SPONTANEOUS AIRWAY PRESSURE RELEASE VENTILATION (S-APRV): A NEW CONCEPT

自主气道压力释放通气 (S-APRV)：一个新概念

• 批准号: 6109198
• 负责人: Theodor Kolobow
• 金额: --
• 依托单位: NATIONAL HEART, LUNG, AND BLOOD INSTITUTE
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/6109198
• 关键词: biomedical equipment development; bronchial mucus; catheterization; clinical biomedical equipment; intubation; respirators; respiratory function; respiratory insufficiency /failure; respiratory therapy; sheep; trachea

Current treatment of severe acute respiratory failure (ARF) relies on intubation and mechanical ventilation to improve arterial oxygenation and carbon dioxide release, to decrease the work of breathing and the adverse effects therefrom, and to provide access for tracheal suctioning. This often leads to tracheal injury, tracheal aspiration, decreased tracheal mucus velocity, barotrauma, and a high incidence of nosocomial pneumonia. We have further improved our new method of minimally invasive passive ventilation that dispenses with tracheal intubation and the use of mechanical ventilation: Spontaneous Airway Pressure Release Ventilation (S-APRV), in which all air/oxygen is delivered to the level of the carina through a small Reverse-Thrust Catheter (RTC), at the level of the carina. We now include in S-APRV a mechanism to provide for a brief (one second or less) timed period in the respiratory cycle during which air/oxygen delivery is transiently increased to allow for more rapid inflation of the lungs - particularly useful in large animals (and in adult man). In studies in sheep with severe ARF following intravenous infusion of oleic acid droplets (mean size, about 220 micrometers) at a total dose of 100 mg/kg, we can reproducibly and consistently induce severe ARF in sheep. In studies currently in progress, we treat such sheep with ARF in one of three ways: 1. Pressure support ventilation through a standard tracheostomy tube, PEEP 5 cm H2O, pressure support 10 cm H2O; 2. CPAP of 5 cm H2O, using a standard tracheostomy tube; and 3. S-APRV, using a minitracheostomy tube, with a RTC catheter. Our preliminary results show that overall, recovery in gas exchange proceeded comparably in the three groups. Sheep in groups 1 and 2 required frequent tracheal aspiration to avoid obstruction to air flow, whereas sheep on S-APRV did not require tracheal suctioning at any time, because of the self-cleaning feature of the RTC catheter. To date, these studies suggest that with S-APRV tracheal intubation can likely be avoided as there appears to be spontaneous removal of secretions from the upper major airways through the effects of the RTC catheter gas flow. We conclude from results of our studies to date that such a method is likely to lead to greatly improved quality of care for ARF patients with a reduction in nosocomial pneumonia (as there is no need for tracheal intubation or tracheal suctioning). In addition, the patient will likely retain the ability to vocalize, swallow, and ingest food and fluid orally.

严重急性呼吸衰竭的治疗现状 (ARF)依靠插管和机械通气来改善 动脉氧合和二氧化碳释放，以减少 呼吸的工作和由此产生的不利影响，并提供 气管吸引的入口。这通常会导致气管损伤， 气管吸入，气管粘液流速降低，气压伤， 以及院内感染性肺炎的高发率我们进一步 改进了我们的微创被动通气新方法 无需气管插管和机械通气 通气：自主气道压力释放通气 （S-APRV），其中所有空气/氧气被输送到 通过一个小的反向推力导管（RTC），在水平隆突 的隆突。我们现在在S-APRV中包括一个机制， 对于呼吸循环中的短暂（一秒或更少）定时周期 在此期间，空气/氧气输送瞬时增加， 用于肺部更快速的充气-特别适用于大型 动物（和成年人）。在重度ARF绵羊研究中 在静脉内输注油酸液滴（平均大小， 约220微米），总剂量为100 mg/kg，我们可以 在绵羊中可重复并持续诱导严重ARF。在 目前正在进行的研究，我们治疗这种羊与ARF在一个 三种方式：1。压力支持通气通过标准 气管切开插管，PEEP 5 cm H2O，压力支持10 cm H2O; 2. 5 cm H2O的CPAP，使用标准气管造口管;以及3. S-APRV，使用微型气管切开管，带RTC导管。我们 初步结果表明，总体而言，气体交换的回收率 在三个小组中进行。第1组和第2组中的绵羊 需要频繁的气管抽吸以避免阻塞空气 流量，而S-APRV上的绵羊不需要气管吸痰 由于RTC的自清洁功能， 导尿管迄今为止，这些研究表明，S-APRV气管 插管可能是可以避免的，因为似乎是自发的， 从上主要气道通过 RTC导管气流的影响。我们从以下结果中得出结论： 我们迄今为止的研究表明，这种方法可能会导致极大的 提高ARF患者的护理质量， 医院获得性肺炎（因为不需要气管插管 或气管抽吸）。此外，患者可能会保留 发音、吞咽、口服食物和液体的能力。