Implementation and assessment of a novel mechanical ventilatory system following a noisy ventilation regime

• Main Author: Marcus Henrique Victor Júnior
• Publication Date: 2014
• Format: Master thesis
• Language: eng
• Source: Biblioteca Digital de Teses e Dissertações do ITA
• Download full: http://www.bd.bibl.ita.br/tde_busca/arquivo.php?codArquivo=3151
• topic: Ventilação; Sistema respiratório; Identificação de parâmetros; Controle adaptativo; Controle

This study concerns the development of a novel mechanical ventilation system, with a view to analysing the results of a new mechanical ventilation technique, referred to noisy ventilation. Additionally, the study addresses the assessment of the system, involving the estimation of certain mechanical parameters of the respiratory system under noisy ventilation and discusses a pilot trial in vivo, with a pig. During acute respiratory failure, intubation and invasive mechanical ventilation may be life saving procedures. The general aim of mechanical ventilation is to provide adequate gas exchange support, while not damaging the respiratory system. This technique is one of the most important life support tools in the intensive care unit. However, it may also be harmful by causing ventilator induced lung injury and other undesirable effects. There is a growing interest in the development and use of variable mechanical ventilation performing variable volume and variable pressure controlled ventilation. The reasons are that this technique can improve lung functions and reduce lung damage, when compared to standard mechanical ventilation. Moreover, variable ventilation can improve lung mechanics and gas exchanges. The new ventilation system has to have the capabilities to perform a noisy ventilation regime, besides the standard mechanical ventilation. The development started with commercial devices: a mechanical ventilator and a personal computer, whose roles were to execute the noisy ventilation regime and to implement the new ventilation pattern by means of a ventilation routine, commanding the mechanical ventilator. After these two components were working together, a bench test was performed, in which a calibrated measuring device and a mechanical lung simulator were utilized. Considering that the system was working properly, it was possible to validate it by analysing the results. As the mechanical properties of the respiratory system are important quantities to know, a parameter estimation method was developed, with a view to estimating some relevant properties, such as compliance, positive end--expiratory pressure, resistance and others. The estimates were related to the adopted model for the respiratory system. In this study, four models were discussed: first order linear model, flow dependent resistance model, volume dependent elastance model and second order linear model. For each one, all parameters were estimated and the outcomes from each estimation were compared with the others, with a view to finding relationships between them and to evaluating the goodness of each model. Furthermore, as some parameters could be adjusted directly in the devices, adjusted and estimated values could also be compared. Finally, one trial in vivo was performed, with a view to assessing the behaviour of the system in a real situation and to showing the developed system to the research team. The system was set to work in a noisy and in a standard ventilation regime. It showed reasonable results in terms of quality of ventilation as well as reliability and maintainability of the ventilatory regime, during the whole test period. The developed parameter estimation methods were utilized to estimate the mechanical respiratory properties of the animal under test and to find cross relationships between these outcomes and others, such as those from blood gas, ultrasonography and electrical impedance tomography.