Entrainment-based mechanical ventilation

基于夹带的机械通气

• 批准号: 7814084
• 负责人: CHI-SANG POON
• 金额: $ 47.09万
• 依托单位: MASSACHUSETTS INSTITUTE OF TECHNOLOGY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-24 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7814084
• 关键词: 5 year old; Accident and Emergency department; Accounting; Acute; Acute respiratory failure; Address; Animals; Area; Basic Life Support; Biomedical Engineering; Brain; Breathing; Cardiac Output; Chronic; Clinic; Clinical; Clinical Engineering; Clinical Research; Clinical Trials; Coupled; Dancing; Development; Dysbarism; Economic Inflation; Effectiveness; Engineering; Environmental air flow; Funding; Future; Gases; Generations; Goals; Home environment; Hospitalization; Incidence; Individual; Intensive Care Units; Interdisciplinary Study; Laboratories; Lead; Learning; Life; Long-Term Care; Mechanical Ventilators; Mechanical ventilation; Mechanics; Mediating; Medical; Memory; Nosocomial Infections; Operating Rooms; Panthera leo; Patients; Persons; Phase; Physics; Procedures; Process; Pulmonary Gas Exchange; Recovery; Reflex action; Rehabilitation therapy; Research Personnel; Respiratory Failure; Risk; Safety; Solutions; Staging; Techniques; Technology; Testing; Translating; Translational Research; United States National Institutes of Health; Ventilator; Ventilator Weaning; Weaning; Work of Breathing; awake; base; clinical application; clinical care; comparative effectiveness; cost; cost effective; effectiveness research; fighting; hazard; improved; insight; mortality; new technology; novel; pressure; programs; prototype; public health relevance; research clinical testing; respiratory; technology development; theories; tool; 5 year old; Accident and Emergency department; Accounting; Acute; Acute respiratory failure; Address; Animals; Area; Basic Life Support; Biomedical Engineering; Brain; Breathing; Cardiac Output; Chronic; Clinic; Clinical; Clinical Engineering; Clinical Research; Clinical Trials; Coupled; Dancing; Development; Dysbarism; Economic Inflation; Effectiveness; Engineering; Environmental air flow; Funding; Future; Gases; Generations; Goals; Home environment; Hospitalization; Incidence; Individual; Intensive Care Units; Interdisciplinary Study; Laboratories; Lead; Learning; Life; Long-Term Care; Mechanical Ventilators; Mechanical ventilation; Mechanics; Mediating; Medical; Memory; Nosocomial Infections; Operating Rooms; Panthera leo; Patients; Persons; Phase; Physics; Procedures; Process; Pulmonary Gas Exchange; Recovery; Reflex action; Rehabilitation therapy; Research Personnel; Respiratory Failure; Risk; Safety; Solutions; Staging; Techniques; Technology; Testing; Translating; Translational Research; United States National Institutes of Health; Ventilator; Ventilator Weaning; Weaning; Work of Breathing; awake; base; clinical application; clinical care; comparative effectiveness; cost; cost effective; effectiveness research; fighting; hazard; improved; insight; mortality; new technology; novel; pressure; programs; prototype; public health relevance; research clinical testing; respiratory; technology development; theories; tool

