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, we 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.

Difficult to wean patients have a mismatch between optimal mechanical ventilation settings lung mechanics and respiratory muscle dynamics

Every other day from initiation of supported mechanical ventilation to successful weaning

PEEP trials, PS trials, surface respiratory muscle EMG, airway occlusion pressures