ARDS: Testing Consequences without Consequence

Acute respiratory distress syndrome (ARDS) is a life-threatening illness in which the lungs are severely damaged. The condition always requires intensive medical care through mechanical ventilation. But not all lungs are the same. To ensure a personalized treatment that is adapted to the individual patient’s lung volume and condition, Ebenbuild relies on digital twins.

Dr. Kei Müller explains the technology and reveals how the healthcare sector can benefit from digital twins.

Dr. Müller, what is the common treatment for patients with acute respiratory distress syndrome and where do you see room for improvement?

Dr. Kei Müller: There is a wide range of treatment options and methods. This includes seemingly simple measures such as positioning the patient. Patients can either lie on their backs or their stomachs. At the same time, physicians use pharmacological interventions to contain acute inflammations through the concerted use of antibiotics. However, artificial ventilation is at the core of any treatment. The use of an artificial respirator regulates the gas exchange in the patient's lungs as ARDS impairs the lungs’ ability to perform this exchange. In other words, the patient is unable to breathe on his or her own.

The biggest challenge facing attending physicians is to treat patients with gentle ventilation whenever possible. If mechanical ventilation is not personalized to the patient, the lungs become overburdened. This can be caused by a mechanical overload of the lungs and may result in permanent lung damage. The big problem, in this case, is that it is currently impossible to say whether mechanical ventilation hurts the lungs or not as there is no valid measurement process. Needless to say, there are statistics and you can definitely gauge how to ventilate a patient. However, these predictions remain vague and it is not possible to make personalized predictions. Although lifesaving, ventilation therefore always includes a risk for the patient. You have to ventilate a patient, but there is a chance that this treatment may do more harm than good. This is where the digital twin comes into play.

What exactly is a digital twin?

Müller: We use the phrase digital twin to describe a computerized replica of a physical asset and/or process. In our case, the human lungs are the physical asset, from which we create a physiologically precise replica in digital form. It is important to emphasize that "replica” in this setting doesn’t just mean a mere image of the lungs, but it also mimics the organ’s functions. This allows us to create a model of an individual patient’s lungs on the computer.

How can this technology help improve the treatment of ARDS?

Müller: This is where we touch on the aforementioned fundamental issue when it comes to treatment, namely personalized and gentle ventilation. The digital twin delivers all the pertinent – previously lacking - information the attending physician needs. The twin reveals everything pertaining to the volume and condition of the lungs, thus facilitating better decision-making with regard to the treatment.

Who uses your technology already and what future applications do you expect to see?

Müller: Our digital twin has primarily been requested by medical device companies who are involved in the mechanical ventilation market. Now we plan to set the course and make this technology an integral part of daily clinical practice. We expect great benefits for intensive care medicine.

What do you generally hope to see from this technology for the healthcare sector that goes beyond the scope of mechanical ventilation?

Müller: It’s all about precision medicine. Digital twins allow us to test things out without putting patients at risk. It’s is generally not possible to try things or to undo a decision in daily clinical practice. A wrong decision in this setting can have serious and dire consequences. In contrast, digital twins give physicians the opportunity to test and explore consequences without consequence and ramifications. You can try things out and say, well this didn’t work, so let's try that again.

Digital twins are ideal for cardiac surgery. Physicians can conduct a virtual dry run test and perform surgeries on a digital twin. This makes them a real alternative to conventional in vivo measurement of the heart. In the US, this has already become a somewhat widespread approach. After analyzing the digital twin, physicians are able to decide whether a specific intervention makes sense. Apart from the safety aspect, this approach is also less expensive and less labor-intensive than an in vivo exam.

The use of digital twins is also a conceivable option in prevention settings. It would allow experts to predict how a person's health will evolve over the next 20 years and take appropriate action.

You are an exhibitor at this year’s MEDICA trade fair and a speaker at the MEDICA CONNECTED HEALTH FORUM. How important is this participation for you as a startup?

Müller: MEDICA affords us a wonderful opportunity to market our company and make people aware of our precision medicine software. We - or rather our software – are unable to do much on our own. We need the human being, namely the physician and all necessary hardware to succeed. We want to use the MEDICA Forum to network and connect with manufacturers along the clinical process chain, including suppliers in the mechanical ventilation market or medical imaging companies. We share interests and common goals and can envision synergies in this area.