Predicting Plateau Pressure in Intensive Medicine for Ventilated Patients - New Contributions in Information Systems and Technologies - page 167

In the intensive medicine field one of the most respiratory diseases verified it is
barotrauma[4]. It was identified by the physicians that high values of Plateau Pressure
value [5] can contribute to a patient has barotrauma.
Framed in the INTCare project [8] and as a first step in order to avoid barotrauma it
was explored DM techniques to predict (classification approach) the Plateau Pressure
using as input only the data provided by the ventilator. This work used real data
provided by the Intensive Care Unit of Centro Hospitalar do Porto - Hospital Santo
António.
This paper consists of six chapters. In the first chapter is made a short introduction
to the problem presented. Then presents the aspects related to the problem studied, the
concepts and technology used in knowledge discovery in database (KDD) process. In
the third chapter is presented the development of the practical component that had as
a guideline the CRISP-DM methodology. The fourth chapter discusses the results and
the most relevant aspects of the work. In the fifth chapter, relevant conclusions are
presented. Finally, possible directions for future work are presented.

2 Background

2.1 Pressure Plateau and ARDS for Barotrauma

Barotrauma is the terminology used for identifying a patient with mechanical
ventilation complications. The incidence of barotrauma associated with mechanical
ventilation may concern the underlying disease for each patient. The occurrence of
barotrauma is greater in patients with severe lung disease, especially patients with
Acute Respiratory Distress Syndrome (ARDS) and pre-existence of chronic lung
diseases [4].
Plateau pressure or static elastic recoil pressure of the respiratory system is useful
to evaluate the elastic properties and the respiratory system resistance of patients with
respiratory failure. Plateau Pressure (PLP) provides important information for the
diagnosis of patients and should be monitored consecutively. It is important to
maintain PLP values <= 30 cm O in order to protect the lungs. The increase of PLP
values is associated with increased respiratory elastic system and with the decreasing
of the respiratory system compliance and vice-versa. [5].
Although mechanical ventilation is able to support and assist the continuity of
patient's life, mechanical ventilation can be harmful to the lungs. Patients such has
ARDS the incidence of pneumothorax and barotrauma varies between 0% and 76%. It
has been demonstrated through a study using a database of patients with ARDS, that
there was not relationship between the ventilator settings and the occurrence of air
leak [6]. The occurrence of barotrauma is increased in patients with pulmonary
illnesses, especially in patients with ARDS, pneumonia and obstructive pulmonary
disease. Researchers argue that there is a relationship between Positive End-
Expiratory Pressure (PEEP) and the occurrence of barotrauma, however there are
researchers which did not detect any relationship between PEEP and barotrauma.
Amato et al [4] argue that tidal volume of 12 ml/kg and high plateau pressures
results in 42% rate of pneumothorax and a mortality rate about 71%.