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B-spline modelling of inspiratory drive in NAVA-ventilated patients

机译：纳瓦通风患者吸气驱动的B样条型造型

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摘要

Model-based approaches are often used to estimate mechanical properties of lungs, such as elastance (E) and airway resistance (R), during invasive and non-invasive mechanical ventilation (MV). Current models are less effective when spontaneous breathing is present. This analysis utilises b-spline functions within a single compartment model framework to identify patient-specific inspiratory driving pressure. A series of 2nd-order, constrained b-spline basis functions are used to identify inspiratory driving pressure breath to breath alongside single E and R using inspiration and expiration data from n=20 breaths for 10 patients ventilated using NAVA. Median [IQR] per patient RMS error for n = 20 breaths was 0.75 [0.6 – 0.9] cmH2O, with elastance ranging from 2.1 – 29.8 cmH20/L, and per-patient median peak driving pressure ranging from -1.9 to -7.9 cmH2O. Inspiratory driving pressure profiles matched esophageal pressures from literature and its value at peak nervous signal to the diaphragm (Eadi) was correlated with peak Eadi (R2=0.25-0.86). Average trans-pulmonary pressure remained consistent between breaths for each patient, despite differences in peak Eadi and peak airway pressure. Overall, the model-based approach resulted in physiologically reasonable inspiratory driving pressures, with trends with electrical activity and matched literature data showing neuro-muscular decoupling as a function of pressure and/or volume.
机译：基于模型的方法通常用于估计肺部的机械性能，例如侵入性和非侵入机械通气（MV）期间弹性（E）和气道阻力（R）。当前呼吸存在时，目前的模型效果较差。该分析利用单个隔间模型框架内的B样条函数来识别患者特异性的吸气驱动压力。一系列2nd订单，约束的B样条函数用于识别吸气的驱动压力呼吸，并使用来自N = 20呼吸的灵感和到期数据来呼吸单e和r，用于使用纳瓦通风的10名患者。 N = 20呼吸每位患者的每个患者的中位[IQR]误差为0.75 [0.6 - 0.9] CMH2O，弹性范围为2.1-29.8 cmH20 / L，每患者中位数峰值驱动压力范围为-1.9至-7.9cmH2O。吸气的驱动压力曲线与文献中的食管压力匹配，其在峰神经信号下对隔膜（EADI）的值与峰值eADI（R2 = 0.25-0.86）相关。尽管峰值eADI和峰值气道压力差异，但每次患者的呼吸之间平均跨肺压力保持一致。总的来说，基于模型的方法导致生理学上合理的吸气驾驶压力，具有电活动的趋势和匹配的文献数据，显示神经肌肉去耦作为压力和/或体积的函数。

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