Ventilation Stethoscope

描述（由申请人提供）：对表面活性剂缺乏继发呼吸窘迫的早产新生儿进行适当有效的通气功能评估是困难的，目前只有粗略的测量方法。在某种程度上，这是由于早产儿的脆弱和脆弱的本质，以及由于过度的肺后坐力而导致的危及生命的条件，而后者又继发于未成熟的II型肺细胞和表面活性剂缺乏。足够高的气道压力对这些婴儿的通气是必要的，接近与气压创伤相关的水平，这本身是非常有害的，并降低生存风险。监测塌陷和肺失电区，以及它们在重新开启通气策略时的反应的能力，对于改善医疗保健和健康婴儿生存的最终目的以及在机械通气期间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“通气听诊器”（VS），设计用于新生儿重症监护病房（NICU），以测量区域通气。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，其次是磁铁设计的最新发展，它允许在一个区域内进行MRI，该区域被投射到外部或远离产生磁场的电流线或永磁体的位置。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检测功能失调表面活性剂挑战兔子的不均匀区域通气的能力。此外，我们将开发和测试定量方法来测量绝对区域通风。本提案响应挑战主题06-HL-111：开发用于评估和支持ICU肺功能评估的设备和仪器。

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.