Effects of the Lower Airway Secretions on Airway Opening Pressures and Suction Pressures in Critically Ill COVID-19 Pati
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Annals of Biomedical Engineering (© 2020) https://doi.org/10.1007/s10439-020-02648-0
Original Article
Effects of the Lower Airway Secretions on Airway Opening Pressures and Suction Pressures in Critically Ill COVID-19 Patients: A Computational Simulation ZHENGLONG CHEN ,1 MING ZHONG,2 LI JIANG,3 NANSHAN CHEN,4 SHENGJIN TU,4 YUAN WEI,4 LING SANG,5 XIA ZHENG,6 CHUNYUAN ZHANG,7 JIALE TAO,2 LINHONG DENG,8 and YUANLIN SONG9 1 School of Medical Instrumentation, Shanghai University of Medicine & Health Sciences, 257 Tianxiong Road, Shanghai 201318, China; 2Department of Intensive Care Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China; 3Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing 100053, China; 4Department of Respiratory and Critical Care Medicine, Wuhan Jinyintan Hospital, 1 Yintan Road, Dongxihu District, Wuhan 430023, China; 5Department of Critical Care Medicine, GuangZhou Institute of Respiratory Health, The First Affiliated Hospital of GuangZhou Medical University, 151 Yanjiangxi Road, Guangzhou 510120, China; 6Department of Critical Care Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou 310003, Zhejiang, China; 7NMPA Key Laboratory for Respiratory and Anaesthetic Equipment, 1 Jinyinhua Road, Shanghai 201321, China; 8Changzhou Key Laboratory of Respiratory Medical Engineering, Institute of Biomedical Engineering and Health Sciences, Changzhou University, Changzhou 213164, Jiangsu, China; and 9Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai 200032, China
(Received 2 July 2020; accepted 3 October 2020) Associate Editor Merryn Tawhai oversaw the review of this article.
Abstract—In patients with critically ill COVID-19 pneumonia, lower airways are filled with plenty of highly viscous exudates or mucus, leading to airway occlusion. The estimation of airway opening pressures and effective mucus clearance are therefore two issues that clinicians are most concerned about during mechanical ventilation. In this study we retrospectively analyzed respiratory data from 24 critically ill patients with COVID-19 who received invasive mechanical ventilation and recruitment maneuver at Jinyintan Hospital in Wuhan, China. Among 24 patients, the mean inspiratory plateau pressure was 52.4 ± 4.4 cmH2O (mean ± [SD]). Particularly, the capnograms presented an upward slope during the expiratory plateau, indicting the existence of airway obstruction. A computational model of airway opening was subsequently introduced to investigate possible fluid dynamic mechanisms for the extraordinarily high inspiratory plateau pressures among these patients. Our simulation results showed that the predicted airway opening pressures could be as high as 40–50 cmH2O and the suction pressure could exceed 20 kPa as the surface tension and viscosity of secretion simulants markedly increased, likely
Address correspondence to Ming Zhong, Department of In
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