Tracking respiratory mechanics around natural breathing rates via variable ventilation.
Tracking respiratory mechanics around natural breathing rates via variable ventilation.
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通过可变通气量跟踪自然呼吸频率的呼吸力学。
DOI：
10.1038/s41598-020-63663-8
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发表时间：
2020
影响因子：
4.6
通讯作者：
Suki,Béla
中科院分区：
文献类型：
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作者：
BouJawde,Samer;Walkey,AllanJ;Majumdar,Arnab;O'Connor,GeorgeT;Smith,BradfordJ;Bates,JasonHT;Lutchen,KennethR;Suki,Béla
测量呼吸阻力和弹性随时间、潮气量、呼吸频率和呼气末正压的变化可以指导机械通气。然而，当前的测量技术受到限制，因为它们是在非生理频率下间歇性评估或涉及专用设备。为此，我们引入了 ZVV，这是一种在可变通气 (VV) 过程中连续跟踪阻力和弹性的实用方法，其中频率和潮气量因呼吸而异。 ZVV 将气道压力和流量记录分割为单独的呼吸，计算每次呼吸的阻力和弹性，根据频率或潮气量对它们进行分类，并根据分类平均值绘制结果。 ZVV 的可行性在五名患有急性肺损伤的人类患者中进行了临床评估，在灌洗损伤前后对五只小鼠进行了实验，并使用粘弹性呼吸模型进行了计算。 ZVV 在两种设置下提供连续测量，而计算研究显示估计误差 <2%。我们的研究结果支持 ZVV 作为评估生理条件下呼吸力学的可行技术。此外，在人类中，ZVV 检测到阻力和弹性随时间分别下降 12.8% 和 6.2%，这表明 VV 可以改善某些患者的肺复张，因此可以作为双重诊断和治疗工具。
Measuring respiratory resistance and elastance as a function of time, tidal volume, respiratory rate, and positive end-expiratory pressure can guide mechanical ventilation. However, current measurement techniques are limited since they are assessed intermittently at non-physiological frequencies or involve specialized equipment. To this end, we introduce ZVV, a practical approach to continuously track resistance and elastance during Variable Ventilation (VV), in which frequency and tidal volume vary from breath-to-breath. ZVV segments airway pressure and flow recordings into individual breaths, calculates resistance and elastance for each breath, bins them according to frequency or tidal volume and plots the results against bin means. ZVV’s feasibility was assessed clinically in five human patients with acute lung injury, experimentally in five mice ventilated before and after lavage injury, and computationally using a viscoelastic respiratory model. ZVV provided continuous measurements in both settings, while the computational study revealed <2% estimation errors. Our findings support ZVV as a feasible technique to assess respiratory mechanics under physiological conditions. Additionally, in humans, ZVV detected a decrease in resistance and elastance with time by 12.8% and 6.2%, respectively, suggesting that VV can improve lung recruitment in some patients and can therefore potentially serve both as a dual diagnostic and therapeutic tool.