DESCRIPTION (provided by applicant): This application addresses broad Challenge Area (15) Translational Science, and specific Challenge Topic, 15- RR-101* Applied Translational Technology Development. Mechanical ventilation is a life support procedure that is indicated for a wide variety of acute or chronic respiratory failure conditions. A major technological challenge facing mechanical ventilation in awake patients with spontaneous breathing activity is how to synchronize the ventilator rhythm with the patient's breathing effort smoothly and effectively. Dyssynchrony could lead to patient discomfort, increased work of breathing and risk of barotrauma, as well as decreases in pulmonary gas exchange efficiency and in cardiac output. Current generation of mechanical ventilators either control the breathing rhythm completely independent of the patient (ventilator-based ventilation), or let the patient trigger the ventilator breath by breath (patient-based ventilation). Neither approach is optimal. We propose a new mode of mechanical ventilation (entrainment-based mechanical ventilation, EMV) that is based on the classical physics theory of mutual entrainment between coupled oscillators, which may provide a cost- effective solution to the problem of patient-ventilator synchrony. This novel technique is motivated by our recent discovery that the brain circuits that control breathing are capable of entraining to a ventilator and adapting to it through learning and memory of the vagally-mediated Hering-Breuer inflation reflex. In EMV, the patient's spontaneous rhythm and the ventilator rhythm are phase-locked to one another on the same tempo, just like two individuals dancing together. The goal of this RC1 project is to transition the base technology from animal studies in the laboratory into the clinic, by first building and bench-testing a prototype of EMV that is suitable for clinical testing (Aim 1) and then carrying out a clinical trial to evaluate its safety and efficacy in comparison with other mechanical ventilation modes such as pressure support ventilation and proportional assist ventilation (Aim 2). Toward this goal, an interdisciplinary research team comprised of a basic researcher/ bioengineer (the PI), a clinician (Co-PI) and a technology developer (Covidien/Puritan-Bennett) has been formed to address the underlying scientific, engineering and clinical problems. Our primary goal is to verify that EMV can be delivered safely and is well tolerated by patients. Secondly, in comparison with pressure support ventilation and proportional assist ventilation we anticipate that entrainment-based ventilation will be: 1) less dependent on patient triggering, hence minimizing the work of breathing: 2) more robust to variabilities of respiratory mechanical parameters and thus should be more stable; 3) more cost-effective in that it does not require sophisticated servo mechanisms to control the instantaneous ventilator pressure. The results will provide valuable insights for further development and optimization of the EMV mode in order to maximize patient-ventilator synchrony in a cost-effective manner, and will lay the groundwork for large-scale clinical testing of its efficacy in comparison with other modes of mechanical ventilation in future. Mechanical ventilation is a basic life support procedure that is integral to any intensive care unit, emergency room, ambulatory unit or ventilator weaning facility, and is ubiquitous in many medical units and rehabilitation or long-term care facilities, including the patient's own home. PUBLIC HEALTH RELEVANCE: A major longstanding problem in delivering mechanical ventilation to patients who can still breathe on their own to some extent is how to synchronize the ventilator rhythm to the patient's spontaneous breathing rhythm so they do not "fight" each other to cause hazards. This project will evolve a novel mechanical ventilation technique called "entrainment-based mechanical ventilation" which will provide a safe and cost-effective solution to this clinical problem.

描述（由申请人提供）：此申请涉及广泛的挑战领域（15）转化科学和特定挑战主题，15- RR-101*应用转化技术开发。机械通气是一种生命支持程序，适用于各种急性或慢性呼吸衰竭条件。在自发呼吸活动的清醒患者中，机械通气面临的主要技术挑战是如何使呼吸机节奏与患者的呼吸努力平稳，有效地同步。异位障碍可能会导致患者不适，呼吸的增加和预压风险，以及肺气交换效率和心输出量的降低。机械呼吸机的当前产生要么完全独立于患者（基于呼吸机的通风），要么控制呼吸节奏，要么让患者通过呼吸触发呼吸机呼吸（基于患者的通风）。两种方法都是最佳的。我们提出了一种新的机械通气模式（基于夹带的机械通气，EMV），该模式基于耦合振荡器之间相互夹带的经典物理学理论，该理论可以为患者 - 替代剂同步的问题提供具有成本效益的解决方案。这种新颖的技术是由我们最近发现的，即控制呼吸的大脑电路能够进入呼吸机，并通过学习和记忆对模糊介导的遗传 - 繁殖异性通货膨胀的反射来适应它。在EMV中，患者的自发节奏和呼吸机节奏在同一节奏上相互锁定，就像两个人一起跳舞一样。 The goal of this RC1 project is to transition the base technology from animal studies in the laboratory into the clinic, by first building and bench-testing a prototype of EMV that is suitable for clinical testing (Aim 1) and then carrying out a clinical trial to evaluate its safety and efficacy in comparison with other mechanical ventilation modes such as pressure support ventilation and proportional assist ventilation (Aim 2).为了实现这一目标，已经成立了一个由基础研究员/生物工程师（PI），临床医生（Co-PI）和技术开发人员（Covidien/ Puritan-Bennett）组成的跨学科研究团队，以解决潜在的科学，工程和临床问题。我们的主要目标是验证EMV是否可以安全地交付，并且患者可以很好地容忍。其次，与压力支持通风和比例辅助通气相比，我们预计基于夹带的通气将是：1）减少依赖患者触发的依赖，因此最大程度地减少了呼吸工作：2）对呼吸机械参数的变化更加可靠，因此应该更稳定； 3）更具成本效益的是，它不需要复杂的伺服机制来控制瞬时呼吸机压力。该结果将为EMV模式的进一步开发和优化提供宝贵的见解，以便以具有成本效益的方式最大化患者 - 易位者同步，并为将来的其他机械雌性模式提供了对其功效进行大规模临床测试的基础。机械通气是一种基本的生命支持程序，是任何重症监护室，急诊室，门诊单位或呼吸机断奶设施不可或缺的一部分，并且在许多医疗部门，康复或长期护理设施（包括患者自己的家）中无处不在。 公共卫生相关性：向仍然可以在某种程度上自行呼吸的患者提供机械通气的主要长期问题是如何使呼吸机节奏与患者的自发呼吸节奏同步，以免互相“战斗”以造成危害。该项目将进化一种称为“基于夹带的机械通气”的新型机械通气技术，该技术将为此临床问题提供安全且具有成本效益的解决方案。