Can computer simulators demonstrate how to reduce lung damage in children?

Can computer simulators demonstrate how to reduce lung damage in children?
© iStock/Natali_Mis

According to researchers at the University of Warwick, UK, computer simulators can show how to reduce lung damage in children in intensive care.

It is often necessary for the use of mechanical ventilation for children in intensive care units, but this can damage the lungs of critically ill patients. However, according to engineering researchers it is possible to change ventilator settings to reduce the risk of damage without putting child patients at risk. And this theory to reduce lung damage was tested with computer simulators on replicated patients using data from real patients collected at the Children’s Hospital of Philadelphia, USA.

Computer simulators reducing damage to lungs

One of the most challenging diseases for doctors to manage in the paediatric intensive care unit is Paediatric Acute Respiratory Distress Syndrome (PARDS) and such a condition can arise due to several different causes, such as pneumonia, sepsis, trauma, and drowning.

Mechanical ventilation is a life-saving medical intervention for many such patients, but the forces and stresses applied by the ventilator can themselves further damage the lungs (so-called ventilator induced lung injury – VILI).

Now published in Intensive Care Medicine, Dr. Nadir Yehya, an attending physician in the paediatric intensive care unit at the Children’s Hospital of Philadelphia, along with researchers from the Department of Engineering at the University of Warwick have developed a computer simulator that predicts how different ventilator settings affect the lungs of individual child patients in the ICU.

Dr. Nadir Yehya from the Division of Critical Care Medicine at the Children’s Hospital of Philadelphia commented: “Collaborations such as these are essential for providing safe care for our sickest children.

“Computer simulations have been relatively under-utilised in paediatric intensive care, and we are excited about the opportunities to address critical areas of research using these technologies.”

Testing the waters of computer simulators

Using patient data, this simulator was used to safely investigate whether, and how, ventilator settings can be changed to be more ‘protective’, such as to lower the risk of causing VILI in different patients, while still maintaining adequate ventilation.

The researchers identified several strategies that, in simulated patients, led to significant reductions in variables that are associated with VILI, such as the volume of air displaced between inhalation and exhalation (known as tidal volumes) and driving pressures.

The next stage of this research will be to test these strategies in patients in formal prospective trials in order to evaluate the clinical benefits of more protective ventilation in real hospital environments.

Professor Declan Bates from the School of Engineering at the University of Warwick commented:

“It has been incredibly exciting to see the potential of computer simulators being realised to develop safer treatment strategies for critically ill children in the intensive care unit. We are sure that combining the expertise of medical doctors and engineers will bring about radical improvements in patient care and medical outcomes over the coming years.”

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