High-Frequency Oscillatory Ventilation and Ventilator-Induced Lung Injury: Size Does Matter.
High-Frequency Oscillatory Ventilation and Ventilator-Induced Lung Injury: Size Does Matter.
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DOI：
10.1097/ccm.0000000000004073
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发表时间：
2020-01
影响因子：
8.8
通讯作者：
Kaczka DW
中科院分区：
文献类型：
--
作者：
Herrmann J;Lilitwat W;Tawhai MH;Kaczka DW
当肺组织拉伸不均匀和/或快速发生时，在高频振荡通气期间最小化潮气量的理论基础可能不合适。本研究的目的是使用人类肺部的计算模型，根据肺的大小，评估成人与新生儿在高频振荡通气期间通气不均匀性增加可能导致呼吸机诱发的肺损伤的程度。计算模型研究。研究实验室。人类肺部的高保真 3D 计算模型，可缩放至代表新生儿、儿童和成人的各种尺寸，并具有不同的损伤严重程度。所有模型均由健康成年男性的一张胸部 CT 图像生成。在每个肺模型中以 0.2 至 40 Hz 的频率模拟振荡通气。正弦气流振荡在每个模型的气道开口处传递，并根据区域实质力学分布在肺部。通过每个模型中所有腺泡的流量大小的变异系数来评估腺泡流量异质性。高频振荡通气模拟表明，随着肺尺寸的增大、死腔与总腺泡体积之比的减小以及高于肺角频率和共振频率的频率的增加，区域实质血流的不均匀性不断增加。在受伤的成人大小的肺部中，共振放大的潜力最大，具有较高的区域质量因子，表明存在欠阻尼的肺部区域。尽管潮气量减少，但高频振荡通气期间呼吸机诱发肺损伤的可能性在高于肺转角频率或共振频率时增强，尤其是在成人中，这是由于异质流的区域放大。在高频振荡通气管理期间应考虑角频率和谐振频率的测量。
The theoretical basis for minimizing tidal volume during high-frequency oscillatory ventilation may not be appropriate when lung tissue stretch occurs heterogeneously and/or rapidly. The objective of this study was to assess the extent to which increased ventilation heterogeneity may contribute to ventilator-induced lung injury during high-frequency oscillatory ventilation in adults compared with neonates on the basis of lung size, using a computational model of human lungs. Computational modeling study. Research laboratory. High-fidelity, 3D computational models of human lungs, scaled to various sizes representative of neonates, children, and adults, with varying injury severity. All models were generated from one thoracic CT image of a healthy adult male. Oscillatory ventilation was simulated in each lung model at frequencies ranging from 0.2 to 40 Hz. Sinusoidal flow oscillations were delivered at the airway opening of each model and distributed through the lungs according to regional parenchymal mechanics. Acinar flow heterogeneity was assessed by the coefficient of variation in flow magnitudes across all acini in each model. High-frequency oscillatory ventilation simulations demonstrated increasing heterogeneity of regional parenchymal flow with increasing lung size, with decreasing ratio of deadspace to total acinar volume, and with increasing frequency above lung corner frequency and resonant frequency. Potential for resonant amplification was greatest in injured adult-sized lungs with higher regional quality factors indicating the presence of underdamped lung regions. The potential for ventilator-induced lung injury during high-frequency oscillatory ventilation is enhanced at frequencies above lung corner frequency or resonant frequency despite reduced tidal volumes, especially in adults, due to regional amplification of heterogeneous flow. Measurements of corner frequency and resonant frequency should be considered during high-frequency oscillatory ventilation management.