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Impact of Positive End-Expiratory Pressure During Heterogeneous Lung Injury: Insights from Computed Tomographic Image Functional Modeling

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Abstract

Image Functional Modeling (IFM) synthesizes three dimensional airway networks with imaging and mechanics data to relate structure to function. The goal of this study was to advance IFM to establish a method of exploring how heterogeneous alveolar flooding and collapse during lung injury would impact regional respiratory mechanics and flow distributions within the lung at distinct positive end-expiratory pressure (PEEP) levels. We estimated regional respiratory system elastance from computed tomography (CT) scans taken in 5 saline-lavaged sheep at PEEP levels from 7.5 to 20 cmH2O. These data were anatomically mapped into a computational sheep lung model, which was used to predict the corresponding impact of PEEP on dynamic flow distribution. Under pre-injury conditions and during lung injury, respiratory system elastance was determined to be spatially heterogeneous and the values were distributed with a hyperbolic distribution in the range of measured values. Increases in PEEP appear to modulate the heterogeneity of the flow distribution throughout the injured lung. Moderate increases in PEEP decreased the heterogeneity of elastance and predicted flow distribution, although heterogeneity began to increase for PEEP levels above 12.5–15 cmH2O. By combining regional respiratory system elastance estimated from CT with our computational lung model, we can potentially predict the dynamic distribution of the tidal volume during mechanical ventilation and thus identify specific areas of the lung at risk of being overdistended.

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Abbreviations

C ROI :

respiratory system compliance of a region of interest

Cg i :

acinar gas compression compliance

CT:

computed tomography

E low :

low frequency respiratory system elastance

E ROI :

respiratory system elastance of a region of interest

E rs :

respiratory system elastance

G i :

tissue damping factor of the ith acini

H i :

tissue elastance of the ith acini

i :

index for acini in model

IFM:

Image Functional Modeling

k :

index for consecutive PEEP levels

N acini :

total number of acini

N ROI :

number of acini within a region of interest

P atm :

atmospheric pressure

PEEP:

positive end-expiratory level

ROI:

region of Interest

R het :

absolute difference between low and high frequency respiratory system resistance

R rs :

respiratory system resistance

sE ROI :

specific respiratory system elastance of a region of interest

V i :

acinar volume

\( {\mathop V\limits^ \bullet }_{{{\text{in}}}} \) :

input flow of unit amplitude and known frequency

V ROI :

air volume of a region of interest

\( {\mathop V\limits^ \bullet }^{{{\text{actual}}}}_{i} \) :

actual acinar flow

\( {\mathop V\limits^ \bullet }^{{{\text{equal}}}}_{i} \) :

acinar flow in homogeneous properties and a symmetrical tree

\( {\mathop V\limits^ \bullet }^{{{\text{Normalized}}}}_{i} \) :

normalized acinar flow

Z i :

acinar mechanical impedance

Zt i :

acinar tissue impedance of the ith acini

η :

tissue hysteresivity

ω :

angular frequency

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Acknowledgments

This work was supported by the National Science Foundation BES-0114538, the National Institutes of Health HL62269-04, the National Institutes of Health HL-073994, The Association for Women in Science, and The Foundation for Anesthesia Education and Research. Additionally, Puritan Bennett/Tyco Healthcare provided the NPB840 used in the experiments.

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Authors and Affiliations

  1. Department of Biomedical Engineering, Boston University, 44 Cummington St., Boston, MA, 02215, USA

    C. L. Bellardine Black, B. Suki & K. R. Lutchen

  2. Tufts University Cummings School of Veterinary Medicine, N. Grafton, MA, USA

    A. M. Hoffman

  3. Pulmonary Division, Brigham and Women’s Hospital, Boston, MA, USA

    L. W. Tsai & E. P. Ingenito

  4. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA

    D. W. Kaczka & B. A. Simon

  5. Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA

    D. W. Kaczka

  6. Department of Medince, Johns Hopkins University, Baltimore, MD, USA

    B. A. Simon

Authors
  1. C. L. Bellardine Black
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  2. A. M. Hoffman
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  4. E. P. Ingenito
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Correspondence to K. R. Lutchen.

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Bellardine Black, C.L., Hoffman, A.M., Tsai, L.W. et al. Impact of Positive End-Expiratory Pressure During Heterogeneous Lung Injury: Insights from Computed Tomographic Image Functional Modeling. Ann Biomed Eng 36, 980–991 (2008). https://doi.org/10.1007/s10439-008-9451-x

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  • DOI: https://doi.org/10.1007/s10439-008-9451-x

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