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 [381] that predicts Rexp from measured FEV1. Then Rinsp is calculated as 65% of Rexp (from Officer et al [270]). 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 [364] (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 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). 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 [381] [270] 12.3 2.5%   Rinsp
ExpiratoryRespiratoryResistance(cmH2O_s/L) EqualTo 18 [381] 17.93 0.4%   Rexp
RespiratoryCompliance(mL/cmH2O) EqualTo 60 [17] 59.59 0.7%   C
PhysiologicDeadSpaceTidalVolumeRatio EqualTo 0.37 [113] 0.345 7.0%   VD/VT
ShuntFraction EqualTo 0.12 [364] 0.1138 5.3%   QS/QT
MechanicalVentilator-TidalVolume(mL) EqualTo 438 [17] 439.4 0.3%   VT (measured)
BloodPH [7.26,7.4] [17] 7.36 0.0%   pH
Aorta-Oxygen-PartialPressure(mmHg) [67,99] [17] 89.83 0.0%   PaO2
Aorta-CarbonDioxide-PartialPressure(mmHg) [45,55] [17] 45.78 0.0%   PaCO2
OxygenSaturation [0.93,0.98] [128] 0.9702 0.0%   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
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 5.17E-14
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
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 [381] [270] 23.55 1.9%   Rinsp
ExpiratoryRespiratoryResistance(cmH2O_s/L) EqualTo 36 [381] 37.05 2.9%   Rexp
RespiratoryCompliance(mL/cmH2O) EqualTo 68 [17] 67.15 1.3%   C
PhysiologicDeadSpaceTidalVolumeRatio EqualTo 0.49 [113] 0.4778 2.5%   VD/VT
ShuntFraction EqualTo 0.19 [364] 0.2019 6.1%   QS/QT
MechanicalVentilator-TidalVolume(mL) EqualTo 534 [17] 531.6 0.5%   VT (measured)
BloodPH [7.26,7.4] [17] 7.361 0.0%   pH
Aorta-Oxygen-PartialPressure(mmHg) [67,99] [17] 73.37 0.0%   PaO2
Aorta-CarbonDioxide-PartialPressure(mmHg) [45,55] [17] 45.71 0.0%   PaCO2
OxygenSaturation [0.93,0.98] [128] 0.9496 0.0%   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
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 2.86E-14
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
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 [381] [270] 32.55 4.4%   Rinsp
ExpiratoryRespiratoryResistance(cmH2O_s/L) EqualTo 51 [381] 50.55 0.9%   Rexp
RespiratoryCompliance(mL/cmH2O) EqualTo 75 [17] 74.6 0.5%   C
PhysiologicDeadSpaceTidalVolumeRatio EqualTo 0.73 [113] 0.7434 1.8%   VD/VT
ShuntFraction EqualTo 0.2 [17] 0.2044 2.2%   QS/QT
MechanicalVentilator-TidalVolume(mL) EqualTo 600 [17] 616.3 2.7%   VT (measured)
BloodPH [7.26,7.4] [17] 7.36 0.0%   pH
Aorta-Oxygen-PartialPressure(mmHg) [67,99] [17] 75.25 0.0%   PaO2
Aorta-CarbonDioxide-PartialPressure(mmHg) [45,55] [17] 45.78 0.0%   PaCO2
OxygenSaturation [0.93,0.98] [128] 0.9526 0.0%   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
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


Figure 4. Select outputs from the scenario.


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