Personalized setup of high frequency percussive ventilator by estimation of respiratory system viscoelastic parameters

Abstract

High Frequency Percussive Ventilation (HFPV) is a non-conventional ventilatory modality which has proven highly effective in patients with severe gas exchange impairment. However, at the present time, HFPV ventilator provides only airway pressure measurement. The airway pressure measurements and gas exchange analysis are currently the only parameters that guide the physician during the HFPV ventilator setup and treatment monitoring. The evaluation of respiratory system resistance and compliance parameters in patients undergoing mechanical ventilation is used for lung dysfunctions detection, ventilation setup and treatment effect evaluation. Furthermore, the pressure measured by ventilator represents the sum of the endotracheal tube pressure drop and the tracheal pressure. From the clinical point of view, it is very important to take into account the real amount of pressure dissipated by endotracheal tube to avoid lung injury. HFPV is pressure controlled logic ventilation, thus hypoventilation and hyperventilation cases are possible because of tidal volume variations in function of pulmonary and endotracheal tube impedance. This thesis offers a new approach for HFPV ventilator setup in accordance with protective ventilatory strategy and optimization of alveolar recruitment using estimation of the respiratory mechanics parameters and endotracheal pressure drop. Respiratory system resistance and compliance parameters were estimated, firstly in vitro and successively in patients undergoing HFPV, applying least squares regression on Dorkin high frequency model starting from measured respiratory signals. The Blasius model was identified as the most adequate to estimate pressure drop across the endotracheal tube during HFPV. Beside measurement device was developed in order to measure respiratory parameters in patients undergoing HFPV. The possibility to tailor HFPV ventilator setup, using respiratory signals measurement and estimation of respiratory system resistance, compliance and endotracheal tube pressure drop, provided by this thesis, opens a new prospective to this particular ventilatory strategy, improving its beneficial effects and minimizing ventilator-induced lung damage.