Funding Programme/ Agency: PROGRAMA ESTATAL PARA IMPULSAR LA INVESTIGACIÓN CIENTÍFICO-TÉCNICA Y SU TRANSFERENCIA/Agencia Estatal De Investigación

Acronym: PdC MVO

Institution: Universitat Politècnica de Catalunya (UPC)

Project type: Proyectos I+D+i Pruebas de Concepto 2023 (Plan Estatal)

Implementation period: 1/1/2024-31/12/2025

Budget: 288,778.60€

PROJECT SUMMARY:

Mechanical ventilation (MV) is a widely used life-support technique in clinical scenarios involving deteriorating respiratory function, whether intra-pulmonary or extra-pulmonary origin. It is administered through various modes offering complete or partial ventilatory support. Consequently, selecting the appropriate ventilatory mode is vital for patient recovery, as their response to the support and recovery time depend on the configuration of ventilation parameters. One of the primary challenges of MV is to provide ventilatory assistance (mode and ventilator settings) that aligns with the patient’s initial and changing clinical condition without jeopardising their physical integrity. This is especially critical when patients have respiratory diseases or significant lung conditions. For example, in high oxygen flow and mechanical energy situations, MV can induce oxygen toxicity and ventilator-induced lung injury. Additionally, poor patient-ventilator interaction can result in discomfort, dyspnea, increased need for sedative or paralytic agents, extended MV duration, prolonged ICU stay, respiratory muscle dysfunction, and, in some instances, patient death [Blanch et al., 2015; Subirà et al., 2018].

Advancements in pathophysiological knowledge and technology have led to the development of a confusing array of advanced ventilatory modes [Chatburn, 2012] designed to make MV more flexible and responsive to patient needs. Ultimately, these modes aim to optimize MV by enhancing patient-ventilator synchronization, reducing the patient’s work of breathing, and improving ventilation [Dellaca et al., 2017; Lellouche et al., 2009]. However, despite innovative ventilation strategies [Tehrani, 2008], most modern ventilators remain primarily open-loop controlled devices that require medical staff intervention to set key ventilator outputs [Mora et al., 2020]. Intensivists need to be familiar with many features of the techniques used by these ventilators so that they can configure an appropriate ventilatory support strategy by diagnosing the patient’s underlying respiratory condition. This task becomes challenging due to:
a) the increasing complexity of modern ventilators;
b) non-unified nomenclature;
c) individual patient characteristics; and
d) the critical nature of the pathological condition.

For these reasons, physicians tend to use basic and standardized settings that may not always meet the patient’s needs [Prasad et al., 2011; Lesley et al., 2020]. For example, in the case of restrictive diseases, lower tidal volumes may be more beneficial, while in obstructive lung diseases, higher PEEP levels are suggested – although these levels vary according to each individual [Berg et al., 2019]. While clinicians can use their knowledge of a patient’s pathophysiological condition and prior experience to adjust ventilatory support levels and help manage mechanical ventilation, difficulties may arise in more complex cases [Wang et al, 2010]. Therefore, the ventilator is often adjusted through a trial-and-error process as the patient’s response is observed, increasing the risk of iatrogenic effects. Furthermore, decisions must be made swiftly in the often busy and sometimes chaotic ICU setting.