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We present a novel computational model for the dynamics of alveolarrecruitment/derecruitment (RD), which reproduces the underlying characteristicstypically observed in injured lungs. The basic idea is a pressure- andtime-dependent variation of the stress-free reference volume in reduceddimensional viscoelastic elements representing the acinar tissue. We choose avariable reference volume triggered by critical opening and closing pressuresin a time-dependent manner from a straightforward mechanical point of view. Inthe case of (partially and progressively) collapsing alveolar structures, thevolume available for expansion during breathing reduces and vice versa,eventually enabling consideration of alveolar collapse and reopening in ourmodel. We further introduce a method for patient-specific determination of theunderlying critical parameters of the new alveolar RD dynamics when integratedinto the tissue elements, referred to as terminal units, of a spatiallyresolved physics-based lung model that simulates the human respiratory systemin an anatomically correct manner. Relevant patient-specific parameters of theterminal units are herein determined based on medical image data and themacromechanical behavior of the lung during artificial ventilation. We test thewhole modeling approach for a real-life scenario by applying it to the clinicaldata of a mechanically ventilated patient. The generated lung model is capableof reproducing clinical measurements such as tidal volume and pleural pressureduring various ventilation maneuvers. We conclude that this new model is animportant step toward personalized treatment of ARDS patients by consideringpotentially harmful mechanisms - such as cyclic RD and overdistension - andmight help in the development of relevant protective ventilation strategies toreduce ventilator-induced lung injury (VILI).

Pressure- and time-dependent alveolar recruitment/derecruitment in a spatially resolved patient-specific computational model for injured human lungs