We present a new approach for physics-based computational modeling of diseased human lungs. Our main object is the development of a model that takes the novel step of incorporating the dynamics of airway recruitment/de-recruitment into an anatomically accurate, spatially resolved model of respiratory system mechanics, and the relation of these dynamics to airway dimensions and the biophysical properties of the lining fluid. The importance of our approach is that it potentially allows for more accurate predictions of where mechanical stress foci arise in the lungs, since it is at these locations that injury is thought to arise and propagate from. We match the model to data from a patient with Acute Respiratory Distress Syndrome (ARDS) to demonstrate the potential of the model for revealing the underlying derangements in ARDS in a patient-specific manner. To achieve this, the specific geometry of the lung and its heterogeneous pattern of injury are extracted from medical CT images. The mechanical behavior of the model is tailored to the patient's respiratory mechanics using measured ventilation data. In retrospective simulations of various clinically performed, pressure-driven ventilation profiles, the model adequately reproduces clinical quantities measured in the patient such as tidal volume and change in pleural pressure. The model also exhibits physiologically reasonable lung recruitment dynamics and has the spatial resolution to allow the study of local mechanical quantities such as alveolar strains. This modeling approach advances our ability to perform patient-specific studies in silico, opening the way to personalized therapies that will optimize patient outcomes.

翻译：本文提出了一种基于物理的疾病人肺计算建模新方法。主要目标是开发一个开创性模型，该模型将气道复张/去复张动力学整合到解剖学精确、空间分辨的呼吸系统力学模型中，并探索这些动力学与气道尺寸及内衬液生物物理特性的关系。该方法的重要性在于，它有望更准确地预测肺部机械应力焦点的产生位置——因为这些位置被认为既是损伤的起源也是其传播的关键区域。我们将模型与急性呼吸窘迫综合征(ARDS)患者的数据进行匹配，以展示该模型在患者特异性层面揭示ARDS潜在病理机制的能力。为此，我们从医学CT图像中提取肺部的具体几何结构及其异质性损伤模式，并利用实测通气数据使模型的力学行为适配患者呼吸力学特征。在对多种临床实施的、压力驱动通气方案进行回顾性模拟时，该模型能准确复现患者临床指标如潮气量和胸膜压变化，同时展现出生理学上合理的肺复张动力学特性，并具备研究局部力学量（如肺泡应变）的空间分辨率。这种建模方法推进了计算机模拟中进行患者特异性研究的能力，为优化患者预后的个性化治疗开辟了新路径。