Ventilation Stethoscope

描述(由申请人提供)：评估因缺乏表面活性物质而继发的呼吸窘迫的早产儿的适当和有效的呼吸功能是困难的，目前只有粗略的措施可用。这在一定程度上是由于早产儿的脆弱和脆弱的本质，以及他们生活在威胁生命的条件下，因为过高的肺反冲，继而继发于未成熟的II型肺泡细胞和表面活性物质缺乏。这些婴儿呼吸所需的足够高的呼吸道压力接近气压创伤的水平，气压创伤本身可能是非常有害的，并危及生存风险。监测塌陷和不通电的肺区的能力，以及它们在通过呼吸策略滴定重新开放病房时的反应，对于改善医疗保健和健康婴儿存活的最终终点以及在机械通风过程中对肺结构造成的最小损害至关重要。为此，我们建议开发一种“通风听诊器”(VS)，用于新生儿重症监护病房(NICU)，以测量区域通气量。VS基于两个关键组件。首先是使用超极化惰性气体来评估通风情况，其次是磁体设计的最新发展，这种磁体设计允许磁共振成像在从产生磁场的电流导线或永久磁铁的位置向外或远处投射的区域。我们的具体目标包括设计和制造便携式磁铁(~0.1T)和系统的射频组件，然后展示VS检测受到功能障碍的表面活性物质刺激的兔的不均匀区域通风的能力。此外，我们还将开发和测试测量绝对区域通气量的定量方法。本提案回应了挑战主题06-HL-111：开发用于评估和支持ICU中肺功能评估的设备和仪器。 公共卫生相关性：呼吸机引起的肺损伤是危重患者呼吸衰竭并发症甚至死亡的常见原因。目前，ICU中还没有测量区域通气量的设备。我们建议建造一种便携式磁共振设备，可以对新生儿重症监护病房的区域通气量进行非侵入性测量，因为大多数患者需要机械通气。该设备的用途将是使临床医生能够最佳地调整呼吸机设置，以便在允许通风的同时避免肺损伤。

DESCRIPTION (provided by applicant): The assessment of proper and effective ventilatory function in premature newborns suffering from respiratory distress secondary to surfactant deficiency is difficult, and only crude measures are currently available. In part this arises from the delicate and fragile nature of the premature infant, and the life threatening conditions in which they live due to excessively high lung recoil, in turn secondary to immature Type II pneumocytes and surfactant deficiency. Sufficiently high airway pressures necessary to ventilate these babies are near levels associated with barotrauma that can itself be highly detrimental and compromise survival risk. The ability to monitor collapsed and atelectatic lung regions, and their response in reopening of units with titration of ventilatory strategies, is essential to improvement of medical care and the ultimate endpoint of the survival of healthy infants as well as minimal damage inflicted on the pulmonary structures during mechanical ventilation. To this end, we propose the development of a "ventilation stethoscope" (VS), designed for use in the Neonatal Intensive Care Unit (NICU), to measure regional ventilation. The VS is based on two key components. First, is the use of hyperpolarized noble gases for the assessment of ventilation and second, is the recent development of magnet designs that allow MRI in a region that is projected externally or remotely from the position of the current wires or permanent magnet that produce the magnetic field. Our specific aims include designing and fabricating a portable magnet (~0.1T) and radio frequency components of the system and then demonstrating the ability of the VS to detect inhomogeneous regional ventilation in rabbits that have been challenged with dysfunctional surfactant. In addition, we will develop and test quantitative methods to measure absolute regional ventilation. This proposal responds to Challenge Topic 06-HL-111: Develop devices and instruments for assessing and supporting assessment of pulmonary function in an ICU. PUBLIC HEALTH RELEVANCE: Ventilator Induced Lung Injury is a common cause of complications and sometimes death in critically ill patients with respiratory failure. At present, there are no devices available to measure regional ventilation in the ICU. We propose to build a portable magnetic resonance device that will allow noninvasive measurement of regional ventilation in the neonatal intensive care unit, where most patients require mechanical ventilation. The utility of this device will be to allow clinicians to optimally adjust ventilator settings to allow ventilation but to avoid lung injury.