III INTERNATIONAL CONGRESS ON COMPUTATIONAL BIOENGINEERING

M. Cerrolaza, H. Rodrigues, M. Doblaré, J. Ambrosio, M. Viceconti

(Eds.)
Isla de Margarita, Venezuela, September 17 to 19, 2007

MODELING AND SIMULATION OF RESPIRATORY RESPONSE IN

MECHANICAL VENTILATION

Dánely Velázquez* and Rubén D. Rojas**

*Postgrado de Ingeniería Biomédica de la Universidad de Los Andes.

e-mail: danely@ula.ve

**Grupo de Ingeniería Biomédica de la Universidad de Los Andes (GIBULA)

e-mail: rdrojas@ula.ve

Keywords: Physiological modeling, Respiratory response, Mechanical Ventilation,

Endotracheal aspiration.

Abstract. This paper presents the modeling and simulation of a patient under mechanical
ventilation as a base to simulate an automatic closed system of endotracheal aspiration. The
mathematical model of the respiration biomechanics during mechanical ventilation presented
makes it possible to simulate artificial ventilation controlled by volume allowing the
parameters determination of the regime for each particular patient. This model showed
variability and reproducibility capacity against changes on inspired volumes and respiratory
frequencies that mimics the equipment and patient changes with small changes on the input
airflow. On the other hand the model allows simulating different degrees of endothracheal tube
obstruction characterizing the physical changes that occurs in the different ventilator-patient
system. The overall result suggests that this model can be used to improve ventilator’s control
system design including the simulation of the automatic closed system of endotracheal
aspiration. It is important to note that the use of the proposed mathematical model makes it
possible to solve the problem of optimizing the mechanical ventilation process completely only
in combination with other parts of a general mathematical model describing gas exchange,
geodynamics, and other necessary subsystems.
 Dánely Velázquez and Rubén D. Rojas

1 INTRODUCTION
The act to breathe is synonymous to live, no other physiological function has been so
closely related to the life, the disease and the death as breathing, from which the necessity
arises from the use of mechanical respirators that are created devices to imitate the respiratory
function when this is it risk [1]. For this reason the importance for the improvement and the
optimization in the operation of these devices are evident. This work presents modeling and
simulation of patients under mechanical ventilation included in a proposal directed towards the
improvement of the systems of control of the mechanical ventilator and the incorporation of
Endotracheal Aspirator Automatic Closed System (SCAAE).

2 BASIC CONCEPTS
The study of the breathing mechanics is fundamental aspect for the elaboration of the
model: understanding of breathing mechanics, the resulting forces that maintain and move the
lung and the chest wall and of the resistance that must surpass the flow [2]. The respiratory
system exhibits properties of resistance, compliance and inertance, analogs to the electrical
properties of resistance, capacitance and inductance [3]:

2.1 Compliance

The elasticity or elastance is defined as the index of ability of a substance to resist to the
deformation by stress. In terms of pressure and volume the elasticity is defined as the
proportion of the change of pressure with respect to the change in volume. Compliance is the
opposed of elasticity; compliance is the ratio of change in volume to the change of pressure. In
pulmonary physiology, compliance is used to describe to the elastic properties of the lungs and
the chest wall. In the form of an equation it is defined by [4]:
V
C (1)
P
Where V = change in volume in liters
P = change in pressure in cm H2O
C = compliance in L/ cm H2O
The normal value for compliance is 0.1 L/ cm H2O for a spontaneously breathing.
Compliance used to represent standard conditions for a patient on controlled ventilation is 0.05
L/ cm H2O [4].

2.2 Airway Resistance

Airway resistance is defined as drop pressure between the mouth (PM) and the alveoli
(PA) divided by the flow rate (Q) (eq. 2). The value for airway resistance in the spontaneously
breathing adult has been estimated to be between 2 and 3 cm H2O /L/s [4].

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 Dánely Velázquez and Rubén D. Rojas

PM  PA
RAW  (2)
Q

3 MECHANICAL ORGANIZATION OF MECHANICS VENTILATORS

Besides to take into account the physiological aspects it is necessary to study the related
ones to the mechanical ventilator, as internal mechanical organization, classification according
to the respiratory phase, etc.
All the mechanical ventilators have similar mechanical organization in broad strokes, with
small own variations of each model and each commercial house. In general the components of
a mechanical ventilator are: drive mechanics, patient circuit, endotracheal tube, flow supply
valve, exhalation valve and system of detection of pressure.

