The Clinical Utilisation of Respiratory Elastance Software (CURE Soft): a bedside software for real-time respiratory mechanics monitoring and mechanical ventilation management.

BACKGROUND: Real-time patient respiratory mechanics estimation can be used to guide mechanical ventilation settings, particularly, positive end-expiratory pressure (PEEP). This work presents a software, Clinical Utilisation of Respiratory Elastance (CURE Soft), using a time-varying respiratory elastance model to offer this ability to aid in mechanical ventilation treatment. IMPLEMENTATION: CURE Soft is a desktop application developed in JAVA. It has two modes of operation, 1) Online real-time monitoring decision support and, 2) Offline for user education purposes, auditing, or reviewing patient care. The CURE Soft has been tested in mechanically ventilated patients with respiratory failure. The clinical protocol, software testing and use of the data were approved by the New Zealand Southern Regional Ethics Committee. RESULTS AND DISCUSSION: Using CURE Soft, patient's respiratory mechanics response to treatment and clinical protocol were monitored. Results showed that the patient's respiratory elastance (Stiffness) changed with the use of muscle relaxants, and responded differently to ventilator settings. This information can be used to guide mechanical ventilation therapy and titrate optimal ventilator PEEP. CONCLUSION: CURE Soft enables real-time calculation of model-based respiratory mechanics for mechanically ventilated patients. Results showed that the system is able to provide detailed, previously unavailable information on patient-specific respiratory mechanics and response to therapy in real-time. The additional insight available to clinicians provides the potential for improved decision-making, and thus improved patient care and outcomes.

Automated logging of inspiratory and expiratory non-synchronized breathing (ALIEN) for mechanical ventilation.

Asynchronous Events (AEs) during mechanical ventilation (MV) result in increased work of breathing and potential poor patient outcomes. Thus, it is important to automate AE detection. In this study, an AE detection method, Automated Logging of Inspiratory and Expiratory Non-synchronized breathing (ALIEN) was developed and compared between standard manual detection in 11 MV patients. A total of 5701 breaths were analyzed (median [IQR]: 500 [469-573] per patient). The Asynchrony Index (AI) was 51% [28-78]%. The AE detection yielded sensitivity of 90.3% and specificity of 88.3%. Automated AE detection methods can potentially provide clinicians with real-time information on patient-ventilator interaction.