Clinical refinement of the automatic lung parameter estimator (ALPE)

• Published in: Journal of clinical monitoring and computing 2013-06, Vol.27 (3), p.341-350
• Main Authors: Thomsen, Lars P., Karbing, Dan S., Smith, Bram W., Murley, David, Weinreich, Ulla M., Kjærgaard, Søren, Toft, Egon, Thorgaard, Per, Andreassen, Steen, Rees, Stephen E.
• Format: Article
• Language: English
• Subjects: Algorithms; Anesthesiology; Bayes Theorem; Critical Care Medicine; Equipment Design; Health Sciences; Humans; Intensive; Medicine; Medicine & Public Health; Models, Biological; Monitoring, Physiologic - instrumentation; Monitoring, Physiologic - statistics & numerical data; Original Research; Oxygen - physiology; Pulmonary Gas Exchange - physiology; Respiration, Artificial; Respiratory Function Tests - instrumentation; Respiratory Function Tests - statistics & numerical data; Statistics for Life Sciences; Ventilation-Perfusion Ratio - physiology
• ISSN: 1387-1307; 1573-2614
• DOI: 10.1007/s10877-013-9442-9

The automatic lung parameter estimator (ALPE) method was developed in 2002 for bedside estimation of pulmonary gas exchange using step changes in inspired oxygen fraction (F i O 2 ). Since then a number of studies have been conducted indicating the potential for clinical application and necessitating systems evolution to match clinical application. This paper describes and evaluates the evolution of the ALPE method from a research implementation (ALPE1) to two commercial implementations (ALPE2 and ALPE3). A need for dedicated implementations of the ALPE method was identified: one for spontaneously breathing (non-mechanically ventilated) patients (ALPE2) and one for mechanically ventilated patients (ALPE3). For these two implementations, design issues relating to usability and automation are described including the mixing of gasses to achieve F i O 2 levels, and the automatic selection of F i O 2 . For ALPE2, these improvements are evaluated against patients studied using the system. The major result is the evolution of the ALPE method into two dedicated implementations, namely ALPE2 and ALPE3. For ALPE2, the usability and automation of F i O 2 selection has been evaluated in spontaneously breathing patients showing that variability of gas delivery is 0.3 % (standard deviation) in 1,332 breaths from 20 patients. Also for ALPE2, the automated F i O 2 selection method was successfully applied in 287 patient cases, taking 7.2 ± 2.4 min and was shown to be safe with only one patient having SpO 2