Cardiovascular and Respiratory Physiology, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands.
Department of Intensive Care, Medisch Spectrum Twente, Enschede, The Netherlands.
Crit Care. 2023 Jul 6;27(1):268. doi: 10.1186/s13054-023-04549-9.
Individualised optimisation of mechanical ventilation (MV) remains cumbersome in modern intensive care medicine. Computerised, model-based support systems could help in tailoring MV settings to the complex interactions between MV and the individual patient's pathophysiology. Therefore, we critically appraised the current literature on computational physiological models (CPMs) for individualised MV in the ICU with a focus on quality, availability, and clinical readiness.
A systematic literature search was conducted on 13 February 2023 in MEDLINE ALL, Embase, Scopus and Web of Science to identify original research articles describing CPMs for individualised MV in the ICU. The modelled physiological phenomena, clinical applications, and level of readiness were extracted. The quality of model design reporting and validation was assessed based on American Society of Mechanical Engineers (ASME) standards.
Out of 6,333 unique publications, 149 publications were included. CPMs emerged since the 1970s with increasing levels of readiness. A total of 131 articles (88%) modelled lung mechanics, mainly for lung-protective ventilation. Gas exchange (n = 38, 26%) and gas homeostasis (n = 36, 24%) models had mainly applications in controlling oxygenation and ventilation. Respiratory muscle function models for diaphragm-protective ventilation emerged recently (n = 3, 2%). Three randomised controlled trials were initiated, applying the Beacon and CURE Soft models for gas exchange and PEEP optimisation. Overall, model design and quality were reported unsatisfactory in 93% and 21% of the articles, respectively.
CPMs are advancing towards clinical application as an explainable tool to optimise individualised MV. To promote clinical application, dedicated standards for quality assessment and model reporting are essential. Trial registration number PROSPERO- CRD42022301715 . Registered 05 February, 2022.
个体化优化机械通气（MV）在现代重症监护医学中仍然很繁琐。基于计算机的模型支持系统可以帮助根据 MV 与个体患者病理生理学之间的复杂相互作用来调整 MV 设置。因此，我们批判性地评估了当前关于 ICU 中个体化 MV 的计算生理模型（CPM）的文献，重点关注质量、可用性和临床准备情况。
我们于 2023 年 2 月 13 日在 MEDLINE ALL、Embase、Scopus 和 Web of Science 上进行了系统文献检索，以确定描述 ICU 中个体化 MV 的 CPM 的原始研究文章。提取了模型化的生理现象、临床应用和准备水平。根据美国机械工程师协会（ASME）标准评估模型设计报告和验证的质量。
在 6333 篇独特的出版物中，有 149 篇被纳入。CPM 自 20 世纪 70 年代以来不断发展，准备水平不断提高。共有 131 篇文章（88%）对肺力学进行了建模，主要用于肺保护性通气。气体交换（n=38，26%）和气体稳态（n=36，24%）模型主要应用于控制氧合和通气。最近出现了用于膈保护性通气的呼吸肌功能模型（n=3，2%）。已经启动了三项随机对照试验，应用 Beacon 和 CURE Soft 模型进行气体交换和 PEEP 优化。总体而言，分别有 93%和 21%的文章在模型设计和质量方面的报告令人不满意。
CPM 作为优化个体化 MV 的一种可解释工具，正在朝着临床应用的方向发展。为了促进临床应用，需要专门的质量评估和模型报告标准。注册号 PROSPERO-CRD42022301715。注册于 2022 年 2 月 5 日。
