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Mechanical ventilation (MV) is one of the most common, but difficult, costly and variably delivered therapies in intensive care. Model-based estimated patient-specific respiratory elastance can be used to guide clinical staff in selecting positive end-expiratory pressure (PEEP) for MV patients. The Clinical Utilisation of Respiratory Elastance (CURE) trial investigates the potential to optimise PEEP in MV patients. A software system, CURE Soft, capable of providing real-time patient-specific respiratory elastance was developed for the purpose of CURE clinical trial. CURE Soft uses airway pressure and flow data from the ventilator to calculate respiratory elastance using a time-varying elastance model. The CURE Soft graphical user interface (GUI) was developed to provide patient-specific respiratory elastance in real time, history and response during a recruitment manoeuvre both of which offer significant clinical insight. CURE Soft was extensively tested on a mechanical test lung to verify the model-based elastance estimation and its robustness. Model fitting errors are low across a range of ventilation modes, showing it can successfully identify respiratory elastance. Real-time monitoring of respiratory elastance enables new insights into patient-specific lung condition, with no added patient burden. The additional insight available to clinicians will provide the information necessary for improved decision-making and patient outcomes.

Current practice in determining Mechanical Ventilation (MV) settings is highly variable with little consensus, forcing clinicians to rely on general approaches and clinical intuition. The Clinical Utilisation of Respiratory Elastance (CURE) system was developed to aid clinical determination of important MV settings by providing real-time patient-specific lung condition information at the patient bedside. The pilot clinical trials to investigate the performance and efficacy of this system are currently being carried out in the Christchurch Hospital ICU, New Zealand. This paper presents the CURE clinical trial protocol and its initial findings from the two patients recruited to date. In particular, this paper focuses on CURE's ability to determine patient-specific responses in real time to PEEP changes and recruitment manoeuvres (RM). The results from this study demonstrate the potential for CURE Soft to improve the reliability and ease with which clinicians make decisions about MV settings in the ICU.