  Non-invasive ventilation is increasingly used for respiratory support in
preterm infants, and is associated with a lower risk of chronic lung disease.
However, this mode is often not successful in the extremely preterm infant in
part due to their markedly increased chest wall compliance that does not
provide enough structure against which the forces of inhalation can generate
sufficient pressure. To address the continued challenge of studying treatments
in this fragile population, we developed a nonlinear lumped-parameter model of
respiratory system mechanics of the extremely preterm infant that incorporates
nonlinear lung and chest wall compliances and lung volume parameters tuned to
this population. In particular we developed a novel empirical representation of
progressive volume loss based on compensatory alveolar pressure increase
resulting from collapsed alveoli. The model demonstrates increased rate of
volume loss related to high chest wall compliance, and simulates laryngeal
braking for elevation of end-expiratory lung volume and constant positive
airway pressure (CPAP). The model predicts that low chest wall compliance
(chest stiffening) in addition to laryngeal braking and CPAP enhance breathing
and delay lung volume loss. These results motivate future data collection
strategies and investigation into treatments for chest wall stiffening.
