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dc.contributor.authorSu, Henry K.
dc.date.accessioned2019-12-04T08:34:14Z
dash.embargo.terms2021-05-01
dc.date.created2019-05
dc.date.issued2019-07-25
dc.date.submitted2019
dc.identifier.citationSu, Henry K. 2019. Phenotyping Breathing Patterns and Patient-Ventilator Dyssychrony in Acute Respiratory Distress Syndrome - a Reapplication of the Campbell Diagram. Doctoral dissertation, Harvard Medical School.
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:41971535*
dc.description.abstractPurpose: Although many forms of patient-ventilator dyssynchrony have been observed and reported, the nature of spontaneous patient efforts and the resulting ventilator response is an underexplored aspect of patient management and may have important clinical implications. Many breathing patterns are difficult to identify solely by inspection of standard ventilator waveforms or even with esophageal manometry time tracings. The Campbell diagram (pressure- volume loops of the chest wall plotting pleural/esophageal pressure and volume changes), may improve our ability to phenotype breathing patterns. Methods: A retrospective analysis was performed on 56 mechanically ventilated patients with ARDS. Subjects had an esophageal balloon placed, were placed on a control mode of ventilation. Volumes were calculated as the integral of the flow and esophageal pressures used as a surrogate for pleural and trans-chest wall pressures to create Campbell diagrams. Unique breathing patterns were identified using the Campbell Diagram and qualitatively described. Results: Unique breathing phenotypes and their characteristic Campbell Diagram appearances were defined. Waveform data consisted of an average of 6.8 minutes per patient for a total of 384.12 minutes and 10323 breaths. Passive breathing accounted for 65.3% of all breaths analyzed. Spontaneous patient efforts were common; active inspiratory efforts, active expiratory efforts, and entrainment represented 25.3%, 6.4%, and 16.4% of all breaths analyzed, respectively. Conclusions: The Campbell Diagram is a promising tool in the identification of breathing phenotypes. Systematically identifying and describing breathing phenotypes will set the foundation for future investigation of their individual and unique clinical importance. Continued application of esophageal manometry and the Campbell Diagram may allow for more accurate phenotyping at the bedside and thus result in increased personalization of ventilator management for patients with ARDS.
dc.description.sponsorshipScholarly Project
dc.format.mimetypeapplication/pdf
dc.language.isoen
dash.licenseLAA
dc.subjectRespiratory Physiology
dc.subjectAcute Respiratory Distress Syndrome
dc.subjectVentilator-Induced Lung Injury
dc.subjectVentilator Dyssynchrony
dc.titlePhenotyping Breathing Patterns and Patient-Ventilator Dyssychrony in Acute Respiratory Distress Syndrome - a Reapplication of the Campbell Diagram
dc.typeThesis or Dissertation
dash.depositing.authorSu, Henry K.
dash.embargo.until2021-05-01
dc.date.available2019-12-04T08:34:14Z
thesis.degree.date2019
thesis.degree.grantorHarvard Medical School
thesis.degree.grantorHarvard Medical School
thesis.degree.levelDoctoral
thesis.degree.levelDoctoral
thesis.degree.nameDoctor of Medicine
thesis.degree.nameDoctor of Medicine
dc.type.materialtext
dash.identifier.vireo
dash.author.emailhenrysu.md@gmail.com


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