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Session: Respiration & Pregnancy
Session starts: Thursday 26 January, 10:30
Presentation starts: 10:45
Room: Room 531

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Sjeng Quicken (Technische Universiteit Eindhoven)
Ulrich Strauch (Maastricht University Medical Centre+)
Frans van de Vosse (Technische Universiteit Eindhoven)

Abstract:
Background: Patients on the intensive care unit (ICU) often require mechanical ventilation (MV). While MV is crucial for ICU patient survival, it often induces ventilator induced lung injury (VILI) which can be life-threatening. VILI mainly develops as a result from inhomogeneous mechanical response of the lung to MV which causes local lung tissue overdistention or collapse. Instead of standard supine position ventilation, patients may be ventilated in prone position to improve MV outcome which has seen a widespread adaptation during the recent COVID pandemic. Research suggests that prone position ventilation can also help minimize VILI. The mechanisms responsible for the positive impact of prone position on VILI development are however largely unknown. In this research a computational respiratory biomechanics model is used to study how prone positioning impacts VILI development. Methods: A realistic airway model was generated using CT data and a respiratory tree growing algorithm. Individual airways were modelled as non-linear resistors. Terminal airways were truncated using lumped-parameter alveolar models. A typical MV pressure curve was prescribed at the trachea, whereas intrapleural pressure distributions for prone and supine position ventilation were estimated from (1, 2). Alveolar overdistention and collapse were assessed by evaluating local alveolar volumetric strains relative to alveolar volume at functional residual capacity. Results: Supine position ventilation resulted in considerably higher strain heterogeneity compared to prone position ventilation. Furthermore, a considerable number of alveoli of the supine position simulation experienced negative strains during the complete respiratory cycle, indicating a tendency for alveolar collapse. In the prone position simulation, alveolar strains were on average higher than those observed in the supine position ventilation and during inhalation, none of the alveolar elements experienced negative strains. Conclusion: Our results suggest that prone position ventilation results in less heterogenous strain conditions and less tendency for alveolar collapse compared to supine position ventilation, which could be a potential mechanism for the benefit of prone position ventilation to combat VILI development. Future research is however still required to further substantiate these finding. 1. A. Kumaresan, et al., Anesthesiology. 128, 1187–1192 (2018). 2. M. H. Tawhai et al., J. Appl. Physiol. 107, 912–920 (2009).