Theoretical open-loop model of respiratory mechanics in the extremely preterm infant.

Autor: Ellwein Fix L; Department of Mathematics and Applied Mathematics, Virginia Commonwealth University, Richmond, Virginia, United States of America., Khoury J; Division of Neonatal Medicine, Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, Virginia, United States of America., Moores RR Jr; Division of Neonatal Medicine, Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, Virginia, United States of America., Linkous L; Department of Mathematics and Applied Mathematics, Virginia Commonwealth University, Richmond, Virginia, United States of America., Brandes M; VCU School of Medicine, Virginia Commonwealth University, Richmond, Virginia, United States of America., Rozycki HJ; Division of Neonatal Medicine, Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, Virginia, United States of America.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2018 Jun 14; Vol. 13 (6), pp. e0198425. Date of Electronic Publication: 2018 Jun 14 (Print Publication: 2018).
DOI: 10.1371/journal.pone.0198425
Abstrakt: Non-invasive ventilation is increasingly used for respiratory support in preterm infants, and is associated with a lower risk of chronic lung disease. However, this mode is often not successful in the extremely preterm infant in part due to their markedly increased chest wall compliance that does not provide enough structure against which the forces of inhalation can generate sufficient pressure. To address the continued challenge of studying treatments in this fragile population, we developed a nonlinear lumped-parameter respiratory system mechanics model of the extremely preterm infant that incorporates nonlinear lung and chest wall compliances and lung volume parameters tuned to this population. In particular we developed a novel empirical representation of progressive volume loss based on compensatory alveolar pressure increase resulting from collapsed alveoli. The model demonstrates increased rate of volume loss related to high chest wall compliance, and simulates laryngeal braking for elevation of end-expiratory lung volume and constant positive airway pressure (CPAP). The model predicts that low chest wall compliance (chest stiffening) in addition to laryngeal braking and CPAP enhance breathing and delay lung volume loss. These results motivate future data collection strategies and investigation into treatments for chest wall stiffening.
Competing Interests: The authors have declared that no competing interests exist.
Databáze: MEDLINE
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