Trend analyses Of Patient-Specific respiratory Physiologal INteractions for weaning decision support

Approximately 30% of the patients receiving mechanical ventilation (MV) in
intensive care units (ICUs) for more than two days have difficulties weaning,
which is directly related to both serious complications of invasive MV, and
poorer patient outcomes. The development of early prognostic factors that
acknowledge the complexity of weaning failure might help to address this
problem. However, the currently available parameters show no more than modest
accuracies in predicting weaning outcomes. To address this problem, the
authors propose an approach that takes the dynamically changing condition of
ventilated patients into account; 1) acquire physiological data over the
entire MV period in order to detect trends in patient status over time, and 2)
use more state-of-the-art data analysis methods, preserving more context in the
data and outcomes. Applied to the concept of breathing effort we propose to
study the interactions between the physiological systems involved in the
breathing; the neural respiratory drive and innervation, the respiratory muscle
dynamics, and the respiratory system mechanics. This approach might provide
more insight in the pathophysiological processes going on in a patient, and can
thus be used to guide MV management decisions throughout the entire weaning
process.

The primary objective of this study is to investigate the relation between, on
the one hand, 1) the balance between the respiratory system mechanics and
muscle dynamics, and 2) the balance between the pressure support level and
respiratory drive, and, on the other hand, the weaning duration in patients
receiving prolonged mechanical ventilation.

Second, the effect of ventilatory support settings with respect to the optima
in these physiological relations on the weaning duration, and the progression
of these relations over the weaning duration are studied. Besides, the
relations of various weaning strategies and aids (e.g. nasal high flow therapy,
and inspiratory muscle training) with the course of the respiratory function
are investigated.

This is a monocentre observational study.

The studied problem is linked to ICU patients, as they are ventilated for
prolonged durations of time. This population is vulnerable by nature. However,
the risks related to prolonged mechanical ventilation, and the current lack of
good early prognostic factors, legitimate an observational study using a
non-invasive measurement protocol, posing only limited discomfort to the
patient, such that burdens and risks are minimised.