William Joy, Beatrice Albanese, Diallo Oakley, Sonal Mistry, Kateryna Nikulina, Andreas Schuppert, Gernot Marx, Bindi S Brook, Jonathan G Hardman, John G Laffey, Louise Rose, Luigi Camporota, Timothy E Scott, Declan G Bates, Sina Saffaran
{"title":"数字双胞胎评估气道压力释放通气与压力控制通气时呼吸机所致肺损伤的风险。","authors":"William Joy, Beatrice Albanese, Diallo Oakley, Sonal Mistry, Kateryna Nikulina, Andreas Schuppert, Gernot Marx, Bindi S Brook, Jonathan G Hardman, John G Laffey, Louise Rose, Luigi Camporota, Timothy E Scott, Declan G Bates, Sina Saffaran","doi":"10.1097/CCM.0000000000006885","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To use digital twins constructed based on data from patients with acute respiratory distress syndrome (ARDS) to calculate all key indices of ventilator-induced lung injury (VILI) during airway pressure release ventilation (APRV), and to compare them with corresponding values obtained during pressure-controlled ventilation (PCV).</p><p><strong>Design: </strong>Digital twins were created by matching a high-fidelity cardiopulmonary simulation model to each patient's data.</p><p><strong>Setting: </strong>Interdisciplinary Collaboration in Systems Medicine Research Network.</p><p><strong>Subjects: </strong>A dataset consisting of pairs of ventilator settings and arterial blood gases for 98 patients with ARDS receiving PCV.</p><p><strong>Interventions: </strong>VILI indices were calculated for each recorded PCV datapoint, and for typical APRV settings in fixed and time-controlled adaptive modes, in the same digital twins. Global optimization algorithms evaluated greater than 4.8 million changes to these settings to identify the lowest values of VILI indices that could be achieved in both modes while preserving adequate gas-exchange.</p><p><strong>Measurements and mains results: </strong>In digital twins, APRV settings of inspiratory pressure equals to 25 cm H2O, low-pressure setting equals to 0 cm H2O, inspiration time equals to 5 s, and expiration time set to achieve 75% of peak expiratory flow rate (mean 0.5 s), reduced mean mechanical power (MP) by 32% and mean tidal alveolar recruitment/de-recruitment by 34% compared with documented PCV settings, at the cost of moderate hypercapnia (mean PaCO2 58.5 mm Hg, pHa 7.32 vs. PaCO2 45.6 mm Hg, pHa 7.37). Mean driving pressure, tidal volume, and lung stress/strain were similar in both modes. Computational optimization showed that these settings were close to optimal in terms of minimizing both mean MP and mean levels of tidal recruitment/de-recruitment during APRV.</p><p><strong>Conclusions: </strong>Using digital twins we found possible lung-protective conditions and beneficial effects of APRV which need further evaluation in randomized clinical trials.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0000,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Digital Twins to Evaluate the Risk of Ventilator-Induced Lung Injury During Airway Pressure Release Ventilation Compared With Pressure-Controlled Ventilation.\",\"authors\":\"William Joy, Beatrice Albanese, Diallo Oakley, Sonal Mistry, Kateryna Nikulina, Andreas Schuppert, Gernot Marx, Bindi S Brook, Jonathan G Hardman, John G Laffey, Louise Rose, Luigi Camporota, Timothy E Scott, Declan G Bates, Sina Saffaran\",\"doi\":\"10.1097/CCM.0000000000006885\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To use digital twins constructed based on data from patients with acute respiratory distress syndrome (ARDS) to calculate all key indices of ventilator-induced lung injury (VILI) during airway pressure release ventilation (APRV), and to compare them with corresponding values obtained during pressure-controlled ventilation (PCV).</p><p><strong>Design: </strong>Digital twins were created by matching a high-fidelity cardiopulmonary simulation model to each patient's data.</p><p><strong>Setting: </strong>Interdisciplinary Collaboration in Systems Medicine Research Network.</p><p><strong>Subjects: </strong>A dataset consisting of pairs of ventilator settings and arterial blood gases for 98 patients with ARDS receiving PCV.</p><p><strong>Interventions: </strong>VILI indices were calculated for each recorded PCV datapoint, and for typical APRV settings in fixed and time-controlled adaptive modes, in the same digital twins. Global optimization algorithms evaluated greater than 4.8 million changes to these settings to identify the lowest values of VILI indices that could be achieved in both modes while preserving adequate gas-exchange.