.9 |
| MechanicalVentilator-TotalPulmonaryVentilation(L/min) | 7.42 |
| MechanicalVentilator-InspiratoryResistance(cmH2O_s/L) | 23.6 |
| MechanicalVentilator-ExpiratoryResistance(cmH2O_s/L) | 37.0 |
| MechanicalVentilator-StaticRespiratoryCompliance(mL/cmH2O) | 67.8 |
| MechanicalVentilator-DynamicRespiratoryCompliance(mL/cmH2O) | 29.6 |
| MechanicalVentilator-EndTidalCarbonDioxidePressure(mmHg) | 40.0 |
| 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 | 5.45e-14 |
| MechanicalVentilator-IntrinsicPositiveEndExpiratoryPressure(cmH2O) | 2.38 |
| MechanicalVentilator-ExtrinsicPositiveEndExpiratoryPressure(cmH2O) | 7.00 |
| MechanicalVentilator-TotalPositiveEndExpiratoryPressure(cmH2O) | 9.38 |
| PhysiologicDeadSpaceTidalVolumeRatio | 0.478 |
| ShuntFraction | 0.204 |
| TotalRespiratoryModelInspiratoryResistance(cmH2O_s/L) | 23.5 |
| TotalRespiratoryModelExpiratoryResistance(cmH2O_s/L) | 37.0 |
| TotalRespiratoryModelCompliance(mL/cmH2O) | 70.9 |
| ExtrinsicPositiveEndExpiratoryPressure(cmH2O) | 7.01 |
| TotalPositiveEndExpiratoryPressure(cmH2O) | 10.4 |
| EndTidalCarbonDioxidePressure(mmHg) | 42.3 |
| PhysiologicDeadSpace(mL) | 201 |
| AlveolarArterialGradient(mmHg) | 120 |
| AlveolarDeadSpace(mL) | 80.7 |
| AnatomicDeadSpace(mL) | 120 |
| ChestWallCompliance(L/cmH2O) | 0.236 |
| FractionOfInspiredOxygen | 0.320 |
| LungCompliance(L/cmH2O) | 0.0972 |
| VentilationPerfusionRatio | 1.73 |
| HeartStrokeVolume(mL) | 72.1 |
| HeartEjectionFraction | 0.554 |
| BloodVolume(L) | 4.24 |
| MeanArterialPressure(mmHg) | 95.2 |
| PulsePressure(mmHg) | 38.2 |
| CardiacOutput(L/min) | 5.40 |
| CarbonDioxideSaturation | 0.274 |
| RespiratoryExchangeRatio | 0.823 |
| SystemicVascularResistance(mmHg_s/mL) | 1.01 |
| OxygenConsumptionRate(mL/min) | 192 |
| CarbonDioxideProductionRate(mL/min) | 158 |
| 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 |
| Property Name | Validation | Engine Value | Percent Error | Percent Change | Notes |
|---|---|---|---|---|---|
| InspiratoryRespiratoryResistance(cmH2O_s/L) | EqualTo 34 [382] [271] | 32.6 | 4.36% | Rinsp | |
| ExpiratoryRespiratoryResistance(cmH2O_s/L) | EqualTo 51 [382] | 50.6 | 0.882% | 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] | 0.206 | 2.90% | 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] | 77.7 | 0.00% | PaO2 | |
| Aorta-CarbonDioxide-PartialPressure(mmHg) | [45.0,55.0] [17] | 46.9 | 0.00% | PaCO2 | |
| OxygenSaturation | [0.930,0.980] [128] | 0.955 | 0.00% | SpO2 |
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| Property Name | Engine Value |
|---|---|
| Patient-Height(in) | 64.3 |
| Patient-IdealBodyWeight(kg) | 60.0 |
| InspiratoryRespiratoryResistance(cmH2O_s/L) | 32.6 |
| ExpiratoryRespiratoryResistance(cmH2O_s/L) | 50.6 |
| RespiratoryCompliance(mL/cmH2O) | 74.8 |
| ClinicalPhysiologicDeadSpaceTidalVolumeRatio | 0.570 |
| ClinicalShuntFraction | 0.206 |
| MechanicalVentilator-TidalVolume(L) | 0.616 |
| BloodPH | 7.35 |
| Aorta-Oxygen-PartialPressure(mmHg) | 77.7 |
| Aorta-CarbonDioxide-PartialPressure(mmHg) | 46.9 |
| Aorta-Bicarbonate-Molarity(mEq/L) | 26.2 |
| OxygenSaturation | 0.955 |
| HorowitzIndex(mmHg) | 185 |
| 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) | 77.1 |
| SystolicArterialPressure(mmHg) | 112 |
| DiastolicArterialPressure(mmHg) | 75.7 |
| MechanicalVentilator-TotalPulmonaryVentilation(L/min) | 8.60 |
| MechanicalVentilator-InspiratoryResistance(cmH2O_s/L) | 32.6 |
| MechanicalVentilator-ExpiratoryResistance(cmH2O_s/L) | 50.5 |
| MechanicalVentilator-StaticRespiratoryCompliance(mL/cmH2O) | 74.9 |
| MechanicalVentilator-DynamicRespiratoryCompliance(mL/cmH2O) | 20.6 |
| MechanicalVentilator-EndTidalCarbonDioxidePressure(mmHg) | 34.4 |
| 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 |
| ShuntFraction | 0.205 |
| 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) | 36.9 |
| PhysiologicDeadSpace(mL) | 312 |
| AlveolarArterialGradient(mmHg) | 200 |
| AlveolarDeadSpace(mL) | 192 |
| AnatomicDeadSpace(mL) | 120 |
| ChestWallCompliance(L/cmH2O) | 0.320 |
| FractionOfInspiredOxygen | 0.420 |
| LungCompliance(L/cmH2O) | 0.0981 |
| VentilationPerfusionRatio | 2.06 |
| HeartStrokeVolume(mL) | 68.5 |
| HeartEjectionFraction | 0.543 |
| BloodVolume(L) | 4.27 |
| MeanArterialPressure(mmHg) | 95.1 |
| PulsePressure(mmHg) | 36.5 |
| CardiacOutput(L/min) | 5.28 |
| CarbonDioxideSaturation | 0.243 |
| RespiratoryExchangeRatio | 0.823 |
| SystemicVascularResistance(mmHg_s/mL) | 1.03 |
| OxygenConsumptionRate(mL/min) | 195 |
| CarbonDioxideProductionRate(mL/min) | 160 |
| 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
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