Entrainment-based mechanical ventilation

基于夹带的机械通气

• 批准号: 7938827
• 负责人: CHI-SANG POON
• 金额: $ 48.18万
• 依托单位: MASSACHUSETTS INSTITUTE OF TECHNOLOGY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-24 至 2013-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7938827
• 关键词: 5 year old; Accident and Emergency department; Accounting; Acute; Acute respiratory failure; Address; Animals; Area; Basic Life Support; Biomedical Engineering; Brain; Breathing; Cardiac Output; Chronic; Clinic; Clinical; Clinical Engineering; Clinical Research; Clinical Trials; Coupled; Dancing; Development; Dysbarism; Economic Inflation; Effectiveness; Engineering; Environmental air flow; Funding; Future; Gases; Generations; Goals; Home environment; Hospitalization; Incidence; Individual; Intensive Care Units; Interdisciplinary Study; Laboratories; Lead; Learning; Life; Long-Term Care; Mechanical Ventilators; Mechanical ventilation; Mechanics; Mediating; Medical; Memory; Nosocomial Infections; Operating Rooms; Panthera leo; Patients; Persons; Phase; Physics; Procedures; Process; Pulmonary Gas Exchange; Recovery; Reflex action; Rehabilitation therapy; Research Personnel; Respiratory Failure; Risk; Safety; Solutions; Staging; Techniques; Technology; Testing; Translating; Translational Research; United States National Institutes of Health; Ventilator; Ventilator Weaning; Weaning; Work of Breathing; awake; base; clinical application; clinical care; comparative effectiveness; cost; cost effective; effectiveness research; fighting; hazard; improved; insight; mortality; new technology; novel; pressure; programs; prototype; public health relevance; research clinical testing; respiratory; technology development; theories; tool

DESCRIPTION (provided by applicant): This application addresses broad Challenge Area (15) Translational Science, and specific Challenge Topic, 15- RR-101* Applied Translational Technology Development. Mechanical ventilation is a life support procedure that is indicated for a wide variety of acute or chronic respiratory failure conditions. A major technological challenge facing mechanical ventilation in awake patients with spontaneous breathing activity is how to synchronize the ventilator rhythm with the patient's breathing effort smoothly and effectively. Dyssynchrony could lead to patient discomfort, increased work of breathing and risk of barotrauma, as well as decreases in pulmonary gas exchange efficiency and in cardiac output. Current generation of mechanical ventilators either control the breathing rhythm completely independent of the patient (ventilator-based ventilation), or let the patient trigger the ventilator breath by breath (patient-based ventilation). Neither approach is optimal. We propose a new mode of mechanical ventilation (entrainment-based mechanical ventilation, EMV) that is based on the classical physics theory of mutual entrainment between coupled oscillators, which may provide a cost- effective solution to the problem of patient-ventilator synchrony. This novel technique is motivated by our recent discovery that the brain circuits that control breathing are capable of entraining to a ventilator and adapting to it through learning and memory of the vagally-mediated Hering-Breuer inflation reflex. In EMV, the patient's spontaneous rhythm and the ventilator rhythm are phase-locked to one another on the same tempo, just like two individuals dancing together. The goal of this RC1 project is to transition the base technology from animal studies in the laboratory into the clinic, by first building and bench-testing a prototype of EMV that is suitable for clinical testing (Aim 1) and then carrying out a clinical trial to evaluate its safety and efficacy in comparison with other mechanical ventilation modes such as pressure support ventilation and proportional assist ventilation (Aim 2). Toward this goal, an interdisciplinary research team comprised of a basic researcher/ bioengineer (the PI), a clinician (Co-PI) and a technology developer (Covidien/Puritan-Bennett) has been formed to address the underlying scientific, engineering and clinical problems. Our primary goal is to verify that EMV can be delivered safely and is well tolerated by patients. Secondly, in comparison with pressure support ventilation and proportional assist ventilation we anticipate that entrainment-based ventilation will be: 1) less dependent on patient triggering, hence minimizing the work of breathing: 2) more robust to variabilities of respiratory mechanical parameters and thus should be more stable; 3) more cost-effective in that it does not require sophisticated servo mechanisms to control the instantaneous ventilator pressure. The results will provide valuable insights for further development and optimization of the EMV mode in order to maximize patient-ventilator synchrony in a cost-effective manner, and will lay the groundwork for large-scale clinical testing of its efficacy in comparison with other modes of mechanical ventilation in future. Mechanical ventilation is a basic life support procedure that is integral to any intensive care unit, emergency room, ambulatory unit or ventilator weaning facility, and is ubiquitous in many medical units and rehabilitation or long-term care facilities, including the patient's own home. PUBLIC HEALTH RELEVANCE: A major longstanding problem in delivering mechanical ventilation to patients who can still breathe on their own to some extent is how to synchronize the ventilator rhythm to the patient's spontaneous breathing rhythm so they do not "fight" each other to cause hazards. This project will evolve a novel mechanical ventilation technique called "entrainment-based mechanical ventilation" which will provide a safe and cost-effective solution to this clinical problem.

描述（由申请人提供）：该申请涉及广泛的挑战领域（15）转化科学，以及特定的挑战主题，15- RR-101*应用转化技术开发。机械通气是一种生命支持程序，适用于各种急性或慢性呼吸衰竭。对于具有自主呼吸活动的清醒患者，机械通气面临的主要技术挑战是如何使呼吸机节律与患者的呼吸力度平稳有效地同步。不同步可能导致患者不适，增加呼吸功和气压损伤的风险，以及肺气体交换效率和心输出量的降低。当前一代的机械呼吸机要么完全独立于患者控制呼吸节奏（以呼吸机为基础的通气），要么让患者一次又一次地触发呼吸机（以患者为基础的通气）。这两种方法都不是最优的。我们提出了一种新的机械通气模式（基于夹带的机械通气，EMV），它基于耦合振荡器之间相互夹带的经典物理理论，这可能为患者-呼吸机同步问题提供一种经济有效的解决方案。这项新技术的灵感来自于我们最近的发现，即控制呼吸的大脑回路能够通过学习和记忆迷走神经介导的Hering-Breuer膨胀反射而被吸入呼吸机并适应它。在EMV中，病人的自发节奏和呼吸机的节奏在相同的节奏上彼此相锁，就像两个个体在一起跳舞一样。RC1项目的目标是将基础技术从实验室的动物研究过渡到临床，首先建立并在台上测试一个适合临床测试的EMV原型（目标1），然后进行临床试验，与其他机械通气模式（如压力支持通气和比例辅助通气）进行比较，评估其安全性和有效性（目标2）。为了实现这一目标，一个由基础研究人员/生物工程师（PI）、临床医生（Co-PI）和技术开发人员（Covidien/Puritan-Bennett）组成的跨学科研究团队已经成立，以解决潜在的科学、工程和临床问题。我们的主要目标是验证EMV可以安全交付并且患者耐受良好。其次，与压力支持通气和比例辅助通气相比，我们预计基于吸入的通气将：1)较少依赖于患者触发，从而最大限度地减少呼吸工作；2)对呼吸机械参数的变异性更强，因此应该更稳定；3)更具成本效益，因为它不需要复杂的伺服机构来控制通风机的瞬时压力。该结果将为进一步开发和优化EMV模式提供有价值的见解，以经济有效的方式最大化患者与呼吸机的同步，并为将来与其他机械通气模式进行大规模临床试验奠定基础。机械通气是一种基本的生命支持程序，是任何重症监护病房、急诊室、门诊病房或呼吸机脱机设施不可或缺的一部分，在许多医疗单位、康复或长期护理设施（包括患者自己的家）中无处不在。