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Fluid dynamic assessment of positive end-expiratory pressure in a tracheostomy tube connector during respiration

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Abstract

High-flow oxygen therapy using a tracheostomy tube is a promising clinical approach to reduce the work of breathing in tracheostomized patients. Positive end-expiratory pressure (PEEP) is usually applied during oxygen inflow to improve oxygenation by preventing end-expiratory lung collapse. However, much is still unknown about the geometrical effects of PEEP, especially regarding tracheostomy tube connectors (or adapters). Quantifying the degree of end-expiratory pressure (EEP) that takes patient-specific spirometry into account would be useful in this regard, but no such framework has been established yet. Thus, a platform to assess PEEP under respiration was developed, wherein three-dimensional simulation of airflow in a tracheostomy tube connector is coupled with a lumped lung model. The numerical model successfully reflected the magnitude of EEP measured experimentally using a lung phantom. Numerical simulations were further performed to quantify the effects of geometrical parameters on PEEP, such as inlet angles and rate of stenosis in the connector. Although sharp inlet angles increased the magnitude of EEP, they cannot be expected to achieve clinically reasonable PEEP. On the other hand, geometrical constriction in the connector can potentially result in PEEP as obtained with conventional nasal cannulae.

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Acknowledgements

This research was supported by JSPS KAKENHI Grant Numbers JP19H01175 and JP20H04504; by Osaka University Global Center for Medical Engineering and Informatics (MEI center); by the Keihanshin Consortium for Fostering the Next Generation of Global Leaders in Research (K-CONNEX), established by Human Resource Development Program for Science and Technology; and by MEXT as “Program for Promoting Researches on the Supercomputer Fugaku” (Development of personalized medical support technology based on simulation data science of whole brain blood circulation) (hp200136). The authors thank Drs. Naoto Yokoyama and Hiroshi Yamashita for their assistance with the preparation of this work.

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Authors and Affiliations

  1. Graduate School of Engineering Science, Osaka University, 1-3 Machikaneyama, Toyonaka, Osaka, 560-8531, Japan

    Shiori Kageyama, Naoki Takeishi & Shigeo Wada

  2. Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan

    Hiroki Taenaka & Takeshi Yoshida

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  1. Shiori Kageyama
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Contributions

S.K. and N.T. analyzed data; H.T. and T.Y. performed experiments; S.K., N.T., and S.W. interpreted simulation results; N.T. prepared figures; N.T. drafted the manuscript; N.T. edited and revised the manuscript; S.K., N.T., H.T., T.Y., and S.W. approved the final version of the manuscript; N.T., T.Y., and S.W. contributed to the research conception and design. All authors have read and agreed to the published version of the manuscript.

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Correspondence to Naoki Takeishi.

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Kageyama, S., Takeishi, N., Taenaka, H. et al. Fluid dynamic assessment of positive end-expiratory pressure in a tracheostomy tube connector during respiration. Med Biol Eng Comput 60, 2981–2993 (2022). https://doi.org/10.1007/s11517-022-02649-2

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