Distribution of mechanical energy intensity during mechanical ventilation: An investigation on the mechanisms of ventilator induced lung injury

机械通气过程中机械能强度的分布：呼吸机所致肺损伤机制的研究

• 批准号: 438791011
• 负责人: Professor Dr. Marcelo Gama de Abreu
• 金额: --
• 依托单位: Klinik und Poliklinik für Anästhesiologie und Intensivtherapie
• 依托单位国家: 德国
• 项目类别: Research Grants
• 财政年份: 2020
• 资助国家: 德国
• 起止时间: 2019-12-31 至 2022-12-31
• 项目状态: 已结题
• 来源: https://gepris.dfg.de/gepris/projekt/438791011?language=en
• 关键词: Distribution; mechanical; energy; intensity; during

Mechanical ventilation requires the setting of lung distending pressures, tidal volume, airway flow (or inspiratory-to-expiratory ratio), respiratory rate and positive end-expiratory pressure (PEEP). Together, all those variables contribute to the mechanical energy that is transferred from the ventilator to the respiratory system. Depending upon the amount of mechanical energy that is dissipated in the lungs, ventilator-induced lung injury (VILI) may result. Current ways to calculate mechanical power, that is the amount of mechanical energy over time, are flawed due to inclusion of a PEEP term. On the other hand, PEEP causes a shift in the volume-pressure curve of the respiratory system, and results in static stress-and-strain, both of which contribute importantly to VILI. Also, it is usually neglected that VILI may differ regionally depending on the distribution of energy across lungs, so-called energy intensity. The two projects proposed in this application are intended to fulfill this gap in knowledge. The first project deals with the innovative concept of mechanical energy intensity and its distribution across the lungs at different protective mechanical ventilation settings in an experimental model of the acute respiratory distress syndrome (ARDS) in pigs. The second project addresses the isolated (without tidal ventilation) and the combined (with tidal ventilation) contribution of PEEP to mechanical energy intensity and VILI also in an experimental model of ARDS in pigs, whereby the use of extracorporeal lung support will be required to obtain the appropriate mechanical ventilation settings. Both projects include a combination of sophisticated lung imaging techniques that permit the determination of regional lung mechanics and inflammation, namely computed tomography (CT), and positron emission tomography (PET) with mathematical modeling of 18F-fluorodeoxyglucose (18F-FDG, inflammation marker) kinetics. In addition, state-of-the-art measurements of inflammation and lung damage using molecular biology and histology techniques will take place. Theoretically, by solving the inconsistencies in the computation of mechanical power, and specially by expanding the concept to static and dynamic energy as well as static and dynamic intensity, both globally and regionally, a unifying mechanism of VILI might result. Also, by estimating the contribution of the energy due to PEEP, strategies aiming at protecting lungs during mechanical ventilation could be decisively improved. Therefore, the results of these investigations would represent a substantial advance in basic science and translational aspects of mechanical ventilation, with impact on clinical practice as well.

机械通气需要设置肺部膨胀压力，潮汐体积，气道流量（或吸气与验证率），呼吸速度和阳性肺泡压力（PEEP）。总之，所有这些变量都有助于从呼吸机传递到呼吸系统的机械能。根据肺部耗散的机械能量，呼吸机诱导的肺损伤（VILI）可能会导致。当前计算机械功率的方法，即随着时间的推移的机械能量，由于包含窥视术语而存在缺陷。另一方面，PEEP会导致呼吸系统的体积压力曲线的变化，并导致静态应力和晶体，这两者都对Vili有重要贡献。同样，通常忽略了VILI在区域上可能会有所不同，具体取决于跨肺的能量分布，即所谓的能量强度。本应用程序中提出的两个项目旨在满足知识的这一差距。第一个项目介绍了在猪中急性呼吸遇险综合征（ARDS）的实验模型中，机械能强度及其在肺部各个肺部分布的创新概念。第二个项目介绍了孤立的（没有潮汐通气），并且在猪的ARDS实验模型中，PEEP对机械能强度的贡献（带有潮汐通气）的贡献也需要进行适当的机械通气设置。这两个项目均包括允许确定区域肺力学和炎症的复杂肺成像技术的组合，即计算出的层析成像（CT）和正电子发射断层扫描（PET）以及18F-氟二氧化葡萄糖（18f-fluorodeoxyoxyoxyoxyglucose（18f-FDG，炎症，炎症标记））的数学建模。此外，还将使用分子生物学和组织学技术对炎症和肺损伤进行最新测量。从理论上讲，通过解决机械能力计算中的不一致，特别是通过将概念扩展到静态和动态能量以及全球和区域性的静态和动态强度，可能会导致Vili的统一机制。同样，通过估计窥视造成的能量的贡献，旨在保护机械通气过程中旨在保护肺部的策略可以果断地改善。因此，这些研究的结果将代表基础科学和机械通气的翻译方面的重大进步，并影响临床实践。