Can computer simulators accurately represent the pathophysiology of individual COPD patients?
Can computer simulators accurately represent the pathophysiology of individual COPD patients?
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DOI：
10.1186/s40635-014-0023-0
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发表时间：
2014-12
影响因子：
3.5
通讯作者：
Bates DG
中科院分区：
文献类型：
--
作者：
Wang W;Das A;Ali T;Cole O;Chikhani M;Haque M;Hardman JG;Bates DG
计算机模拟模型可以发挥关键作用，在开发新的治疗策略，慢性阻塞性肺疾病（COPD）患者，如果他们可以被证明是准确地代表个别患者的病理生理特征。我们评估了计算模拟器再现COPD对肺泡力学的异质性影响的能力，这些影响是在许多不同的患者数据集中捕获的。我们的研究结果表明，准确地代表个别COPD患者的病理生理需要使用大量（高达200）的气体交换室的模拟模型。这种复杂的模拟模型的调整“手”，以匹配患者的数据是不可行的，因此，我们提出了一种自动化的方法的基础上使用的全局优化算法和高性能计算。使用这种方法，我们能够实现模拟器和一系列患者数据之间的非常接近的匹配，包括PaO 2，PaCO 2，肺死腔分数，肺分流分数和通气/灌注（V今/Q）曲线。使用模拟器，我们计算了呼吸机设置的组合，这些组合最佳地管理了确保充分气体交换和最大限度地降低单个COPD患者呼吸机相关肺损伤风险之间的权衡。我们的研究结果显着加强了计算机模拟模型的可信度，作为研究工具，在COPD和其他肺部疾病状态的新的管理协议的发展。本文的在线版本（doi：10.1186/s40635-014-0023-0）包含补充材料，可供授权用户使用。
Computer simulation models could play a key role in developing novel therapeutic strategies for patients with chronic obstructive pulmonary disease (COPD) if they can be shown to accurately represent the pathophysiological characteristics of individual patients. We evaluated the capability of a computational simulator to reproduce the heterogeneous effects of COPD on alveolar mechanics as captured in a number of different patient datasets. Our results show that accurately representing the pathophysiology of individual COPD patients necessitates the use of simulation models with large numbers (up to 200) of compartments for gas exchange. The tuning of such complex simulation models ‘by hand’ to match patient data is not feasible, and thus we present an automated approach based on the use of global optimization algorithms and high-performance computing. Using this approach, we are able to achieve extremely close matches between the simulator and a range of patient data including PaO2, PaCO2, pulmonary deadspace fraction, pulmonary shunt fraction, and ventilation/perfusion (V̇/Q) curves. Using the simulator, we computed combinations of ventilator settings that optimally manage the trade-off between ensuring adequate gas exchange and minimizing the risk of ventilator-associated lung injury for an individual COPD patient. Our results significantly strengthen the credibility of computer simulation models as research tools for the development of novel management protocols in COPD and other pulmonary disease states. The online version of this article (doi:10.1186/s40635-014-0023-0) contains supplementary material, which is available to authorized users.