An open-source software for automatic calculation of respiratory parameters based on esophageal pressure

• We provide an open-source tool for the estimation of works of breathing and other physiological parameters of respiration.
• We developed a technique for the identification of the beginning of inspiratory effort in esophageal pressure waveform.
• We offer a user-friendly graphical user interface for expert verification of signals and results.
• Our tool was validated in adults and pediatric patients presenting with various conditions.
• The tool can easily be modified to include additional parameters and features.

PurposeWe have developed a software that automatically calculates respiratory effort indices, including intrinsic end expiratory pressure (PEEPi) and esophageal pressure–time product (PTPeso).Materials and methodsThe software first identifies respiratory periods. Clean signals are averaged to provide a reference mean cycle from which respiratory parameters are extracted. The onset of the inspiratory effort is detected automatically by looking backward from the onset of inspiratory flow to the first point where the esophageal pressure derivative is equal to zero (inflection point). PEEPi is derived from this point. Twenty-three recordings from 16 patients were analyzed with the algorithm and compared with experts’ manual analysis of signals: 15 recordings were performed during spontaneous breathing, 1 during non-invasive mechanical ventilation, and 7 under both conditions.ResultsFor all values, the coefficients of determinations (r2) exceeded 0.94 (p < 0.001). The bias (mean difference) between PEEPi calculated by hand and automatically was −0.26 ± 0.52 cm H2O during spontaneous breathing and the precisions (standard deviations of the differences) was 0.52 cm H2O with limits of agreement of 0.78 and −1.30 cm H2O. The mean difference between PTPeso calculated by hand and automatically was −0.38 ± 1.42 cm H2O s/cycle with limits of agreement of 2.46 and −3.22 cm H2O s/cycle.ConclusionsOur program provides a reliable method for the automatic calculation of PEEPi and respiratory effort indices, which may facilitate the use of these variables in clinical practice. The software is open source and can be improved with the development and validation of new respiratory parameters.