Sun Qianhui, Chase J Geoffrey, Zhou Cong, Tawhai Merryn H, Knopp Jennifer L, Möller Knut, Shaw Geoffrey M
Department of Mechanical Engineering, Centre for Bio-Engineering, University of Canterbury, Christchurch, New Zealand.
School of Civil Aviation, Northwestern Polytechnical University, Xi'an, China.
J Clin Monit Comput. 2023 Apr;37(2):389-398. doi: 10.1007/s10877-022-00900-7. Epub 2022 Aug 3.
Clinical measurements offer bedside monitoring aiming to minimise unintended over-distension, but have limitations and cannot be predicted for changes in mechanical ventilation (MV) settings and are only available in certain MV modes. This study introduces a non-invasive, real-time over-distension measurement, which is robust, predictable, and more intuitive than current methods. The proposed over-distension measurement, denoted as OD, is compared with the clinically proven stress index (SI). Correlation is analysed via R and Spearman r. The OD safe range corresponding to the unit-less SI safe range (0.95-1.05) is calibrated by sensitivity and specificity test. Validation is fulfilled with 19 acute respiratory distress syndrome (ARDS) patients data (196 cases), including assessment across ARDS severity. Overall correlation between OD and SI yielded R = 0.76 and Spearman r = 0.89. Correlation is higher considering only moderate and severe ARDS patients. Calibration of OD to SI yields a safe range defined: 0 ≤ OD ≤ 0.8 cmHO. The proposed OD offers an efficient, general, real-time measurement of patient-specific lung mechanics, which is more intuitive and robust than SI. OD eliminates the limitations of SI in MV mode and its less intuitive lung status value. Finally, OD can be accurately predicted for new ventilator settings via its foundation in a validated predictive personalized lung mechanics model. Therefore, OD offers potential clinical value over current clinical methods.
临床测量提供床边监测，旨在尽量减少意外的过度扩张，但存在局限性，无法预测机械通气（MV）设置的变化，且仅在某些MV模式下可用。本研究引入了一种非侵入性的实时过度扩张测量方法，该方法比现有方法更可靠、可预测且更直观。将所提出的过度扩张测量值（记为OD）与经临床验证的应力指数（SI）进行比较。通过R和Spearman相关系数r分析相关性。通过敏感性和特异性测试校准与无量纲SI安全范围（0.95 - 1.05）相对应的OD安全范围。利用19例急性呼吸窘迫综合征（ARDS）患者的数据（196例）进行验证，包括对ARDS严重程度的评估。OD与SI之间的总体相关性为R = 0.76，Spearman相关系数r = 0.89。仅考虑中度和重度ARDS患者时相关性更高。OD与SI的校准得出定义的安全范围：0≤OD≤0.8 cmH₂O。所提出的OD提供了一种高效、通用的实时测量患者特异性肺力学的方法，比SI更直观且更可靠。OD消除了SI在MV模式下的局限性及其不太直观的肺状态值。最后，基于经过验证的预测性个性化肺力学模型，OD可以准确预测新的呼吸机设置。因此，与当前临床方法相比，OD具有潜在的临床价值。
