Spontaneous Airway Pressure Release Ventilation (s-aprv)

自主气道压力释放通气 (s-aprv)

• 批准号: 6541691
• 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/6541691
• 关键词: biomedical equipment development; bronchial mucus; clinical biomedical equipment; disease /disorder model; intubation; nosocomial infections; pathologic process; pneumonia; respirators; respiratory function; respiratory insufficiency /failure; respiratory therapy; sheep; trachea

1. We have replicated high incidence of ventilator associated nosocomial pneumonia (VAP) in sheep, subjected to care similar to that now practiced in patients on mechanical ventilation in a hospital ICU: semirecumbent position with head elevated 30 , and periodic tracheal suctioning. Healthy sheep, anesthetized and paralyzed, were subjected to mechanical pulmonary ventilation in the prone position, with head, neck, and tracheal tube elevated 30 above horizontal, and suctioned periodically. Sheep developed progressive impairment of gas exchange, sepsis, and sometimes death. The trachea and the bronchopulmonary tree were uniformly heavily colonized with pathogens. Early studies, using continuous subglottic suctioning (Hi-Lo evac Mallinckrodt ETT), did not change this poor outcome. However, when sheep were positioned for 72 h prone, with trachea/tracheal tube horizontal and with no suctioning (routinely or otherwise), there was no growth of pathogens in the trachea and the give lobes of the lungs (sampled at 11 sites), normal lung function remained, and lungs appeared normal. We have also shown that the tracheal tube can be oriented horizontally with our custom gantry system, with periodic rotation of sheep from side to side, with equally good results. Importantly, nasogastric feeding was well tolerated (in contrast to conventional practice). We believe this gantry system and routine care based on our studies is readily adaptable to clinical use. 2. We have developed a thin-walled/two stage/lowest dead space/lowest resistance/twin endotracheal tube (UTTS-T-ETT) for use in adult, child, or infant. In the preterm infant, the dead space of this system is lower than that in the healthy, non-intubated newborn. Such a system can permit CPAP with least patient effort, and is likely to reduce greatly the need for mechanical ventilation in patients of all age groups.

1.我们在绵羊中复制了呼吸机相关性医院获得性肺炎（VAP）的高发病率，并进行了类似于目前在医院ICU机械通气患者中实施的护理：半卧位，头部抬高30，定期气管吸痰。将麻醉和麻痹的健康绵羊以俯卧位进行机械肺通气，头部、颈部和气管导管升高至水平以上30，并定期抽吸。绵羊出现进行性气体交换障碍、败血症，有时甚至死亡。气管和支气管肺动脉树均匀地大量定植有病原体。早期研究使用连续声门下吸引（Hi-Lo evac Mallinckrodt ETT）并没有改变这种不良结果。 然而，当绵羊俯卧放置72小时，气管/气管插管水平且无抽吸（常规或其他）时，气管和肺叶中无病原体生长（在11个部位取样），肺功能保持正常，肺表现正常。我们还表明，气管插管可以水平定向与我们的定制机架系统，与定期旋转的羊从一边到另一边，同样良好的结果。重要的是，鼻饲耐受性良好（与传统实践相反）。我们相信，基于我们的研究，这种机架系统和常规护理很容易适应临床使用。 2.我们开发了一种用于成人、儿童或婴儿的薄壁/两级/最低死腔/最低阻力/双气管插管（UTTS-T-ETT）。在早产儿中，该系统的死腔低于健康的未插管新生儿。这样的系统可以允许以最少的患者努力进行CPAP，并且可能大大减少所有年龄组的患者对机械通气的需求。