Assessing SB effort via a non-invasive model-based method in mechanically ventilated patients in Malaysian ICU hospital

Nor Salwa Damanhuri, Noor Najwa Noor Ariffin, Nor Azlan Othman, Yeong Shiong Chiew, Azrina Md Ralib, Mohd Basri Mat Noor, Paul D. Docherty, J. Geoffrey Chase


Patients with Acute Respiratory Distress Syndrome (ARDS) required mechanical ventilation (MV) for breathing support. However, some MV patients encountered spontaneous breathing (SB) efforts while fully sedated which can obscure the true underlying respiratory mechanics of these patients. Thus, a model-based method is required to reconstruct the missing pressure and calculate the breathing effort that produced by the patients without additional clinical protocols or invasive procedure. In this paper, results of spontaneous breathing effort in Malaysian critically-ill patients adopting the developed pressure reconstruction model are presented. By using the pressure reconstruction model, the SB affected pressure waveform is reconstructed to approximate true respiratory mechanics and quantifies the SB effort. The SB breathing efforts were computed and compared with the results from Christchurch Hospital, New Zealand. The substitute measure of SB effort can be indicated from the difference between the reconstructed and unreconstructed pressure. Results shows that all patients from both cohorts exhibited SB effort with the highest SB effort at 11.48% for Malaysian patient and 21.07% for Christchurch patient. Overall, the well-developed non-invasive pressure reconstruction method is able to measure the SB effort produced by Malaysian MV patients that help the clinicians in selecting the optimal MV setting. This first non-invasive guidance in selecting the optimal setting of MV in Malaysia is potentially reduced the ICU cost and improve the MV management in Malaysian hospital.


Mechanical ventilation, ARDS, Lung mechanics, Mathematical modelling, Spontaneous breathing

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