The AIRVENT Simulation Study
Study Investigators
Dr. Ewan Goligher (ext. 6810, ewan.goligher@uhn.ca)
Dr. Damian Ratona (damian.ratano@uhn.ca)
Dr. Timothy Chan
Binghao Zhang, BASc, PhD Student
Study Contact
Dr. Damian Ratona (damian.ratano@uhn.ca)
Study Summary
Simulation study of a mathematical physiology-based model of ventilation aiming at protecting both lungs and diaphragm by optimizing respiratory muscle effort and lung stress together with ensuring acceptable gas exchange. This ventilation strategy is called Lung and Diaphragm Protective Ventilation (LDPV).
Study Population
Simulated patients with varying respiratory mechanics, respiratory failure, sedation and metabolic derangements.
Study Objectives
Estimate the proportion of patients in whom the LDPV strategy target values can be achieved under different simulated clinical scenarios.
Test the limits of the model by simulating extreme conditions of disease.
Simulate the effect of extracorporeal CO2 removal (clinically called ECCO2R) in respiratory drive and lung mechanics.
Determine whether PAV+ theoretically increases the feasibility of achieving LDPV targets compared to PSV.
Study Interventions
The model will be fed with every input variable (clinically acceptable ranges) that can be controlled. The variables will be combined together in multiple scenarios. The model will be run following an algorithm (see LANDMARK algorithm) until the target values of △Pes, △PL and acid-base are met. If the model fails, ECCO2R will be applied and the algorithm run again. If the model can’t reach the goals, the scenario will be analyzed for plausibility and defined as a limit if relevant.
Why it Matters
The model could help to identify the patient population who may benefit from the LDPV strategy. Also, the LDPV strategy might be difficult to apply at the bedside. Testing our mathematical model in a simulated environment is one of the many step that could further result in a Clinical Decision Support System (CDSS) which aim would be to help the clinician to apply the LDPV strategy at the bedside.