Computationally-directed mechanical ventilation in a porcine model of ARDS.

Summary

In a randomized porcine ARDS model (n=27), the team implemented computationally-directed APRV on a transport ventilator to adapt expiratory duration. All groups developed moderate-to-severe ARDS and showed similar recovery, demonstrating feasibility of real-time computational control of APRV.

Key Findings

• Modified a military-grade transport ventilator to deliver APRV with computationally-directed expiratory duration control.
• Randomized porcine ARDS model (n=27) with heterogeneous lung injury followed by 6 hours of ventilation.
• All groups developed moderate-to-severe ARDS and exhibited similar recovery in lung injury, indicating feasibility rather than superiority.

Clinical Implications

While preclinical, computationally-directed APRV could enable patient- and disease-tailored expiratory timing on commonly available transport ventilators. Translation requires safety and efficacy testing in longer-term large-animal and human studies.

Limitations

• Short 6-hour ventilation period limits assessment of long-term outcomes and injury progression
• Preclinical animal model; results may not directly translate to humans

Future Directions

Evaluate longer-duration computational APRV in large-animal models and pilot human feasibility trials, incorporating injury biomarkers and lung-protective endpoints.