End-Inspiratory Occlusion in the Presence of Intrinsic PEEP

Abstract

Typical modern mechanical ventilators offer the clinician the possibility of automatically performing end-inspiratory occlusion maneuvers. The static conditions induced by such maneuvers are indeed favorable to estimating patient's respiratory mechanics in terms of total resistance (R) and elastance (E). These are parameters of wide clinical interest. However, in the presence of intrinsic PEEP, the standard formula used to compute E via the occlusion maneuver is known to be inaccurate. In this paper we propose an alternative method for the estimation of E via the occlusion maneuver that eliminates the bias by leveraging concepts derived from physiological modeling of the respiratory system dynamics. The proposed method is also capable of accounting for respiratory efforts triggering the breath, and hence can be applied in both passive and spontaneously breathing conditions.