The following is a summary of “Digital Twins of Acute Hypoxemic Respiratory Failure Patients Suggest a Mechanistic Basis for Success and Failure of Noninvasive Ventilation,” published in the September 2024 issue of Critical Care by Weaver et al.
Researchers conducted a retrospective study to describe the mechanistic basis for the success or failure of noninvasive ventilation (NIV) in acute hypoxemic respiratory failure (AHRF).
They used data from the Interdisciplinary Collaboration in Systems Medicine Research Network of 30 moderate-to-severe patients with AHRF who failed high-flow nasal cannula (HFNC) therapy and underwent a trial of NIV.
The results showed in digital twins of patients who completed/failed NIV, after 2 hours of the trial, the mean (SD) of the change in total lung stress was –10.9 (6.2)/–0.35 (3.38) cm H2O, mechanical power –13.4 (12.2)/–1.0 (5.4) J/min, and total lung strain 0.02 (0.24)/0.16 (0.30). The positive end-expiratory pressure (PEEP) produced by HFNC was identical to that set during NIV, who failed NIV vs. those who followed, intrinsic PEEP was 3.5 (0.6) vs. 2.3 (0.8) cm H2O, inspiratory pressure aid was 8.3 (5.9) vs. 22.3 (7.2) cm H2O, and tidal volume was 10.9 (1.2) vs. 9.4 (1.8) mL/kg. A successful NIV increased respiratory system compliance by +25.0 (16.4) mL/cm H2O, lowered inspiratory muscle pressure –9.7 (9.6) cm H2O, and decreased the assistance of patient spontaneous breathing to total driving pressure by 57.0% were also analyzed in digital twins with successful NIV.
They concluded that in digital twins of patients with AHRF, successful NIV improved lung mechanics, reduced respiratory effort, and lowered indices were associated with lung injury. Patients with failed NIV required low levels of positive inspiratory pressure support to avoid self-inflicted lung injury due to excessive tidal volume.
Source: journals.lww.com/ccmjournal/fulltext/2024/09000/digital_twins_of_acute_hypoxemic_respiratory.27.aspx
