New Intramuscular Electrodes for Respiratory Pacing in SCI

 描述(由申请人提供)： 这是上级脊髓损伤个体调查中呼吸护理的延续建议。 有效的刺激装置和方法。提出了五个方面的调查建议。目的1、咳嗽的腹部刺激：通过在电流、电极数目和位置、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，显示使用(A)表面和(B)植入PermalocTM映射电极的最大腹部呼气流量和容量对刺激的响应。目的2，上胸刺激治疗咳嗽：通过在电流、电极数目和位置、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，使用(A)表面和(B)植入PerMaloc(R)标测电极来阐明在不超过前肢轻微移动的情况下上胸大吸气流量和容量反应。目的3，联合膈外肌治疗咳嗽：比较单独刺激膈外肌(目标1和2)与使用表面电极和埋置电极联合刺激最大呼吸道流量和容量的方法。目的4、联合隔外肌的通气法：通过参数反应试验，根据恒定微小通气法的低O2利用率和CO2产生量，确定单独和联合使用体表电极和埋置电极延长隔外肌起搏的有效方法。目的5，联合横隔肌和隔外肌进行(A)咳嗽(B)呼吸机和(C)12通道刺激：A.咳嗽，使用目标3中对表面电极和埋置电极的有效组合方法，加上最大限度的横隔肌刺激，以诱导高呼吸道流量和容量。B.通风，使用有效的方法进行表面和植入电极的目标4，增加隔膜刺激，以证明低氧气利用率和二氧化碳的产生使用恒定的分钟通风方案，进行横隔膜电流响应测试与调整的外肌刺激，以获得恒定的分钟通气量。方法：在为期一年的研究中，对10只处于急性麻醉状态的犬进行研究。在过度换气后出现呼吸暂停的期间，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，将进行最大呼吸道呼气反应的刺激。对于分钟通气量，主要的结果衡量标准将是低氧气利用率和二氧化碳产生。将进行单独和联合呼吸肌刺激试验。模拟测试将包括重复测试。

 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.