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A new infant hybrid respiratory simulator: preliminary evaluation based on clinical data

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Abstract

A new hybrid (numerical–physical) simulator of the respiratory system, designed to simulate spontaneous and artificial/assisted ventilation of preterm and full-term infants underwent preliminary evaluation. A numerical, seven-compartmental model of the respiratory system mechanics allows the operator to simulate global and peripheral obstruction and restriction of the lungs. The physical part of the simulator is a piston-based construction of impedance transformer. LabVIEW real-time software coordinates the work of both parts of the simulator and its interaction with a ventilator. Using clinical data, five groups of “artificial infants” were examined: healthy full-term infants, very low-birth-weight preterm infants successfully (VLBW) and unsuccessfully extubated (VLBWun) and extremely low-birth-weight preterm infants without (ELBW) and with bronchopulmonary dysplasia (ELBW_BPD). Pressure-controlled ventilation was simulated to measure peak inspiratory pressure, mean airway pressure, total (patient + endotracheal tube) airway resistance (R), total dynamic compliance of the respiratory system (C), and total work of breathing by the ventilator (WOB). The differences between simulation and clinical parameters were not significant. High correlation coefficients between both types of data were obtained for R, C, and WOB (γ R  = 0.99, P < 0.0005; γ C  = 0.85, P < 0.005; γWOB = 0.96, P < 0.05, respectively). Thus, the simulator accurately reproduces infant respiratory system mechanics.

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Abbreviations

ETT:

Endotracheal tube

ID:

Inner diameter of ETT (mm)

R :

Total airway resistance of an intubated patient (kPa s l−1)

C :

Total dynamic compliance of respiratory system of an intubated patient (ml kPa−1)

R c :

Central airway resistance (kPa s l−1)

L :

Central airway inertance (kPa s2 l−1)

R 1, R 2 :

Resistance of peripheral airway in the first and second compartment, respectively (kPa s l−1)

C 1, C 2 :

Lung compliance in the first and second compartment, respectively (ml kPa−1)

T 1, T 2 :

Time constant for the first and second compartment of peripheral airway, respectively

C w :

Thorax compliance (ml kPa−1)

C x :

Gas compliance in piston chamber of TR

P A1, P A2 :

Alveolar pressure the first and second compartment, respectively (kPa)

P pl :

Pleural pressure (kPa)

P m :

Pressure at the input of the numerical model of respiratory system (kPa)

F m :

Flow at the input of the numerical model of respiratory system (l min−1)

P :

Pressure at input of TR (kPa)

F :

Flow at the input of TR (l min−1)

F 1, F 2 :

Gas flow in the first and second compartment, respectively (l min−1)

f :

Breath frequency (min−1)

ω :

Angular frequency (s−1)

FRC:

Fractional residual capacity (ml)

V :

Lung volume above FRC (ml)

V 1, V 2 :

Gas volume, in the first and second compartment, respectively (ml)

TR:

Impedance transformer

Z :

Input impedance of the simulator (kPa s l−1)

Z m :

Impedance of the numeric part of the simulator (kPa s l−1)

C x :

Pneumatic capacitor representing gas compliance in piston chamber of TR (ml kPa−1)

Z x :

Impedance of C x (kPa s l−1)

PC:

Pressure-controlled ventilation

MV:

Minute ventilation (l)

I:E :

Inspiration to expiration time ratio

PIP:

Peak inspiratory pressure (kPa)

MAP:

Mean airway pressure (kPa)

PEEP:

Positive end expiratory pressure

WOB:

Total work of breathing by the ventilator (J l−1)

FT:

A group of full-term infants,

FTp1:

A patient from the FT group with the highest R and the lowest C

VLBW:

A group of very low-birth-weight preterm infants successfully extubated

VLBWun:

A group of very low-birth-weight preterm infants with extubation failure

VLBWun_f:

A group of VLBWun ventilated with breath frequency: 35, 44 or 49 (min−1)

ELBW:

A group of extremely low-birth-weight preterm infants

ELBW_BPD:

A group of extremely low-birth-weight preterm infants with bronchopulmonary dysplasia

SD:

Standard deviation

δ R , δ C , δ PIP, δ MAP, δ WOB :

Percentage difference of R, C, PIP, MAP, and WOB, respectively, between equivalent patient cases (e.g., ELBW_BPD vs ELBW) within the group consisted of 10 cases (5 equivalent): FT, FTp1, VLBW_49, VLBWun_49, VLWB_44, VLBWun_44, VLBW_35, VLBWun_35, ELBW_BPD, ELBW

P :

Level of significance of the difference between groups

1 − β :

Test power

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This research did not receive any specific grant from founding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Biomedical Systems and Technologies, Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 4 Trojdena Street, Warsaw, Poland

    Barbara Stankiewicz, Krzysztof J. Pałko, Marek Darowski, Krzysztof Zieliński & Maciej Kozarski

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  1. Barbara Stankiewicz
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Correspondence to Barbara Stankiewicz.

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Stankiewicz, B., Pałko, K.J., Darowski, M. et al. A new infant hybrid respiratory simulator: preliminary evaluation based on clinical data. Med Biol Eng Comput 55, 1937–1948 (2017). https://doi.org/10.1007/s11517-017-1635-9

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