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 [401] that predicts Rexp from measured FEV1. Then Rinsp is calculated as 65% of Rexp (from Officer et al [280]). 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 [18] (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 [117] (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 [382] (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 [18] (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 [18] (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 [18] 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 [18] (Table 2). Expected values for SpO2 were calculated from PaO2 using the equation from Gadrey et al [133].

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	Notes
InspiratoryRespiratoryResistance(cmH2O_s/L)	EqualTo 12 [401] [280]	12.4	3.09%	Rinsp
ExpiratoryRespiratoryResistance(cmH2O_s/L)	EqualTo 18 [401]	17.9	-0.73%	Rexp
RespiratoryCompliance(mL/cmH2O)	EqualTo 60 [18]	58.8	-1.95%	C
PhysiologicDeadSpaceTidalVolumeRatio	EqualTo 0.37 [117]	0.345	-6.75%	VD/VT (determined from blood gas values)
ClinicalShuntFraction	EqualTo 0.12 [382]	0.126	4.61%	QS/QT (determined from blood gas values)
MechanicalVentilator-TidalVolume(mL)	EqualTo 438 [18]	439	0.32%	VT (measured)
BloodPH	[7.26,7.40] [18]	7.36	0.00%	pH
Aorta-Oxygen-PartialPressure(mmHg)	[67.0,99.0] [18]	88.8	0.00%	PaO2
Aorta-CarbonDioxide-PartialPressure(mmHg)	[45.0,55.0] [18]	42.9	-4.61%	PaCO2
OxygenSaturation	[0.930,0.980] [133]	0.970	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)	17.9
RespiratoryCompliance(mL/cmH2O)	58.8
ClinicalPhysiologicDeadSpaceTidalVolumeRatio	0.328
ClinicalShuntFraction	0.126
MechanicalVentilator-TidalVolume(L)	0.439
BloodPH	7.36
Aorta-Oxygen-PartialPressure(mmHg)	88.8
Aorta-CarbonDioxide-PartialPressure(mmHg)	42.9
Aorta-Bicarbonate-Molarity(mEq/L)	26.2
OxygenSaturation	0.970
HorowitzIndex(mmHg)	318
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)	75.8
SystolicArterialPressure(mmHg)	112
DiastolicArterialPressure(mmHg)	74.3
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)	39.6
MechanicalVentilator-EndTidalOxygenPressure(mmHg)	166
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	0.127
TotalRespiratoryModelInspiratoryResistance(cmH2O_s/L)	12.3
TotalRespiratoryModelExpiratoryResistance(cmH2O_s/L)	17.9
TotalRespiratoryModelCompliance(mL/cmH2O)	67.2
ExtrinsicPositiveEndExpiratoryPressure(cmH2O)	5.00
TotalPositiveEndExpiratoryPressure(cmH2O)	5.52
EndTidalCarbonDioxidePressure(mmHg)	40.9
PhysiologicDeadSpace(mL)	145
AlveolarArterialGradient(mmHg)	77.1
AlveolarDeadSpace(mL)	24.9
AnatomicDeadSpace(mL)	120
ChestWallCompliance(L/cmH2O)	0.159
FractionOfInspiredOxygen	0.279
LungCompliance(L/cmH2O)	0.0954
VentilationPerfusionRatio	0.865
HeartStrokeVolume(mL)	70.8
HeartEjectionFraction	0.552
BloodVolume(L)	4.14
MeanArterialPressure(mmHg)	94.2