3.1 Drive mechanics

The drive mechanism of the ventilator is the one that determines the waveform of the
pressure and the incoming flow to the lungs and gives to the criterion for the classification of
the ventilator in the inspiration. Several types of drive mechanisms of the ventilators have been
developed: weighted bellows, spring-loaded bellows, linear-drive pistons, non-linear-drive
pistons, pressure-reducing valves, blowers, and injectors [4].
The spring-loaded bellows simulates the resistance and elasticity of the lungs [5]. The
accomplishment of the model of the bellows the Windkessel models was used, which is based
on the concept of an elastic storage device, referred in individual to the blood vessels [6], the
similarity of which exists a linear relationship pressure-volume in a closed compartment
referred the elastance of a closed container, similar principles to which it handles spring-loaded
bellows. It is assumed in the Windkessel model that the air pressure and the air volume into the
camera is constant and the flow of the fluid through the pipes that they connect the air chamber
to the bellows follows the Poiseuille’s law and is proportional to the pressure of the fluid, the
following equation differential relates the flow in this case of air and pressure (eq. 3):
P (t ) dP(t )
I (t )  C (3)
R dt
Where I (t) = flow out of the bellows.
P (t) = pressure in the bellows (cm H2O)
C = bellows compliance (L/ cm H2O)
R = bellows resistance (cm H2O /L/s)

3.2 Patient circuit

The patient circuit traditionally consists of long lengths of tubing for both the
inspiratory and expiratory leg, and is where control of pressure and flow takes place since this
typically where pressure is monitored, and provides the transfer of flow from the ventilator to
the patient and from the patient to the atmosphere. For a rigid walled patient circuit,
disregarding circuit resistance, the model can be written as (eq. 4) [5]:

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 Dánely Velázquez and Rubén D. Rojas


Pc  Ec (Qp  QL)dt (4)

3.3 Endotracheal tube

The endotracheal tube links flow between patient circuit, Y piece and the patient’s upper
airway [5]. The diameter of this tube is smaller than the diameter of the airway, reason to the
positioning of this tube increases the resistance throughout the airway, and a standard value of
resistance of airway in mechanical ventilation of 6 cm H2O/L/s is assumed [4]. The size of the
diameter of the tubes goes of 2,5 up to 9 mm, according to the age of the patient. Considering a
nonlinear relation and that the flow through endotrácheal tube is bidirectional [5] (eq. 5):

Pc  PL  KLQL 2 sgn( QL) (5)

3.4 Flow supply valve

The dynamics of the operating device and/or the flow feedback loop should be included.
This is most often a DC motor stepper motor. The equation describing a flow supply valve (eq.
6) [5]:

Qv  KvHi(s) (6)

3.5 Exhalation valve

For this valve the model can be written using a parabolic relationship between differential
pressure and flow. Assuming atmospheric pressure is constant the expression for the exhalation
valve can be written as a function of pressure circuit. As in the flow supply valve the dynamics
of the operating device are expressed in equation 7 [5]:

QE  Ao ( ) Pc .He( s) (7)

3.6 Lungs

The lungs are in a compartment with flexible walls that expand significantly when a
volume is introduced, the lungs follow a nonlinear relationship, showing to this relationship
between pressure and volume an “s” curve form. The lungs are locked up in a cavity between
the parietal and visceral pleura. The operating diaphragm and its muscles cause that the
pressure inside de chest falls below the atmospheric pressure, producing a pulmonary
expansion and the low air through the trachea until arriving at the alveoli. The degree of
elasticity of the lungs with respect to the stretching of muscles of the diaphragm makes the
ability effective of the patient to drag a suitable volume of gas. For linear pulmonary
compliance the equation can be written [5]:

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 Dánely Velázquez and Rubén D. Rojas


PL  EL QLdt  PM (8)

3.7 Pressures system detection

3.7.1 Peak Inspiratory Pressure

The highest pressure developed during the inspiratory phase. If this pressure is measured
before the humidifier then the level will vary with changes in: the resistance of the ventilator
circuit, which includes the humidifier, the compliance of the ventilator, which includes the
circuit and humidifier, the patient’s airway resistance, which includes the endotracheal tube
includes, the patient’s compliance (total compliance) [4].

3.7.2 Plateau Pressure

A plateau pressure is established when a volume has been delivered from the ventilator but
the exhalation valve remains closed by a predetermined time. At the onset of this mode a drop
in the pressure from the peak is observed; it results from the distribution of the gas from the
upper airways to the lower airways. When the pressure in plateau is flat, the pressure displayed
is the actual pressure in the lungs and the ventilator circuit. However the level of the plateau
pressure will vary with changes in: the ventilators and circuit compliance, the patient’s
compliance [4].

3.7.3 End-expiratory Pressure

The end-expiratory pressure is defined as the pressure maintained in the lungs during the
expiratory pause. The lungs are normally allowed to empty to atmospheric pressure. However,
the pressure can be clinician-selected to bellow -atmospheric pressure (negative end-expiratory
pressure, NEEP) or to above-atmospheric pressure (positive end-expiratory pressure, PEEP)
[4].

3.7.4 Mean Airway Pressure:

It is defined as the area under the pressure curve for the duration of one respiratory cycle.
Any ventilatory parameter that alters the area under this curve translates as a change in mean
airway pressure. Factors affecting mean airway pressure: Inspiratory:Expiratory ratio,
inspiratory hold, expiratory resistance, negative end-expiratory pressure, positive end-
expiratory pressure [4].

