Validation and application of a high-fidelity, computational model of acute respiratory distress syndrome to the examination of the indices of oxygenation at constant lung-state.
Validation and application of a high-fidelity, computational model of acute respiratory distress syndrome to the examination of the indices of oxygenation at constant lung-state.
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DOI：
10.1093/bja/aen181
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发表时间：
2008-09
影响因子：
9.8
通讯作者：
中科院分区：
文献类型：
--
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计算的静脉混合气（Qs/Qt）被认为是氧合的最佳指标;已经开发了替代指标（Pao 2/Fio 2、呼吸指数和动脉肺泡Po 2差异），但这些指标随Fio 2而变化，错误地表明肺状态的变化。使用一种新的模型，我们旨在量化上述氧合指数在生理和治疗因素变化期间的行为。这项研究是开发一种准确和非侵入性工具来量化氧合缺陷的第一步。本文基于诺丁汉生理模拟器，对急性呼吸窘迫综合征（ARDS）气体交换的一种新的计算模型进行了静态和动态验证。将动脉气体张力预测值与来自ARDS患者的数据进行比较。随后的研究检查了指数对Fio 2（0.3-1.0）、血红蛋白浓度（Hb：6-14 g dl−1）、氧消耗量（Vo 2：250-350 ml min−1）和Paco 2（4-8 kPa）独立变化引起的变化的敏感性。静态验证产生的平均误差为-0.3%，比以前的模型提高了10倍。动态验证产生的Pao 2和Paco 2的平均预测误差分别为-0.05 kPa和0.09 kPa。每个参数，特别是FiO 2，引起所有指标的变化。最小的FiO 2依赖性指数为Qs/Qt（变异：5.1%）。相比之下，Pao 2/Fio 2在Fio 2范围内变化77%。我们通过使用复杂的呼吸模型改进了ARDS中气体交换的模拟。使用经验证的模型，我们已经证明，目前的氧合指数随着Hb，Paco 2和Vo 2的变化而变化，除了他们以前充分记录的依赖Fio 2。
Calculated venous admixture (Qs/Qt) is considered the best index of oxygenation; surrogates have been developed (Pao2/Fio2, respiratory index, and arterioalveolar Po2 difference), but these vary with Fio2, falsely indicating a change in lung-state. Using a novel model, we aimed to quantify the behaviour of the indices of oxygenation listed above during physiological and treatment factor variation. The study is the first step in developing an accurate and non-invasive tool to quantify oxygenation defects. We present the static and dynamic validation of a novel computational model of gas exchange in acute respiratory distress syndrome (ARDS) based upon the Nottingham Physiology Simulator. Arterial gas tension predictions were compared with data derived from ARDS patients. The subsequent study examined the indices’ susceptibility to variation induced by independent changes in Fio2 (0.3–1.0), haemoglobin concentration (Hb: 6–14 g dl−1), oxygen consumption (Vo2: 250–350 ml min−1), and Paco2 (4–8 kPa). Static validation produced a mean error of −0.3%, a 10-fold improvement over previous models. Dynamic validation produced a mean prediction error of −0.05 kPa for Pao2 and 0.09 kPa for Paco2. Every parameter, especially Fio2, induced variation in all indices. The least Fio2-dependent index was Qs/Qt (variation: 5.1%). In contrast, Pao2/Fio2 varied by 77% through the range of Fio2. We have improved simulation of gas exchange in ARDS by using a sophisticated respiratory model. Using the validated model, we have demonstrated that the current indices of oxygenation vary with alteration in Hb, Paco2, and Vo2 in addition to their previously well-documented dependence on Fio2.
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影响因子：
9.8
作者：
Hardman, JG;Bedforth, NM;Aitkenhead, AR
通讯作者：
Aitkenhead, AR
影响因子：
10.7
作者：
McNamara, MJ;Hardman, JG
通讯作者：
Hardman, JG
影响因子：
3.3
作者：
ROSSAINT, R;HAHN, SM;RADERMACHER, P
通讯作者：
RADERMACHER, P
影响因子：
2.1
作者：
ZETTERSTROM, H
通讯作者：
ZETTERSTROM, H
影响因子：
8.8
作者：
Gowda, MS;Klocke, RA
通讯作者：
Klocke, RA