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Optimal PEEP selection in Mechanical Ventilation using EIT Ravi B. Bhanabhai Carleton University - 2009/11 M.A.Sc January 20, 2012 Ravi B. Bhanabhai (Carleton U) Safe Keeping Ventilation Patients 01/20/2012 1 / 28 Outline Introduction 1

  1. Optimal PEEP selection in Mechanical Ventilation using EIT Ravi B. Bhanabhai Carleton University - 2009/11 M.A.Sc January 20, 2012 Ravi B. Bhanabhai (Carleton U) Safe Keeping Ventilation Patients 01/20/2012 1 / 28

  2. Outline Introduction 1 The Problem How to solve the problem? Contributions 2 IP Calculation Fuzzy Logic System Results 3 Sigmoid vs. Linear Linear vs. Visual Optimal PEEP References 4 Ravi B. Bhanabhai (Carleton U) Safe Keeping Ventilation Patients 01/20/2012 2 / 28

  3. Introduction Introduction This is a presentation outlining the work done within Ravi Bhanabhai M.A.Sc thesis. Purpose: Investigate the use of Electrical Impedance Tomography (EIT) within mechanical ventilation. Ravi B. Bhanabhai (Carleton U) Safe Keeping Ventilation Patients 01/20/2012 3 / 28

  4. Introduction Introduction This is a presentation outlining the work done within Ravi Bhanabhai M.A.Sc thesis. Purpose: Investigate the use of Electrical Impedance Tomography (EIT) within mechanical ventilation. Mathematical Tools: Linear and Non-Linear curve fitting techniques 1 Fuzzy Logic. 2 Ravi B. Bhanabhai (Carleton U) Safe Keeping Ventilation Patients 01/20/2012 3 / 28

  5. Introduction Introduction This is a presentation outlining the work done within Ravi Bhanabhai M.A.Sc thesis. Purpose: Investigate the use of Electrical Impedance Tomography (EIT) within mechanical ventilation. Mathematical Tools: Linear and Non-Linear curve fitting techniques 1 Fuzzy Logic. 2 Contribtions: Summarize scholarly papers on ALI. 1 Inflection Point (IP) location on EIT and pressure data. 2 Creation of Fuzzy Logic System using IP. 3 Ravi B. Bhanabhai (Carleton U) Safe Keeping Ventilation Patients 01/20/2012 3 / 28

  6. Introduction Introduction This is a presentation outlining the work done within Ravi Bhanabhai M.A.Sc thesis. Purpose: Investigate the use of Electrical Impedance Tomography (EIT) within mechanical ventilation. Mathematical Tools: Linear and Non-Linear curve fitting techniques 1 Fuzzy Logic. 2 Contribtions: Summarize scholarly papers on ALI. 1 Inflection Point (IP) location on EIT and pressure data. 2 Creation of Fuzzy Logic System using IP. 3 Novel Aspects: Use of short recruitment maneuever ( ≤ 2min) 1 Regional Inflection Points used 2 Use of Inflection Points within an automated classification system 3 Ravi B. Bhanabhai (Carleton U) Safe Keeping Ventilation Patients 01/20/2012 3 / 28

  7. Introduction The Problem ALI & VILI Respiratory Failure Oxygenation Ventilatory Failure Failure (hypercapnia) (hypoxemia) + more oxygen related conditions Acute Lung Injury Ventilator Induce Lung Injury (ALI) (VILI) * Cyclic opening and closing PEEP * overdistension Ravi B. Bhanabhai (Carleton U) Safe Keeping Ventilation Patients 01/20/2012 4 / 28

  8. Introduction How to solve the problem? Respiratory Function Models P ao = V C + ˙ V R + ¨ V I − P mus (1) Ravi B. Bhanabhai (Carleton U) Safe Keeping Ventilation Patients 01/20/2012 5 / 28

  9. Introduction How to solve the problem? Respiratory Function Models P ao = V C + ˙ V R + ¨ V I − P mus (1) Interested in V C only. Ravi B. Bhanabhai (Carleton U) Safe Keeping Ventilation Patients 01/20/2012 5 / 28

  10. Introduction How to solve the problem? Respiratory Function Models P ao = V C + ˙ V R + ¨ V I − P mus (1) Interested in V C only. To remove other components this thesis data did two things: Slow Constant Flow 1 Antheysia 2 Ravi B. Bhanabhai (Carleton U) Safe Keeping Ventilation Patients 01/20/2012 5 / 28

  11. Linear Fit − Inflation Linear Fit − Deflation 6 6 Original Original EIT Conductivity EIT Conductivity 4 4 Sigmoid Fitted Sigmoid Fitted Inflection Points Inflection Points 2 2 0 0 −2 −2 0 5 10 15 20 25 30 35 0 5 10 15 20 25 30 35 Pressure (mbar) Pressure (mbar) Introduction How to solve the problem? Pressure-Volume Curves Used to help guide ventilation strategies by locating points of compliance change. Ravi B. Bhanabhai (Carleton U) Safe Keeping Ventilation Patients 01/20/2012 6 / 28

  12. Linear Fit − Inflation Linear Fit − Deflation 6 6 Original Original EIT Conductivity EIT Conductivity 4 4 Sigmoid Fitted Sigmoid Fitted Inflection Points Inflection Points 2 2 0 0 −2 −2 0 5 10 15 20 25 30 35 0 5 10 15 20 25 30 35 Pressure (mbar) Pressure (mbar) Introduction How to solve the problem? Pressure-Volume Curves Used to help guide ventilation strategies by locating points of compliance change. Points are Lower Inflection Point (LIP) and Upper Inflection Point (UIP) Ravi B. Bhanabhai (Carleton U) Safe Keeping Ventilation Patients 01/20/2012 6 / 28

