Resuscitation--impedance threshold devices in pediatrics

复苏——儿科阻抗阈值装置

• 批准号: 7053810
• 负责人: KEITH G LURIE
• 金额: $ 16.88万
• 依托单位: ADVANCED CIRCULATORY SYSTEMS, INC.
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-03-01 至 2008-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7053810
• 关键词: animal mortality; apnea; atelectasis; bioengineering /biomedical engineering; biomedical equipment development; biomedical equipment safety; blood pressure; brain circulation; clinical biomedical equipment; disease /disorder model; electrical impedance; emergency care; hemodynamics; hemorrhagic shock; hypovolemia; immature animal; intracranial pressure; nonhuman therapy evaluation; oxygen transport; pediatrics; resuscitation; swine; therapy design /development; thoracic pressure; animal mortality; apnea; atelectasis; bioengineering /biomedical engineering; biomedical equipment development; biomedical equipment safety; blood pressure; brain circulation; clinical biomedical equipment; disease /disorder model; electrical impedance; emergency care; hemodynamics; hemorrhagic shock; hypovolemia; immature animal; intracranial pressure; nonhuman therapy evaluation; oxygen transport; pediatrics; resuscitation; swine; therapy design /development; thoracic pressure

DESCRIPTION (provided by applicant): Traumatic injury and hypovolemic shock are leading causes of death in children worldwide. Rapid, large volume crystalloid infusion and positive intrathoracic pressure ventilation resuscitation strategies often increase morbidity and mortality following hemorrhage. Augmenting negative intrathoracic pressure, even without fluid resuscitation, improves hemodynamic parameters and outcome in adult porcine hemorrhagic shock. Vascular biology, physiology, and tissue injury mechanisms change as the child matures from infancy through adolescence, and are distinctly different from adults. The optimal method to restore intravascular volume, prevent secondary organ damage, and prevent progression of reversible shock to irreversible circulatory collapse following severe blood loss in children is not known. Our central hypothesis is that breathing through an impedance threshold device (ITD) or, in apneic patients, use of the intrathoracic pressure regulator (ITPR), enhances negative intrathoracic pressure and thus will augment preload, improve cardiac output, enhance cerebral oxygenation, and delay or prevent the progression of reversible shock to irreversible circulatory collapse for infants and children. The goal of this proposal is to demonstrate the proof of concept of a novel resuscitative strategy for hypovolemic shock in pediatrics that improves outcomes. The strategy involves the use of an impedance threshold device (ITD) in spontaneously breathing infants and children and the intrathoracic pressure regulator (ITPR) in patients requiring assisted ventilation. Both lower intrathoracic pressures and thereby enhance venous return and cardiac output while simultaneously lowering intracranial pressures. This phase 1 investigation proposes to: 1) determine the optimal ITD "cracking pressure" in a pediatric model of hemorrhagic shock, 2) demonstrate proof of concept of the impedance threshold valve in pediatric swine by evaluating the device in an established pediatric porcine model of hemorrhagic shock for its ability to: a) improve hemodynamics, and b) increase the 24-hour survival rate, and 3) demonstrate proof of concept of the intrathoracic pressure regulator (ITPR) in ventilator dependent pediatric swine by evaluating the prototype in an established piglet model of hemorrhagic shock for its ability to: a) improve hemodynamics, b) increase the 24-hour survival rate, and c) be used without adverse events, specifically the occurrence of atelectasis. An optimal ITD and ITPR resuscitation strategy has a great potential to successfully combat hypovolemic shock and circulatory collapse, the most common cause of morbidity and mortality in children worldwide.

描述（由申请人提供）：全球儿童的创伤性损伤和低血症性休克是导致死亡的主要原因。快速，大容量的晶体输注和呈阳性的胸前压力通气复苏策略通常会增加出血后的发病率和死亡率。即使没有液体复苏，也会增加负面的胸腔内压力，可改善成人猪出血性休克的血液动力学参数和结果。随着儿童从婴儿期到青春期的成熟，血管生物学，生理和组织损伤机制发生了变化，并且与成年人明显不同。尚不清楚儿童严重失血后，可恢复血管内体积，防止次要器官损害的最佳方法，防止可逆性冲击向不可逆的循环崩溃。我们的中心假设是，通过阻抗阈值装置（ITD）呼吸，或者在呼吸暂停的患者中使用胸前压力调节剂（ITPR），可以增强负面的胸腔内压力，从而增强预紧力，改善心脏输出，改善心脏输出，增强脑部氧气，并延迟造成可逆的造成可逆性循环且可逆地造成的循环。该提案的目的是证明儿科中新型复苏策略的概念证明是改善结果的概念。该策略涉及在自发呼吸的婴儿和儿童中使用阻抗阈值设备（ITD）以及胸前压力调节剂（ITPR）在需要辅助通风的患者中。较低的胸内压力都会增强静脉回流和心脏输出，同时降低颅内压力。该阶段1的调查提出：1）在出血性休克的儿科模型中确定最佳的ITD“开裂压力”，2）通过评估既定的小儿毛震动的儿科模型，以提高猪的能力，并提高Hemymanty的范围，并提高Hemodynals的范围，并通过评估儿科猪的固定性阈值的概念证明。通过在固定的小儿猪依赖性小儿猪中的胸内压调节剂（ITPR）的概念，通过评估既定的仔猪模型的原型出血性休克模型的原型：最佳的ITD和ITPR复苏策略具有成功打击低血容量减震和循环崩溃的巨大潜力，这是全球儿童发病率和死亡率的最常见原因。