PulsePressure(mmHg)	37.5
CardiacOutput(L/min)	5.37
CarbonDioxideSaturation	0.0439
RespiratoryExchangeRatio	0.811
SystemicVascularResistance(mmHg_s/mL)	1.00
OxygenConsumptionRate(mL/min)	198
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)	2.24
Patient-ResidualVolume(L)	0.871
Patient-TidalVolumeBaseline(L)	0.406
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	Notes
InspiratoryRespiratoryResistance(cmH2O_s/L)	EqualTo 24 [401] [280]	23.8	-0.99%	Rinsp
ExpiratoryRespiratoryResistance(cmH2O_s/L)	EqualTo 36 [401]	37.1	2.92%	Rexp
RespiratoryCompliance(mL/cmH2O)	EqualTo 68 [18]	67.7	-0.38%	C
PhysiologicDeadSpaceTidalVolumeRatio	EqualTo 0.49 [117]	0.478	-2.49%	VD/VT (determined from blood gas values)
ClinicalShuntFraction	EqualTo 0.19 [382]	0.182	-4.04%	QS/QT (determined from blood gas values)
MechanicalVentilator-TidalVolume(mL)	EqualTo 534 [18]	532	-0.45%	VT (measured)
BloodPH	[7.26,7.40] [18]	7.36	0.00%	pH
Aorta-Oxygen-PartialPressure(mmHg)	[67.0,99.0] [18]	76.9	0.00%	PaO2
Aorta-CarbonDioxide-PartialPressure(mmHg)	[45.0,55.0] [18]	42.8	-4.96%	PaCO2
OxygenSaturation	[0.930,0.980] [133]	0.957	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)	23.8
ExpiratoryRespiratoryResistance(cmH2O_s/L)	37.1
RespiratoryCompliance(mL/cmH2O)	67.7
ClinicalPhysiologicDeadSpaceTidalVolumeRatio	0.448
ClinicalShuntFraction	0.182
MechanicalVentilator-TidalVolume(L)	0.532
BloodPH	7.36
Aorta-Oxygen-PartialPressure(mmHg)	76.9
Aorta-CarbonDioxide-PartialPressure(mmHg)	42.8
Aorta-Bicarbonate-Molarity(mEq/L)	26.2
OxygenSaturation	0.957
HorowitzIndex(mmHg)	240
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)	82.2
SystolicArterialPressure(mmHg)	111
DiastolicArterialPressure(mmHg)	76.6
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)	36.1
MechanicalVentilator-EndTidalOxygenPressure(mmHg)	203
MechanicalVentilator-ExpiratoryTidalVolume(L)	0.532
MechanicalVentilator-InspiratoryExpiratoryRatio	0.433
MechanicalVentilator-InspiratoryTidalVolume(L)	0.532
MechanicalVentilator-PeakExpiratoryFlow(L/s)	0.285
MechanicalVentilator-LeakFraction	0.00
MechanicalVentilator-IntrinsicPositiveEndExpiratoryPressure(cmH2O)	2.38
MechanicalVentilator-ExtrinsicPositiveEndExpiratoryPressure(cmH2O)	7.00
MechanicalVentilator-TotalPositiveEndExpiratoryPressure(cmH2O)	9.38
PhysiologicDeadSpaceTidalVolumeRatio	0.478
PhysiologicShuntFraction	0.189
TotalRespiratoryModelInspiratoryResistance(cmH2O_s/L)	23.5
TotalRespiratoryModelExpiratoryResistance(cmH2O_s/L)	37.0
TotalRespiratoryModelCompliance(mL/cmH2O)	72.8
ExtrinsicPositiveEndExpiratoryPressure(cmH2O)	7.01
TotalPositiveEndExpiratoryPressure(cmH2O)	10.4
EndTidalCarbonDioxidePressure(mmHg)	37.5
PhysiologicDeadSpace(mL)	201
AlveolarArterialGradient(mmHg)	125
AlveolarDeadSpace(mL)	80.7
AnatomicDeadSpace(mL)	120
ChestWallCompliance(L/cmH2O)	0.228
FractionOfInspiredOxygen	0.320
LungCompliance(L/cmH2O)	0.0972
