Visualisation of inspiratory effort and respiratory mechanics to promote lung-and diaphragm protective ventilation.

Inappropriately applied mechanical ventilation in the intensive care unit (ICU) can cause clinically important injury to the lung and the diaphragm. While the importance and impact of lung-protective ventilation is well-established, the concept of diaphragm-protective ventilation has only recently emerged as a complementary therapeutic strategy. A fundamentally important concept in diaphragm protective ventilation is the preservation of a low-normal amount of diaphragm activity during mechanical ventilation. Unfortunately, adoption of diaphragm protective ventilation in clinical practice has remained problematic. The integration of lung-protective ventilation with diaphragm-protective strategies has proven to be challenging for the clinician. Furthermore, several subgroups likely have their own specific targets, particularly the pediatric population. This research proposition aims to close this gap between the concept of lung- and diaphragm protective ventilation and the clinical implementation. We aim to develop a clinical tool that will assist the clinician to avoid lung and diaphragm injury, through visualizing ventilatory and respiratory targets. A part of this research proposal is a prospective cohort study, where we aim to include 150 ventilated adult and pediatric patients in the ICU across three international research centers. We will correlate the level of inspiratory activity measured with esophageal pressure monitoring with the occurrence of diaphragm dysfunction, to define diaphragmprotective inspiratory effort cutoff levels. The effect of spontaneous breathing on lung injury will then be evaluated, and merged into a lungand diaphragm protective respiratory dynamics model. The clinician is thus provided with a to deliver individualized mechanical ventilation, which will result in shorter duration of mechanical ventilation, reduced length of stay in the ICU and hospital, and eventually reduced mortality.

Keywords:RESPIRATORY FUNCTIONS

Disciplines:Other (bio)medical engineering not elsewhere classified, Medical intensive care, Respiratory medicine

Project type:Collaboration project