A computerized decision support system to predict the variations in the cerebral blood flow of mechanically ventilated infants

A computerized decision support system is described to predict the changes in the cerebral blood flow (CBF) of mechanically ventilated infants in response to different ventilatory settings. A CBF controller was developed and combined with a mathematical model of the infant's respiratory system to simulate the effects of ventilatory settings on the infant's CBF. The performance of the system was examined under various ventilatory treatments and the results were compared with available experimental data. The comparisons showed good agreement between the simulation results and experimental data for preterm infants. These included the results obtained under conditions of hypoventilation, hyperventilation, hypoxia, and hyperoxia. The presented decision support system has the potential to be used as an aide to the intensivist in choosing appropriate ventilation treatments for infants to prevent the untoward consequences of hazardous changes in CBF in mechanically ventilated infants such as hypoxic-ischemic brain injuries.

[1]  S. Kempley,et al.  Arterial blood pressure and blood flow velocity in major cerebral and visceral arteries. I. Interindividual differences. , 1993, Early human development.

[2]  P. Hardy,et al.  Retinopathy of prematurity: understanding ischemic retinal vasculopathies at an extreme of life. , 2010, The Journal of clinical investigation.

[3]  D. K. Williams,et al.  Tracheal suctioning is associated with prolonged disturbances of cerebral hemodynamics in very low birth weight infants , 2008, Journal of Perinatology.

[4]  Effect of PaCO2 and Haemoglobin Concentration on Day to Day Variation of CBF in Preterm Neonates , 1989, Acta paediatrica Scandinavica. Supplement.

[5]  Ramon Costa-Castelló,et al.  Learning Respiratory System Function in BME Studies by Means of a Virtual Laboratory: RespiLab , 2008, IEEE Transactions on Education.

[6]  D H Evans,et al.  Transient hyperoxia and cerebral blood flow velocity in infants born prematurely and at full term. , 1988, Archives of disease in childhood.

[7]  Gorm Greisen,et al.  Monitoring of cerebral haemodynamics in newborn infants. , 2010, Early human development.

[8]  P. Farrell,et al.  Hyaline membrane disease. , 1975, The American review of respiratory disease.

[9]  Valentina Vanzo,et al.  Influence of ventilation mode on neonatal cerebral blood flow and volume. , 2009, Early human development.

[10]  F. Tehrani.  Autoregulation of the cerebral blood flow in preterm infants , 1995, Proceedings of 17th International Conference of the Engineering in Medicine and Biology Society.

[11]  P. Mahajan,et al.  Respiratory Distress , 2005, Clinical pediatrics.

[12]  G. Greisen.  Cerebral blood flow and energy metabolism in the newborn. , 1997, Clinics in perinatology.

[13]  M. Levene,et al.  Carbon Dioxide Reactivity of the Cerebral Circulation in Extremely Premature Infants: Effects of Postnatal Age and Indomethacin , 1988, Pediatric Research.

[14]  Robert Grino,et al.  Control system response of different respiratory models under ventilatory stimuli and pathologies , 2002 .

[15]  J. Forthomme,et al.  [HYALINE MEMBRANE DISEASE]. , 1964, Les Cahiers du College de medecine des hopitaux de Paris.

[16]  F. Riedel.  Long Term Effects of Artificial Ventilation in Neonates , 1987, Acta paediatrica Scandinavica.

[17]  D. Evans,et al.  Cerebrovascular carbon dioxide reactivity and failure of autoregulation in preterm infants. , 1992, Archives of disease in childhood.

[18]  I. Brandt.  Respiratory distress syndrome of the newborn. , 1958, Connecticut state medical journal.

[19]  F. Tehrani,et al.  Mathematical analysis and computer simulation of the respiratory system in the newborn infant , 1993, IEEE Transactions on Biomedical Engineering.