Ventilation Stethoscope

描述（由申请方提供）：评估继发于表面活性物质缺乏的呼吸窘迫早产儿的适当和有效的呼吸功能是困难的，目前只有粗略的测量方法。这部分地是由于早产儿的脆弱和脆弱的性质，以及由于过高的肺回缩而导致的危及生命的状况，而过高的肺回缩又继发于不成熟的II型肺细胞和表面活性剂缺乏。足够高的气道压力是使这些婴儿恢复正常所必需的，接近气压伤的水平，气压伤本身是非常有害的，并危及生存风险。监测萎陷和肺不张肺区域的能力，以及它们在重新开放单位时的反应，对改善医疗护理和健康婴儿存活的最终终点以及机械通气期间对肺结构造成的最小损伤至关重要。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室（NICU），以测量区域通气。VS基于两个关键组件。第一，是使用超极化惰性气体评估通气，第二，是最近开发的磁体设计，其允许在从产生磁场的电流线或永磁体的位置向外或远程投射的区域中进行MRI。我们的具体目标包括设计和制造一个便携式磁铁（~0.1T）和射频组件的系统，然后证明VS检测不均匀的区域通气的能力，在兔子已经与功能失调的表面活性剂的挑战。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。 公共卫生相关性：呼吸机诱导的肺损伤是呼吸衰竭危重患者并发症和死亡的常见原因。目前，没有设备可用于测量ICU中的区域通气。我们建议建立一个便携式磁共振设备，将允许在新生儿重症监护病房，其中大多数患者需要机械通气的区域通气的非侵入性测量。该器械的用途是允许临床医生最佳调整呼吸机设置，以允许通气，但避免肺损伤。

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.