Linear model and algorithm to automatically estimate the pressure limit of pressure controlled ventilation for delivering a target tidal volume

To theoretically assess the viability of an automatic procedure to support the anesthesiologist in properly setting mechanical ventilators when the operating conditions are switched from volume controlled to pressure controlled ventilation whilst maintaining the preset tidal volume. The procedure is based on a simple linear model of the ventilator breathing system with constant parameters and utilizes the signals gathered by the ventilator without the need to add further equipment. After a short period of stable volume controlled ventilation with the desired tidal volume, the herewith described algorithm allows the calculation of the value of pressure limit to set in pressure controlled mode which assures the previously settled tidal volume with the same breathing frequency and inspiratory-expiratory time ratio. Methods: The algorithm allows the online identification of the four parameters necessary for the mathematical model that are obtained by means of a direct comparison between the pressure, flow and volume waveforms generated by the model and the analog signals provided by the ventilator. The theoretical approach was validated by two different ventilators, various settings, two breathing circuits, endotracheal tubes of various sizes and two mechanical simulators of the respiratory system operating in various conditions. Results: Errors usually less than 5% (p<0.05) on the target tidal volume were obtained for various settings typically used for adult ventilation in less than 10 seconds. The theoretical approach shows its limitations (errors of 105%, p<0.05) at high breathing frequencies (30-40 bpm) and low tidal volumes (200-300 ml). Conclusions: The proposed theoretical approach shows the viability, for adult settings, of one of the simplest mathematical model for mechanical ventilation in order to quickly and safely switch from volume controlled to pressure controlled ventilation. The algorithm could easily be in perspective implemented in the software of the ventilator providing the anesthesiologist with an indication on the value of pressure limit to set in order to safely switch ventilation mode.