</p><p><strong>Measurements and mains results: </strong>In digital twins, APRV settings of inspiratory pressure equals to 25 cm H2O, low-pressure setting equals to 0 cm H2O, inspiration time equals to 5 s, and expiration time set to achieve 75% of peak expiratory flow rate (mean 0.5 s), reduced mean mechanical power (MP) by 32% and mean tidal alveolar recruitment/de-recruitment by 34% compared with documented PCV settings, at the cost of moderate hypercapnia (mean PaCO2 58.5 mm Hg, pHa 7.32 vs. PaCO2 45.6 mm Hg, pHa 7.37). Mean driving pressure, tidal volume, and lung stress/strain were similar in both modes. Computational optimization showed that these settings were close to optimal in terms of minimizing both mean MP and mean levels of tidal recruitment/de-recruitment during APRV.</p><p><strong>Conclusions: </strong>Using digital twins we found possible lung-protective conditions and beneficial effects of APRV which need further evaluation in randomized clinical trials.</p>\",\"PeriodicalId\":10765,\"journal\":{\"name\":\"Critical Care Medicine\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":6.0000,\"publicationDate\":\"2025-09-24\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Critical Care Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/CCM.0000000000006885\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Critical Care Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/CCM.0000000000006885","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
Digital Twins to Evaluate the Risk of Ventilator-Induced Lung Injury During Airway Pressure Release Ventilation Compared With Pressure-Controlled Ventilation.
Objective: To use digital twins constructed based on data from patients with acute respiratory distress syndrome (ARDS) to calculate all key indices of ventilator-induced lung injury (VILI) during airway pressure release ventilation (APRV), and to compare them with corresponding values obtained during pressure-controlled ventilation (PCV).
Design: Digital twins were created by matching a high-fidelity cardiopulmonary simulation model to each patient's data.
Setting: Interdisciplinary Collaboration in Systems Medicine Research Network.
Subjects: A dataset consisting of pairs of ventilator settings and arterial blood gases for 98 patients with ARDS receiving PCV.
Interventions: VILI indices were calculated for each recorded PCV datapoint, and for typical APRV settings in fixed and time-controlled adaptive modes, in the same digital twins. Global optimization algorithms evaluated greater than 4.8 million changes to these settings to identify the lowest values of VILI indices that could be achieved in both modes while preserving adequate gas-exchange.
Measurements and mains results: In digital twins, APRV settings of inspiratory pressure equals to 25 cm H2O, low-pressure setting equals to 0 cm H2O, inspiration time equals to 5 s, and expiration time set to achieve 75% of peak expiratory flow rate (mean 0.5 s), reduced mean mechanical power (MP) by 32% and mean tidal alveolar recruitment/de-recruitment by 34% compared with documented PCV settings, at the cost of moderate hypercapnia (mean PaCO2 58.5 mm Hg, pHa 7.32 vs. PaCO2 45.6 mm Hg, pHa 7.37). Mean driving pressure, tidal volume, and lung stress/strain were similar in both modes. Computational optimization showed that these settings were close to optimal in terms of minimizing both mean MP and mean levels of tidal recruitment/de-recruitment during APRV.
Conclusions: Using digital twins we found possible lung-protective conditions and beneficial effects of APRV which need further evaluation in randomized clinical trials.
期刊介绍：
Critical Care Medicine is the premier peer-reviewed, scientific publication in critical care medicine. Directed to those specialists who treat patients in the ICU and CCU, including chest physicians, surgeons, pediatricians, pharmacists/pharmacologists, anesthesiologists, critical care nurses, and other healthcare professionals, Critical Care Medicine covers all aspects of acute and emergency care for the critically ill or injured patient.
Each issue presents critical care practitioners with clinical breakthroughs that lead to better patient care, the latest news on promising research, and advances in equipment and techniques.
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