New Intramuscular Electrodes for Respiratory Pacing in SCI

用于 SCI 呼吸起搏的新型肌内电极

• 批准号: 8859379
• 负责人: James S. Walter
• 金额: --
• 依托单位: EDWARD HINES JR VA HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-02-01 至 2016-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8859379
• 关键词: Abdomen; Abdominal Muscles; Acute; Anesthesia procedures; Apnea; Area; Autopsy; Bilateral; Canis familiaris; Carbon Dioxide; Cardiac; Caring; Cervical spinal cord injury; Chest; Coughing; Data; Devices; Electric Stimulation; Electrodes; Environmental air flow; Forelimb; Frequencies; Hyperventilation; Implant; Implanted Electrodes; Individual; Intercostal Muscles; Intramuscular; Investigation; Lead; Light; Location; Maps; Measures; Mechanical ventilation; Methods; Modeling; Movement; Muscle; Outcome Measure; Oxygen; Partial Pressure; Patients; Photography; Pneumonia; Production; Protocols documentation; Ramp; Rehabilitation Research; Research; Respiration; Respiratory Diaphragm; Respiratory Muscles; Signal Transduction; Skin; Spinal cord injury; Structure of phrenic nerve; Students; Surface; Technology Transfer; Test Result; Testing; United States Department of Veterans Affairs; Ventilator; Veterans; base; improved; metabolic abnormality assessment; mortality; primary outcome; programs; public health relevance; research and development; respiratory; response

 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.

 描述（由申请人提供）： 这是对高级 SCI 个体调查的呼吸护理的延续提案 有效的刺激装置和方法。建议刺激膈外肌肉、腹部和上胸部，同时激活膈肌。根据我们最近在膈外肌中使用四组双侧表面和植入 PermalocTM 电极进行的强烈呼吸反应的发现，有必要进行进一步的研究。提出了五个调查领域。目标 1，腹部刺激咳嗽：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方面进行参数响应测试，展示使用 (A) 表面和 (B) 植入 PermalocTM 映射电极刺激的最大腹部呼气流量和容量反应。目标 2，上胸部刺激咳嗽：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方面进行参数响应测试，使用 (A) 表面和 (B) 植入的 Permaloc(r) 映射电极，阐明大的上胸部吸气流量和容量反应，而无需轻微的前肢运动。目标 3，联合膈外肌治疗咳嗽：将单独刺激膈外肌（目标 1 和 2）与使用表面和植入电极以获得最大气道流量和容量的联合方法进行比较。目标 4，联合膈外肌通气：通过进行参数响应测试，基于恒定每分钟通气量方案期间的低 O2 利用率和 CO2 产生，确定单独和组合使用表面和植入电极延长膈外肌起搏的有效方法。目标 5，组合膈肌和膈外肌用于 (A) 咳嗽 (B) 通气和 (C) 12 通道刺激： A. 咳嗽，使用目标 3 中针对表面和植入电极的有效组合方法，添加最大的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，添加膈肌刺激，通过调整膈外肌肉刺激进行膈肌电流响应测试，以证明使用恒定每分钟通气量方案的低 O2 利用率和 CO2 产生，以获得恒定的每分钟通气量。方法：在为期一年的调查中，将对十只处于急性麻醉状态的犬进行研究。在过度通气后出现呼吸暂停期间，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，将刺激最大气道呼气反应。对于每分钟通气量，主要结果指标是低氧气利用率和二氧化碳产生量。将进行单独和组合呼吸肌刺激测试。刺激测试将包括重复测试。尸检期间将通过摄影记录通过皮肤放置的植入式 PermalocTM 多引线电缆以及植入的 Permaloc 连接器和电极。方差分析与 Student-Neuman-Keuls 事后分析将用于阐明统计显着性；所有数据均以平均值+SEM 的形式呈现。