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Journal of Clinical Monitoring and Computing
Published in: Journal of Clinical Monitoring and Computing 3/2016

01-06-2016 | Original Research

Real time noninvasive estimation of work of breathing using facemask leak-corrected tidal volume during noninvasive pressure support: validation study

Authors: Michael J. Banner, Carl G. Tams, Neil R. Euliano, Paul J. Stephan, Trevor J. Leavitt, A. Daniel Martin, Nawar Al-Rawas, Andrea Gabrielli

Published in: Journal of Clinical Monitoring and Computing | Issue 3/2016

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Abstract

We describe a real time, noninvasive method of estimating work of breathing (esophageal balloon not required) during noninvasive pressure support (PS) that uses an artificial neural network (ANN) combined with a leak correction (LC) algorithm, programmed to ignore asynchronous breaths, that corrects for differences in inhaled and exhaled tidal volume (VT) from facemask leaks (WOBANN,LC/min). Validation studies of WOBANN,LC/min were performed. Using a dedicated and popular noninvasive ventilation ventilator (V60, Philips), in vitro studies using PS (5 and 10 cm H2O) at various inspiratory flow rate demands were simulated with a lung model. WOBANN,LC/min was compared with the actual work of breathing, determined under conditions of no facemask leaks and estimated using an ANN (WOBANN/min). Using the same ventilator, an in vivo study of healthy adults (n = 8) receiving combinations of PS (3–10 cm H2O) and expiratory positive airway pressure was done. WOBANN,LC/min was compared with physiologic work of breathing/min (WOBPHYS/min), determined from changes in esophageal pressure and VT applied to a Campbell diagram. For the in vitro studies, WOBANN,LC/min and WOBANN/min ranged from 2.4 to 11.9 J/min and there was an excellent relationship between WOBANN,LC/breath and WOBANN/breath, r = 0.99, r2 = 0.98 (p < 0.01). There were essentially no differences between WOBANN,LC/min and WOBANN/min. For the in vivo study, WOBANN,LC/min and WOBPHYS/min ranged from 3 to 12 J/min and there was an excellent relationship between WOBANN,LC/breath and WOBPHYS/breath, r = 0.93, r2 = 0.86 (p < 0.01). An ANN combined with a facemask LC algorithm provides noninvasive and valid estimates of work of breathing during noninvasive PS. WOBANN,LC/min, automatically and continuously estimated, may be useful for assessing inspiratory muscle loads and guiding noninvasive PS settings as in a decision support system to appropriately unload inspiratory muscles.
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Metadata
Title
Real time noninvasive estimation of work of breathing using facemask leak-corrected tidal volume during noninvasive pressure support: validation study
Authors
Michael J. Banner
Carl G. Tams
Neil R. Euliano
Paul J. Stephan
Trevor J. Leavitt
A. Daniel Martin
Nawar Al-Rawas
Andrea Gabrielli
Publication date
01-06-2016
Publisher
Springer Netherlands
Published in
Journal of Clinical Monitoring and Computing / Issue 3/2016
Print ISSN: 1387-1307
Electronic ISSN: 1573-2614
DOI
https://doi.org/10.1007/s10877-015-9716-5

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