在猪肺损伤模型中通过呼吸参数变化诱导主体与呼吸机不同步。

IF 5.8 2区 医学 Q1 Medicine Respiratory Research Pub Date : 2024-10-03 DOI:10.1186/s12931-024-02984-y
Xi Ran, Martin Scharffenberg, Jakob Wittenstein, Mark Leidermann, Andreas Güldner, Thea Koch, Marcelo Gama de Abreu, Robert Huhle
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引用次数: 0

摘要

背景:研究表明,受试者与呼吸机不同步(SVA)与不良临床结果有关。为了阐明病理生理学途径以及 SVA 对肺组织学的影响,我们开发并评估了一种可重复的人工诱导不同步动物模型:呼吸机参数的改变被用来诱导三种主要类型的不同步:无效努力(IE)、自动触发(AT)和双重触发(DT)。记录气道流量和压力以及食道压力波形,对不同步周期进行人工分类,并计算不同步指数(AIX)。在主动肺模拟器上进行了台架测试,呼吸机设置逐周期改变。在三项试点实验中对所开发的算法进行了评估,并在 AIX = 25% 的情况下对通气 12 小时的猪进行了研究:结果:分别通过呼气末屏气和调整呼吸频率诱发了 IE 和 AT,结果可靠且无故障。气道压力斜坡延长可诱发 DT,但在飞行员中没有得到特别控制。在随后的研究中,AIX=28.8%[24.0%-34.4%]被诱导并维持了12个小时:该方法可重复诱导并维持在通气患者身上观察到的三种临床相关类型的 SVA,因此可作为未来研究异步对细胞和炎症影响的有用工具。
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Induction of subject-ventilator asynchrony by variation of respiratory parameters in a lung injury model in pigs.

Background: Subject-ventilator asynchrony (SVA) was shown to be associated with negative clinical outcomes. To elucidate pathophysiology pathways and effects of SVA on lung tissue histology a reproducible animal model of artificially induced asynchrony was developed and evaluated.

Methods: Alterations in ventilator parameters were used to induce the three main types of asynchrony: ineffective efforts (IE), auto-triggering (AT), and double-triggering (DT). Airway flow and pressure, as well as oesophageal pressure waveforms, were recorded, asynchrony cycles were manually classified and the asynchrony index (AIX) was calculated. Bench tests were conducted on an active lung simulator with ventilator settings altered cycle by cycle. The developed algorithm was evaluated in three pilot experiments and a study in pigs ventilated for twelve hours with AIX = 25%.

Results: IE and AT were induced reliably and fail-safe by end-expiratory hold and adjustment of respiratory rate, respectively. DT was provoked using airway pressure ramp prolongation, however not controlled specifically in the pilots. In the subsequent study, an AIX = 28.8% [24.0%-34.4%] was induced and maintained over twelve hours.

Conclusions: The method allows to reproducibly induce and maintain three clinically relevant types of SVA observed in ventilated patients and may thus serve as a useful tool for future investigations on cellular and inflammatory effects of asynchrony.

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来源期刊
Respiratory Research
Respiratory Research RESPIRATORY SYSTEM-
CiteScore
9.70
自引率
1.70%
发文量
314
审稿时长
4-8 weeks
期刊介绍: Respiratory Research publishes high-quality clinical and basic research, review and commentary articles on all aspects of respiratory medicine and related diseases. As the leading fully open access journal in the field, Respiratory Research provides an essential resource for pulmonologists, allergists, immunologists and other physicians, researchers, healthcare workers and medical students with worldwide dissemination of articles resulting in high visibility and generating international discussion. Topics of specific interest include asthma, chronic obstructive pulmonary disease, cystic fibrosis, genetics, infectious diseases, interstitial lung diseases, lung development, lung tumors, occupational and environmental factors, pulmonary circulation, pulmonary pharmacology and therapeutics, respiratory immunology, respiratory physiology, and sleep-related respiratory problems.
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