New Intramuscular Electrodes for Respiratory Pacing in SCI

 描述（由申请人提供）： 这是一个延续性的建议，在呼吸护理的上层SCI个人调查 有效的刺激装置和方法。建议刺激腹侧和上胸部的肌外肌，并结合肌肉激活。根据我们最近的研究结果，在两个外肌中使用四组双侧表面和植入PermalocTM电极进行了稳健的呼吸反应，需要进一步研究。提出了五个调查领域。目标1，咳嗽的腹部刺激：通过在电流、电极数量和位置、刺激频率、电极配置和电极刺激交错等方面进行参数响应测试，证明使用（A）表面电极和（B）植入PermalocTM标测电极对刺激的最大腹部呼气流量和容量响应。目标2，上胸刺激治疗咳嗽：通过在电流、电极数量和位置、刺激频率、电极配置和电极刺激交错等领域进行参数响应测试，使用（A）表面和（B）植入Permaloc（r）标测电极，阐明上胸吸气流量和容量反应较大，前肢运动不超过轻微。目的3，联合膈肌外肌肉治疗咳嗽：比较单独刺激膈肌外肌肉（目的1和2）与使用表面和植入电极的联合方法，以获得最大气道流量和容量。目的4，联合脑外肌进行通气：通过进行参数反应测试，基于恒定分钟通气方案期间的低O2利用率和CO2产生，确定单独和联合使用表面电极和植入电极延长脑外肌起搏的有效方法。目的5，膈肌和膈肌外肌联合用于（A）咳嗽（B）通气和（C）12通道刺激：A。咳嗽，使用目标3中针对表面电极和植入电极的有效组合方法，增加最大膈肌刺激以诱导高气道流量和容量。B。通气，使用目标4中的表面和植入电极的有效方法，增加隔膜刺激，以证明使用恒定分钟通气方案的低O2利用率和CO2产生，方法是通过使用调整的肌外肌肉刺激进行隔膜电流响应测试，以获得恒定分钟通气量。方法：在为期一年的研究中，将对10只急性麻醉下的犬进行研究。在过度通气后呼吸暂停期间，将进行呼吸起搏研究。将测试不同的PermalocR和表面电极。为了模拟咳嗽，将进行最大气道呼气反应的刺激。对于每分钟通气量，主要结局指标将是低O2利用率和CO2产生。将进行单独和联合呼吸肌刺激试验。刺激测试将包括重复测试。植入式Permaloc？多电极导线-通过皮肤放置的植入式Permaloc连接器和电极将在尸检期间通过摄影记录。将使用ANOVA和Student-Neuman-Keuls事后分析阐明统计学显著性;所有数据均以平均值± SEM表示。

 DESCRIPTION (provided by applicant): This is a continuation proposal in respiratory care of the upper-level SCI individual investigating effective stimulatory devices and methods. Stimulation of extradiaphragmatic muscles, abdominal and upper-thorax, in conjunction with diaphragmatic activation is proposed. Based upon our recent findings of robust respiratory responses with four bilateral sets of surface and implanted PermalocTM electrodes in both extradiaphragmatic muscles, further research is warranted. Five areas of investigations are proposed. Aim 1, Abdominal Stimulation for Cough: Demonstrate maximal abdominal expiratory flow and volume responses to stimulation using (A) surface and (B) implanted PermalocTM Mapping electrodes by conducting parameter-response tests in the areas of current, electrode numbers and locations, stimulating frequency, electrode configurations and electrode stimulation staggering. Aim 2, Upper-Thorax Stimulation for Cough: Elucidate large upper-thoracic inspiratory flow and volume responses without more than slight forelimb movement using (A) surface and (B) implanted Permaloc(r) Mapping electrodes by conducting parameter-response testing in the areas of current, electrode numbers and locations, stimulation frequencies, electrode configurations and electrode stimulation staggering. Aim 3, Combined Extra Diaphragmatic Muscles for Cough: Compare stimulation of extradiaphragmatic muscles alone (Aims 1 and 2) to combined methods using surface and implanted electrodes for maximal airway flow and volume. Aim 4, Combined Extradiaphragmatic Muscles for Ventilation: Ascertain effective methods of extended pacing of extradiaphragmatic muscles alone and in combination using surface and implanted electrodes based on low O2 utilization and CO2 production during constant minute-ventilation protocols by conducting parameter-response tests. Aim 5, Combined Diaphragm and Extradiaphragmatic muscles for (A) Cough (B) Ventilation and (C) 12- Channel Stimulation: A. Cough, using effective combined methods from Aim 3 for surface and implanted electrodes, add maximal diaphragm stimulation to induce high airway flow and volume. B. Ventilation, using effective methods for surface and implanted electrodes from Aim 4, add diaphragm stimulation to demonstrate low O2 utilization and CO2 production using constant minute-ventilation protocol by conducting diaphragm current-response tests with adjusted extradiaphragmatic muscles stimulation to obtain constant minute ventilation. Methods: Ten canines under acute anesthesia will be studied during this one-year investigation. During periods of respiratory apnea following hyperventilation, respiratory pacing studies will be conducted. Different PermalocR and surface electrodes will be tested. To model cough, stimulation for maximal airway expiratory responses will be carried out. For minute ventilation, the primary outcome measure will be low O2 utilization and CO2 production. Individual and combined respiratory muscle stimulation tests will be conducted. Stimulation testing will include duplicate testing. Implantable PermalocTM Multi-Lead-Cables placed through the skin with implanted Permaloc connectors and electrodes will be documented by photography during autopsy. ANOVAs with Student-Neuman-Keuls post-hoc analysis will be used to elucidate statistical significance; all data will be presented as mean + SEM.