  13. Introduction How to solve the problem? Pressure-Volume Curves Used to help guide ventilation strategies by locating points of compliance change. Points are Lower Inflection Point (LIP) and Upper Inflection Point (UIP) Linear Fit − Inflation Linear Fit − Deflation 6 6 Original Original EIT Conductivity EIT Conductivity 4 4 Sigmoid Fitted Sigmoid Fitted Inflection Points Inflection Points 2 2 0 0 −2 −2 0 5 10 15 20 25 30 35 0 5 10 15 20 25 30 35 Pressure (mbar) Pressure (mbar) (e) Linear Fit of PI data Time Alignment 1 global EIT Pressure 0.8 0.6 0.4 0.2 Ravi B. Bhanabhai (Carleton U) Safe Keeping Ventilation Patients 01/20/2012 6 / 28 0 −20 −10 0 10 20 30

  14. Introduction How to solve the problem? Data used Data used: 26 patients low constant flow maneuver (4 L/min) start 0 mbar → 35 mbar / 2L Pressure Maneuver 20 Pressure [mbar] 15 10 5 0 20 40 60 80 100 120 140 160 180 200 Volume Maneuver 1500 Volume [ml] 1000 500 0 20 40 60 80 100 120 140 160 180 200 Flow Maneuver 40 Flow [L/min] 20 0 −20 20 40 60 80 100 120 140 160 180 200 Time [sec] Ravi B. Bhanabhai (Carleton U) Safe Keeping Ventilation Patients 01/20/2012 7 / 28

  15. Introduction How to solve the problem? Electrical Impedance Tomography (EIT) EIT is real-time impedance tomography, it can be used to accuratly measure air distrubtion within the thorax. Ravi B. Bhanabhai (Carleton U) Safe Keeping Ventilation Patients 01/20/2012 8 / 28

  16. Introduction How to solve the problem? Electrical Impedance Tomography (EIT) EIT is real-time impedance tomography, it can be used to accuratly measure air distrubtion within the thorax. (a) Start of Inflation (b) Max Pressure (c) End of Deflation Figure: Example reconstruction using the GREIT methods of a healthy lung patient (patient 7). Ravi B. Bhanabhai (Carleton U) Safe Keeping Ventilation Patients 01/20/2012 8 / 28

  17. Contributions Contributions Automated IP calculation Ravi B. Bhanabhai (Carleton U) Safe Keeping Ventilation Patients 01/20/2012 9 / 28

  18. Contributions Contributions Automated IP calculation Rule-base Fuzzy Logic Classifier Ravi B. Bhanabhai (Carleton U) Safe Keeping Ventilation Patients 01/20/2012 9 / 28

  19. Contributions IP Calculation IP Calculation Three Types of IP location methods were used: Ravi B. Bhanabhai (Carleton U) Safe Keeping Ventilation Patients 01/20/2012 10 / 28

  20. Contributions IP Calculation IP Calculation Three Types of IP location methods were used: 1 Sigmoid method Ravi B. Bhanabhai (Carleton U) Safe Keeping Ventilation Patients 01/20/2012 10 / 28

  21. Contributions IP Calculation IP Calculation Three Types of IP location methods were used: 1 Sigmoid method 2 Visual heuristics Ravi B. Bhanabhai (Carleton U) Safe Keeping Ventilation Patients 01/20/2012 10 / 28

  22. Contributions IP Calculation IP Calculation Three Types of IP location methods were used: 1 Sigmoid method 2 Visual heuristics 3 3-piece linear spline method Ravi B. Bhanabhai (Carleton U) Safe Keeping Ventilation Patients 01/20/2012 10 / 28

  23. Contributions IP Calculation IP Calculation Three Types of IP location methods were used: 1 Sigmoid method 2 Visual heuristics 3 3-piece linear spline method Multiple methods were implemented for comparison reasons. Ravi B. Bhanabhai (Carleton U) Safe Keeping Ventilation Patients 01/20/2012 10 / 28

  24. Contributions IP Calculation Sigmoid Method Sigmoid Method 1200 c= 17 cm H20 1000 800 volume − ml Plip =c - 2d 600 =11.1 b= 1173 ml Plip =c +2d =22.9 400 200 a= 12ml 0 0 5 10 15 20 25 30 35 pressure − mbar Ravi B. Bhanabhai (Carleton U) Safe Keeping Ventilation Patients 01/20/2012 11 / 28

  25. Contributions IP Calculation Visual Heuristics Clinicians used this method to locate Inflection Points from global PV curves. Multiple methods exist: Ravi B. Bhanabhai (Carleton U) Safe Keeping Ventilation Patients 01/20/2012 12 / 28

  26. Contributions IP Calculation Visual Heuristics Clinicians used this method to locate Inflection Points from global PV curves. Multiple methods exist: Find location where PV curve has linear compliance 1 Ravi B. Bhanabhai (Carleton U) Safe Keeping Ventilation Patients 01/20/2012 12 / 28

  27. Contributions IP Calculation Visual Heuristics Clinicians used this method to locate Inflection Points from global PV curves. Multiple methods exist: Find location where PV curve has linear compliance 1 Pressure where rapid increase in compliance occurs 2 Ravi B. Bhanabhai (Carleton U) Safe Keeping Ventilation Patients 01/20/2012 12 / 28

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