Computational Analysis of Noninvasive Ventilation

描述（由申请人提供）：尽管机械通气被公认为是一种挽救生命的干预措施，也是现代重症监护和急诊护理的基石，但它可能既不舒服又有害。患者特征与呼吸机施加流量和压力的方式之间复杂的相互作用决定了支持的水平和充分性、患者的舒适程度以及受伤的可能性。患者：呼吸机互动是一个复杂而动态的过程，充满了反馈循环和适应。这种复杂性在压力支持无创通气（PSNIV）的设置中是最重要的，PSNIV是一种越来越普遍的支持呼吸衰竭患者的方法。目前还没有一个严谨的优化PSNIV应用的概念基础。我们将开发一个数学上严谨的概念框架和一套实用工具，用于分析、监测和优化压力支持无创通气的应用，实现4个具体目标。

DESCRIPTION (provided by applicant): Despite its recognition as a lifesaving intervention and cornerstone of modern intensive and emergency care, mechanical ventilation can be both uncomfortable and injurious. Complex interactions between patient characteristics and the manner in which the ventilator applies flow and pressure determine the level and adequacy of support, the degree of patient comfort, and the potential for injury. Patient: ventilator interaction is a complex and dynamic process, fraught with feedback loops and adaptation. This complexity is of greatest importance in the setting of pressure support noninvasive ventilation (PSNIV), an increasingly common approach to supporting individuals with respiratory failure. There is not at present a rigorous conceptual foundation for optimizing the application of PSNIV. We will develop both a mathematically rigorous conceptual framework and a suite of practical tools for analyzing, monitoring, and optimizing the application of pressure support noninvasive ventilation by accomplishing 4 specific aims. 1) Specific Aim One: Develop, calibrate, and validate practical mathematical models and tools for the real- time analysis of pressure support noninvasive ventilation; 2) Specific Aim Two: Use human data to construct libraries of patient impedance (lung "stiffness" and resistance) characteristics and patterns of respiratory effort during assisted breathing and systematically investigate interactions between model complexity and the accuracy and robustness of model predictions; 3) Specific Aim Three: Apply contemporary mathematical techniques to identify approaches for applying PSNIV that are anticipated to improve the likelihood of adequate support in specific populations; 4) Specific Aim Four: Develop automated, noninvasive tools to a) identify airway opening flow- and pressure profiles indicating potential patient: ventilator conflict and b) objectively classify patient breathing patterns. These tools will be developed from "first principles," with rigorous mathematical and laboratory analyses and optimization that will be tightly linked to clinical calibration, evaluation, and validation. This work will ultimately help us to better manage patients who are treated with noninvasive ventilation, whether for an acute illness (such as an exacerbation of emphysema), or at home (as in the case of obstructive sleep apnea).