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Effects of the Lower Airway Secretions on Airway Opening Pressures and Suction Pressures in Critically Ill COVID-19 Patients: A Computational Simulation.

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Title: Effects of the Lower Airway Secretions on Airway Opening Pressures and Suction Pressures in Critically Ill COVID-19 Patients: A Computational Simulation.
Authors: Chen, Zhenglong1 (AUTHOR), Zhong, Ming2 (AUTHOR) zhong_ming@fudan.edu.cn, Jiang, Li3 (AUTHOR), Chen, Nanshan4 (AUTHOR), Tu, Shengjin4 (AUTHOR), Wei, Yuan4 (AUTHOR), Sang, Ling5 (AUTHOR), Zheng, Xia6 (AUTHOR), Zhang, Chunyuan7 (AUTHOR), Tao, Jiale2 (AUTHOR), Deng, Linhong8 (AUTHOR), Song, Yuanlin9 (AUTHOR)
Source: Annals of Biomedical Engineering. 2020, Vol. 48 Issue 12, p3003-3013. 11p.
Subjects: COVID-19, Critically ill, Mucociliary system, Airway (Anatomy), Artificial respiration, Secretion, Surface tension, Respiratory muscles
Geographic Terms: Wuhan (China)
Abstract: In patients with critically ill COVID-19 pneumonia, lower airways are filled with plenty of highly viscous exudates or mucus, leading to airway occlusion. The estimation of airway opening pressures and effective mucus clearance are therefore two issues that clinicians are most concerned about during mechanical ventilation. In this study we retrospectively analyzed respiratory data from 24 critically ill patients with COVID-19 who received invasive mechanical ventilation and recruitment maneuver at Jinyintan Hospital in Wuhan, China. Among 24 patients, the mean inspiratory plateau pressure was 52.4 ± 4.4 cmH2O (mean ± [SD]). Particularly, the capnograms presented an upward slope during the expiratory plateau, indicting the existence of airway obstruction. A computational model of airway opening was subsequently introduced to investigate possible fluid dynamic mechanisms for the extraordinarily high inspiratory plateau pressures among these patients. Our simulation results showed that the predicted airway opening pressures could be as high as 40–50 cmH2O and the suction pressure could exceed 20 kPa as the surface tension and viscosity of secretion simulants markedly increased, likely causing the closures of the distal airways. We concluded that, in some critically ill patients with COVID-19, limiting plateau pressure to 30 cmH2O may not guarantee the opening of airways due to the presence of highly viscous lower airway secretions, not to mention spontaneous inspiratory efforts. Active airway humidification and effective expectorant drugs are therefore strongly recommended during airway management. [ABSTRACT FROM AUTHOR]
Copyright of Annals of Biomedical Engineering is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Effects of the Lower Airway Secretions on Airway Opening Pressures and Suction Pressures in Critically Ill COVID-19 Patients: A Computational Simulation.
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  Data: <searchLink fieldCode="AR" term="%22Chen%2C+Zhenglong%22">Chen, Zhenglong</searchLink><relatesTo>1</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Zhong%2C+Ming%22">Zhong, Ming</searchLink><relatesTo>2</relatesTo> (AUTHOR)<i> zhong_ming@fudan.edu.cn</i><br /><searchLink fieldCode="AR" term="%22Jiang%2C+Li%22">Jiang, Li</searchLink><relatesTo>3</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Chen%2C+Nanshan%22">Chen, Nanshan</searchLink><relatesTo>4</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Tu%2C+Shengjin%22">Tu, Shengjin</searchLink><relatesTo>4</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Wei%2C+Yuan%22">Wei, Yuan</searchLink><relatesTo>4</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Sang%2C+Ling%22">Sang, Ling</searchLink><relatesTo>5</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Zheng%2C+Xia%22">Zheng, Xia</searchLink><relatesTo>6</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Zhang%2C+Chunyuan%22">Zhang, Chunyuan</searchLink><relatesTo>7</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Tao%2C+Jiale%22">Tao, Jiale</searchLink><relatesTo>2</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Deng%2C+Linhong%22">Deng, Linhong</searchLink><relatesTo>8</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Song%2C+Yuanlin%22">Song, Yuanlin</searchLink><relatesTo>9</relatesTo> (AUTHOR)
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  Data: <searchLink fieldCode="DE" term="%22COVID-19%22">COVID-19</searchLink><br /><searchLink fieldCode="DE" term="%22Critically+ill%22">Critically ill</searchLink><br /><searchLink fieldCode="DE" term="%22Mucociliary+system%22">Mucociliary system</searchLink><br /><searchLink fieldCode="DE" term="%22Airway+%28Anatomy%29%22">Airway (Anatomy)</searchLink><br /><searchLink fieldCode="DE" term="%22Artificial+respiration%22">Artificial respiration</searchLink><br /><searchLink fieldCode="DE" term="%22Secretion%22">Secretion</searchLink><br /><searchLink fieldCode="DE" term="%22Surface+tension%22">Surface tension</searchLink><br /><searchLink fieldCode="DE" term="%22Respiratory+muscles%22">Respiratory muscles</searchLink>
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– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: In patients with critically ill COVID-19 pneumonia, lower airways are filled with plenty of highly viscous exudates or mucus, leading to airway occlusion. The estimation of airway opening pressures and effective mucus clearance are therefore two issues that clinicians are most concerned about during mechanical ventilation. In this study we retrospectively analyzed respiratory data from 24 critically ill patients with COVID-19 who received invasive mechanical ventilation and recruitment maneuver at Jinyintan Hospital in Wuhan, China. Among 24 patients, the mean inspiratory plateau pressure was 52.4 ± 4.4 cmH2O (mean ± [SD]). Particularly, the capnograms presented an upward slope during the expiratory plateau, indicting the existence of airway obstruction. A computational model of airway opening was subsequently introduced to investigate possible fluid dynamic mechanisms for the extraordinarily high inspiratory plateau pressures among these patients. Our simulation results showed that the predicted airway opening pressures could be as high as 40–50 cmH2O and the suction pressure could exceed 20 kPa as the surface tension and viscosity of secretion simulants markedly increased, likely causing the closures of the distal airways. We concluded that, in some critically ill patients with COVID-19, limiting plateau pressure to 30 cmH2O may not guarantee the opening of airways due to the presence of highly viscous lower airway secretions, not to mention spontaneous inspiratory efforts. Active airway humidification and effective expectorant drugs are therefore strongly recommended during airway management. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Annals of Biomedical Engineering is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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      – Type: doi
        Value: 10.1007/s10439-020-02648-0
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      – Code: eng
        Text: English
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        PageCount: 11
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      – SubjectFull: COVID-19
        Type: general
      – SubjectFull: Critically ill
        Type: general
      – SubjectFull: Mucociliary system
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      – SubjectFull: Airway (Anatomy)
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      – SubjectFull: Artificial respiration
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