Journal of Critical Care
Volume 25, Issue 3 , Pages 367-374 , September 2010

Prospective evaluation of a decision support system for setting inspired oxygen in intensive care patients

  • Dan S. Karbing, PhD

      Affiliations

    • Center for Model-based Medical Decision Support, Department of Health Science and Technology, Aalborg University, DK-9220 Aalborg East, Denmark
    • Corresponding Author InformationCorresponding author. MMDS, Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7, E4-204, DK-9220, Aalborg East, Denmark.
    • ,
  • Charlotte Allerød, MD

      Affiliations

    • Center for Model-based Medical Decision Support, Department of Health Science and Technology, Aalborg University, DK-9220 Aalborg East, Denmark
    • Anesthesia and Intensive Care, Region North Jutland, Aalborg Hospital, Aarhus University, DK-9000 Aalborg, Denmark
    • ,
  • Per Thorgaard, MD

      Affiliations

    • Anesthesia and Intensive Care, Region North Jutland, Aalborg Hospital, Aarhus University, DK-9000 Aalborg, Denmark
    • ,
  • Ann-Maj Carius, BSc

      Affiliations

    • Anesthesia and Intensive Care, Region North Jutland, Aalborg Hospital, Aarhus University, DK-9000 Aalborg, Denmark
    • ,
  • Lotte Frilev, BSc

      Affiliations

    • Anesthesia and Intensive Care, Region North Jutland, Aalborg Hospital, Aarhus University, DK-9000 Aalborg, Denmark
    • ,
  • Steen Andreassen, PhD, DrTech

      Affiliations

    • Center for Model-based Medical Decision Support, Department of Health Science and Technology, Aalborg University, DK-9220 Aalborg East, Denmark
    • ,
  • Søren Kjærgaard, PhD

      Affiliations

    • Anesthesia and Intensive Care, Region North Jutland, Aalborg Hospital, Aarhus University, DK-9000 Aalborg, Denmark
    • ,
  • Stephen E. Rees, PhD

      Affiliations

    • Center for Model-based Medical Decision Support, Department of Health Science and Technology, Aalborg University, DK-9220 Aalborg East, Denmark

References 

  1. Dreyfuss D, Saumon G. Ventilator-induced lung injury—lessons from experimental studies. Am J Respir Crit Care Med. 1998;157:294–323
  2. Brower RG, Matthey MA, Morris A, et al. The acute respiratory distress syndrome (ARDS) Network: ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342:1301–1308
  3. Nash G, Blennerhassett JB, Pontoppidan H. Pulmonary lesions associated with oxygen therapy and artificial ventilation. N Engl J Med. 1967;276:368–374
  4. Altemeier WA, Sinclair SE. Hyperoxia in the intensive care unit: why more is not always better. Curr Opin Crit Care. 2007;13:73–78
  5. Dantzker DR, Wagner PD, West JB. Instability of lung units with low V/Q ratios during O2 breathing. J Appl Physiol. 1975;38:886–895
  6. Edmark LK, Kostova-Aherdan K, Enlund M, et al. Optimal oxygen concentration during induction of general anesthesia. Anesthesiology. 2003;98:28–33
  7. Aboab J, Jonson B, Kouatchet A, et al. Effect of inspired oxygen fraction on alveolar derecruitment in acute respiratory distress syndrome. Intensive Care Med. 2006;32:1979–1986
  8. Rees SE, Allerød C, Murley D, et al. Using physiological models and decision theory for selecting appropriate ventilator settings. J Clin Monit Comput. 2006;35:421–429
  9. Kjærgaard S, Rees SE, Nielsen JA, et al. Modelling of hypoxaemia after gynaecological laparotomy. Acta Anaesthesiol Scand. 2001;45:349–356
  10. Kjaergaard S, Rees S, Malczynski J, et al. Non-invasive estimation of shunt and ventilation-perfusion mismatch. Intensive Care Med. 2003;29:727–734
  11. Kjaergaard S, Rees SE, Grønlund J, et al. Hypoxaemia after cardiac surgery: clinical application of a model of pulmonary gas exchange. Eur J Anaesthesiol. 2004;21:296–301
  12. Karbing DS, Kjaergaard S, Smith BW, et al. Variation in the Pao2/Fio2 ratio with Fio2: mathematical and experimental description and clinical relevance. Crit Care. 2007;11:R118
  13. Keeney RL, Raiffa H. Decisions with multiple objectives. Cambridge: Cambridge University Press; 1993;
  14. Karbing D.S., Kjærgaard S., Smith B.W. et al. Decision support of inspired oxygen fraction using a model of oxygen transport. IFAC PapersOnLine 2008, Proceedings of the 2008 Congress of the International Federation of Automatic Control, Seoul, Korea, July 6-11, Vol. 17(1) (doi: 10.3182/20080706-5-KR-1001.2130)
  15. Allerød C, Rees SE, Rasmussen BS, et al. A decision support system for suggesting ventilator settings: retrospective evaluation in cardiac surgery patients ventilated in the ICU. Comput Methods Programs Biomed. 2008;92:205–212
  16. Gattinoni L, Vagginelli F, Chiumello D, et al. Physiologic rationale for ventilator setting in acute lung injury/acute respiratory distress syndrome patients. Crit Care Med. 2003;31:S300–S304
  17. Hedenstierna G. The hidden pulmonary dysfunction in acute lung injury. Intensive Care Med. 2006;32:1933–1934[editorial]
  18. Lumb AB. Nunn's applied respiratory physiology. Boston: Butterworth Heinemann; 2000;
  19. Rees SE, Kjærgaard S, Thorgaard P, et al. The Automatic Lung Parameter Estimator (ALPE) system: non-invasive estimation of pulmonary gas exchange parameters in 10-15 minutes. J Clin Monit Comput. 2002;17:43–52
  20. Gehan EA, George SL. Estimation of human body surface area from height and weight. Cancer Chemother Rep. 1970;54:225–235
  21. Rees SE, Andreassen S. Mathematical models of oxygen and carbon dioxide storage and transport: the acid-base chemistry of blood. Crit Rev Biomed Eng. 2005;33:209–264
  22. Bland JM. An introduction to medical statistics. New York: Oxford University Press; 2000;
  23. Murley D, Rees S, Rasmussen B, et al. Decision support of inspired oxygen selection based on Bayesian learning of pulmonary gas exchange parameters. Artif Intell Med. 2005;34:53–63
  24. Meade MO, Cook DJ, Guyatt GH, et al. Ventilation strategy using low tidal volumes, recruitment maneuvers, and high positive end-expiratory pressure for acute lung injury and acute respiratory distress syndrome—a randomized controlled trial. JAMA. 2008;299:637–645
  25. Mercat A, Richard JM, Vielle B, et al. Positive end-expiratory pressure setting in adults with acute lung injury and acute respiratory distress syndrome—a randomized controlled trial. JAMA. 2008;299:646–655

☆ This work was partially supported by the Programme Commission on Nanoscience, Biotechnology, and IT under the Danish Council for Strategic Research.

PII: S0883-9441(10)00013-4

doi: 10.1016/j.jcrc.2009.12.013

Journal of Critical Care
Volume 25, Issue 3 , Pages 367-374 , September 2010

Article Tools

* Image Usage & Resolution