Hyper-protective mechanical ventilation by gas exchange-optimizing ventilation profiles

当患者处于全身麻醉或患有肺部疾病时，机械通气是主要的救生治疗方法。高潮气量和相关的高压、高流速、不均匀的气体分布和肺组织的潮气呼吸复张/去复张导致可能使肺实质过载的循环机械负荷。在常规的机械通气下，强制性的或作为增强的自主呼吸提供的，呼气过程遵循快速指数衰减函数，其时间常数由呼吸系统的顺应性和阻力（在这种情况下可能是病理改变的）确定。我们研究小组开发的“流量控制呼气”（FLEX）和正弦通气（SINE）的特点是主动控制总通气时间。在小型和大型动物模型的通气呼吸系统中，FLEX和SINE导致肺损伤较少，局灶性炎症减少，与被动呼气的传统通气相比，顺应性改善，气体交换更有效。基于我们的初步工作，我们设计了一种新的方法来优化通气的时间模式，目的是改善肺气体交换。通过将线性模式与正弦模式相结合，我们创建了LINUS通气模式。在这个项目中，我们研究了LINUS通气模式在改善气体交换及其肺保护潜力方面的作用。因此，重点是减少潮气量和呼吸频率以及减速通气模式本身的肺保护作用。为了全面了解新通气模式的潜在机制和肺保护潜力，本研究将在健康呼吸系统和急性肺损伤呼吸系统的小动物模型上进行一系列实验失败

Mechanical ventilation is the main life-saving therapy when a patient is under general anaesthesia or suffers from a lung disease. High tidal volumes and associated high pressures, high flow rates, inhomogeneous gas distribution and tidal respiratory recruitment/de-recruitment of lung tissue lead to cyclic mechanical load that can overburden the lung parenchyma. Under conventional mechanical ventilation, mandatory or provided as augmented spontaneous breathing, the course of expiration follows a rapid exponential decay function, the time constant of which is determined by compliance and resistance of the (as the case may be pathologically altered) respiratory system. The "flow-controlled expiration" (FLEX) and the sinusoidal ventilation (SINE) developed in our research group are characterised by active control of the total ventilation period.In small and large animal models of the ventilated respiratory system, FLEX and SINE resulted in less lung damage and reduced focal inflammation, as well as improved compliance and more efficient gas exchange compared to conventional ventilation with passive expiration. Based on our preliminary work, we designed a new approach to optimise the temporal pattern of ventilation with the aim of improving pulmonary gas exchange. By combining a linear with a sinusoidal pattern we created the LINUS ventilation pattern. In this project we investigate the effects of the LINUS ventilation pattern with regard to improving gas exchange and its lung-protective potential. Thereby, the focus is on the reduction of tidal volume and respiratory rate as well as on the lung-protective effects of the decelerated ventilation pattern itself.In order to gain comprehensive insights into the underlying mechanisms and the lung-protective potential of the new ventilation pattern, series of experiments will be conducted in small animal models of the mechanically ventilated healthy respiratory system and the respiratory system in acute lung failure.