Modeling Lung Derecruitment in VILI Due to Fluid-Occlusion: The Role of Emergent Behavior.
Modeling Lung Derecruitment in VILI Due to Fluid-Occlusion: The Role of Emergent Behavior.
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DOI：
10.3389/fphys.2020.542744
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发表时间：
2020
影响因子：
4
通讯作者：
Bates JHT
中科院分区：
文献类型：
--
作者：
Mori V;Smith BJ;Suki B;Bates JHT
呼吸机引起的肺损伤 (VILI) 是由体积伤和肺不张损伤引起的，这两种损伤可以协同作用，损害血气屏障。我们假设这种协同作用是通过一种富者愈富的机制产生的，即肺不张损伤导致血气屏障中形成孔洞，而伴随的容量伤导致易受影响的孔洞随着 VILI 恶化而逐渐扩大。我们之前基于这个想法开发了一个分析模型，该模型可以准确预测随着 VILI 在数小时内的进展，肺复张操作后立即观察到的肺弹性的逐渐增加。在本研究中，我们扩展了该模型，以考虑肺复张后几分钟内由于肺单位关闭而导致的弹性变化率。我们发现整个肺部的单位闭合速度的分布可以通过指数为-2的幂律来描述，该幂律与之前发布的与肺复张动态相关的幂律相匹配。因此，我们的模型揭示了肺萎陷作为紧急复杂行为的一个例子，并将受伤肺部功能改变的动态与结构损伤联系起来，从而解释了由机械通气施加的持续压力和应变引起的损伤进展机制。
Ventilator-induced lung injury (VILI) is driven by the processes of volutrauma and atelectrauma, which can act synergistically to compromise the blood-gas barrier. We have postulated that this synergy arises through a rich-get-richer mechanism whereby atelectrauma causes holes to form in the blood-gas barrier while concomitant volutrauma causes susceptible holes to progressively enlarge as VILI worsens. We previously developed an analytical model based on this idea that accurately predicts the progressive increases in lung elastance seen immediately following a recruitment maneuver as VILI progresses over the course of hours. In the present study we extend this model to account for the rate of change of elastance, due to closure of lung units, in the minutes following a recruitment maneuver. We found that the distribution of unit closing velocities throughout the lung can be described by a power law with an exponent of −2 that matches previously published power laws associated with the dynamics of lung recruitment. Our model thus reveals lung collapse as an example of emergent complex behavior and links the dynamics of altered function in the injured lung to structural damage in a way that explains the mechanisms of injury progression arising from the ongoing stresses and strains applied by mechanical ventilation.
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