Managing Patient-Specific Mechanical Ventilation: Clinical Utilisation of Respiratory Elastance (CURE) – Model and Software Development

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.