Document Detail

Linear and nonlinear analysis of pressure and flow during mechanical ventilation.
MedLine Citation:
PMID:  11030161     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Linear modeling as a method of exploring respiratory mechanics during mechanical ventilation, was compared to nonlinear modeling for flow dependence of resistance in three distinct groups of patients, those with: (a) normal respiratory function (NRF), (b) chronic obstructive pulmonary disease (COPD), or (c) adult respiratory distress syndrome (ARDS). DESIGN AND PATIENTS: Airways opening pressure (Pao), flow (V'), and volume (V) signals were recorded in 32 ICU mechanically ventilated patients, under sedation and muscle relaxation (10 NRF, 11 COPD, 11 ARDS). All patients were ventilated with controlled mandatory ventilation mode at three levels of end-expiratory pressure (PEEPe): 0, 5, and 10 hPa. Data were analyzed according to: (a) Pao = PE + Ers V + Rrs V' and (b) Pao = PE + Ers V + k1V' + k2¿V'¿V'; where Ers and Rrs represent the intubated respiratory system (RS) elastance and resistance, k1 and k2 the linear and the nonlinear RS resistive coefficients, and PE the end-expiratory pressure. The model's goodness of fit to the data was evaluated by the root mean square difference of predicted minus measured Pao values. RESULTS: NRF data fit both models well at all PEEPe levels. ARDS and particularly COPD data fit the nonlinear model better. Values of k2 were often negative in COPD and ARDS groups, and they increased in parallel with PEEPe. A gradual increase in PEEPe resulted in better fit of ARDS and COPD data to both models. CONCLUSIONS: The model of V' dependence of resistance is more suitable for the ARDS and particularly the COPD groups. PEEP tends to diminish the V' dependence of respiratory resistance during the respiratory cycle, particularly in the COPD group, probably through an indirect effect of the increased lung volume.
M P Vassiliou; L Petri; A Amygdalou; M Patrani; C Psarakis; D Nikolaki; G Georgiadis; P K Behrakis
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Intensive care medicine     Volume:  26     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  2000 Aug 
Date Detail:
Created Date:  2001-01-12     Completed Date:  2001-02-01     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1057-64     Citation Subset:  IM    
Lung Function Department, St. Savas Hospital, Athens, Greece.
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MeSH Terms
Linear Models*
Lung Diseases, Obstructive / physiopathology,  therapy
Middle Aged
Nonlinear Dynamics*
Positive-Pressure Respiration
Respiration, Artificial / statistics & numerical data*
Respiratory Distress Syndrome, Adult / physiopathology,  therapy
Respiratory Function Tests / statistics & numerical data*
Respiratory Mechanics

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