The pressures system detection was constructed based to the equation of motion for the
respiratory system:

Vol
presión   flow * raw (9)
compliance

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 Dánely Velázquez and Rubén D. Rojas

4 METHODOLOGY

4.1 Mathematical Modeling of the Ventilator Mechanical – Patient System (SVMP)

In this stage, firstly a mechanical ventilator of the existing ones in the Hospital
Universitario de Los Andes (HULA) was chosen that satisfied criteria imposed for their
selection (operated by microprocessor, clinical versatility, uses, etc.) Soon as analyzed
literature models existing to adapt them to our case of study.

4.2 Simulation of the SVMP

The obtained model was implemented using Matlab/Simulink® and considering the
dynamic equations of each component of the model, varying the parameters to value its
capacity to simulate pathological situations.

4.3 Validation of the model of the SVMP

For the model validation additionally to data reported in literature and 20 adult patients
were evaluated from both sexes, without pulmonary pathology, connected to mechanical
ventilation with a ventilator of the type previously chosen, in mode controlled volume, under
this operation mode, the patient does not have any control on the ventilatory process is the
mechanical ventilator which assume this function and the change of inspiratory to exhalatory
phase is made when it reaches the volume that the operator indicated to device [4]. The data
was collected provided by the ventilator every 4 minutes until completing 30 observations by
patient for later confrontation and comparison with the generated by the model.

4.4 Simulation of the obstruction of the airway

It was made based to Poiseuille equation, who demonstrates, if the radius is reduced to half,
the fall of pressure throughout the tube is 16 times greater than the initial.

8 L
R (10)
r 4

5 RESULTS
a) After bibliographical revision of models and selection of the ventilator (Servo 900C), the
model was constituted by 6 elements finally (bellows, flow supply valve, exhalation valve,
patient circuit, endotracheal tube, lungs, pressures system detection: peak inspiratory
pressure, plateau pressure, mean airway pressure.
b) The obtained model was implemented in Simulink® and as simulations was made to
verify their capacity to reproduce situations whose physiological response is well-known,
as comparing their response with the obtained experimentally.

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 Dánely Velázquez and Rubén D. Rojas

c) The model turned out valued to simulate the normal response of a patient under
mechanical ventilation as being varied the parameters and valuing its physiological
repercussion according to data of literature. In order to make the validation with patients
introduced the real data collected of respiratory rate and tidal volume, as well as the
parameters as work pressure of the ventilator, in each case, the model was implemented for
a equal time to the collecting data. (116 minutes). The results was introduced in a table
then were compared by means of ANOVA with the real data for each one of the patients,
accepting themselves that significant differences between the two populations of values do
not exist. In figure 1 it is possible to be observed as the response of peak inspiratory
pressure, plateau pressure, mean airway pressure for the SVMP reproduce the normal
physiological response.

(a) (b)

(c) (d)

Figure 1 Graphs of a) Pressure into patient circuit, b) Pulmonary flow c) pulmonary pressure. D). peak
inspiratory pressure, plateau pressure

Figure 2 Simulation of the change in airway resistance

d) Simulation airway obstruction: Based on equation 10, it was added in the mean airway
pressure subsystems, the equation of Poiseuille to demonstrate the effect of diameter
reduction, in this case, the shown data correspond to a reduction of 55% of the diameter of
the airway and its repercussion in the rest of the system. (Fig 2 and 3)

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 Dánely Velázquez and Rubén D. Rojas

(a) (b)

(c) (d)

Figure 3 Graphs of a) peak inspiratory pressure, plateau pressure, b) Pulmonary flow c. pulmonary
pressure d. patient circuit pressure. In case of radius obstruction of 55% the endotracheal tube.

6 CONCLUSIONS
The obtained mathematical modeling showed to be been worth to simulate the respiratory
response in a connected patient to mechanical ventilation. Which allows knowing the changes
and their repercussions physiological when the parameters of the ventilator are modified, in
addition that allows studying parameters that are not shown in a ventilator of the available ones
commercially; being an essential tool in the design and simulation of the SCAAE when it
happens an obstruction of the airway.

The present model has the limitation of which single it predicts the conduct of patients who
perform the criteria of inclusion in the work (adult, without pulmonary pathology, connected to
mechanical ventilation with a Servo ventilator 900C, in way controlled volume), this limitation
this related to the own characteristics of the mechanical devices of each ventilator, which
causes that the dynamic equations vary in each case.

REFERENCES
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Universidad Politécnica de Cataluña. España
[2] Best y Taylor. Bases Fisiológicas de la Práctica Médica. Editorial Panamericana. Argentina.
Décimo Primera Edición. 16: 379 – 382. 1986.
[3] Bronzino Joseph. Principles of engineer biomedical. New York, CPR Press. 1995
[4] Dupis Yvon. Ventilators. Mosby Year book, St. Lois. 1992
[5] Borrello M. (1997). Biomedical systems: modeling and simulation of lung mechanics and
ventilator controls design. VisSim, tutorial series. Boston.
[6] Kerner Daniel. Solving Windkessel Models with MLAB http://www.civilized.com/
(acceso Enero 2005)