VentilationPerfusionRatio	0.941
HeartStrokeVolume(mL)	63.6
HeartEjectionFraction	0.524
BloodVolume(L)	4.15
MeanArterialPressure(mmHg)	95.2
PulsePressure(mmHg)	34.7
CardiacOutput(L/min)	5.23
CarbonDioxideSaturation	0.0349
RespiratoryExchangeRatio	0.808
SystemicVascularResistance(mmHg_s/mL)	1.04
OxygenConsumptionRate(mL/min)	199
CarbonDioxideProductionRate(mL/min)	161
Patient-AlveoliSurfaceArea(m^2)	10.9
Patient-ExpiratoryReserveVolume(L)	0.743
Patient-FunctionalResidualCapacity(L)	1.67
Patient-InspiratoryCapacity(L)	2.65
Patient-InspiratoryReserveVolume(L)	2.25
Patient-ResidualVolume(L)	0.929
Patient-TidalVolumeBaseline(L)	0.406
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	Notes
InspiratoryRespiratoryResistance(cmH2O_s/L)	EqualTo 34 [401] [280]	32.9	-3.11%	Rinsp
ExpiratoryRespiratoryResistance(cmH2O_s/L)	EqualTo 51 [401]	50.5	-0.97%	Rexp
RespiratoryCompliance(mL/cmH2O)	EqualTo 75 [18]	74.8	-0.24%	C
PhysiologicDeadSpaceTidalVolumeRatio	EqualTo 0.73 [117]	0.743	1.84%	VD/VT
ClinicalShuntFraction	EqualTo 0.2 [18]	0.216	7.80%	QS/QT (determined from blood gas values)
MechanicalVentilator-TidalVolume(mL)	EqualTo 600 [18]	616	2.71%	VT (measured)
BloodPH	[7.26,7.40] [18]	7.36	0.00%	pH
Aorta-Oxygen-PartialPressure(mmHg)	[67.0,99.0] [18]	73.1	0.00%	PaO2
Aorta-CarbonDioxide-PartialPressure(mmHg)	[45.0,55.0] [18]	43.0	-4.49%	PaCO2
OxygenSaturation	[0.930,0.980] [133]	0.951	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	0.532
ClinicalShuntFraction	0.216
MechanicalVentilator-TidalVolume(L)	0.616
BloodPH	7.36
Aorta-Oxygen-PartialPressure(mmHg)	73.1
Aorta-CarbonDioxide-PartialPressure(mmHg)	43.0
Aorta-Bicarbonate-Molarity(mEq/L)	26.2
OxygenSaturation	0.951
HorowitzIndex(mmHg)	174
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)	89.4
SystolicArterialPressure(mmHg)	109
DiastolicArterialPressure(mmHg)	78.1
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)	31.6
MechanicalVentilator-EndTidalOxygenPressure(mmHg)	286
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	0.221
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)	33.8
PhysiologicDeadSpace(mL)	312
AlveolarArterialGradient(mmHg)	210
AlveolarDeadSpace(mL)	192
AnatomicDeadSpace(mL)	120
ChestWallCompliance(L/cmH2O)	0.320
FractionOfInspiredOxygen	0.420
LungCompliance(L/cmH2O)	0.0981
VentilationPerfusionRatio	0.885
HeartStrokeVolume(mL)	57.2
HeartEjectionFraction	0.500
BloodVolume(L)	4.14
MeanArterialPressure(mmHg)	94.6
PulsePressure(mmHg)	31.3
CardiacOutput(L/min)	5.11
CarbonDioxideSaturation	0.0476
RespiratoryExchangeRatio	0.806
SystemicVascularResistance(mmHg_s/mL)	1.06
OxygenConsumptionRate(mL/min)	202
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)	2.25
Patient-ResidualVolume(L)	1.04
Patient-TidalVolumeBaseline(L)	0.406
Patient-TotalLungCapacity(L)	4.44
Patient-VitalCapacity(L)	3.40

Scenario Output Plots

Figure 4. Select outputs from the scenario.