Medical Research Center, Chongqing General Hospital, Chongqing University, Chongqing, China.
Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany.
Respir Res. 2024 Oct 3;25(1):358. doi: 10.1186/s12931-024-02984-y.
Subject-ventilator asynchrony (SVA) was shown to be associated with negative clinical outcomes. To elucidate pathophysiology pathways and effects of SVA on lung tissue histology a reproducible animal model of artificially induced asynchrony was developed and evaluated.
Alterations in ventilator parameters were used to induce the three main types of asynchrony: ineffective efforts (IE), auto-triggering (AT), and double-triggering (DT). Airway flow and pressure, as well as oesophageal pressure waveforms, were recorded, asynchrony cycles were manually classified and the asynchrony index (AIX) was calculated. Bench tests were conducted on an active lung simulator with ventilator settings altered cycle by cycle. The developed algorithm was evaluated in three pilot experiments and a study in pigs ventilated for twelve hours with AIX = 25%.
IE and AT were induced reliably and fail-safe by end-expiratory hold and adjustment of respiratory rate, respectively. DT was provoked using airway pressure ramp prolongation, however not controlled specifically in the pilots. In the subsequent study, an AIX = 28.8% [24.0%-34.4%] was induced and maintained over twelve hours.
The method allows to reproducibly induce and maintain three clinically relevant types of SVA observed in ventilated patients and may thus serve as a useful tool for future investigations on cellular and inflammatory effects of asynchrony.
研究表明，受试者-呼吸机不同步（SVA）与负面临床结果相关。为了阐明 SVA 对肺组织组织学的病理生理途径和影响，开发并评估了一种可重现的人工诱导不同步的动物模型。
改变呼吸机参数以诱导三种主要类型的不同步：无效努力（IE）、自动触发（AT）和双重触发（DT）。记录气道流量和压力以及食管压力波形，手动分类不同步周期，并计算不同步指数（AIX）。在主动肺模拟器上进行台架测试，呼吸机设置逐周期改变。开发的算法在三个初步实验和一项在猪身上进行的 AIX = 25%、持续 12 小时的实验中进行了评估。
通过呼气末保持和调整呼吸频率可靠且安全地诱导出 IE 和 AT。使用气道压力斜坡延长来引发 DT，但在初步实验中并未专门控制。在随后的研究中，诱导并维持了 12 小时的 AIX = 28.8% [24.0%-34.4%]。
该方法可重现地诱导和维持三种在接受通气的患者中观察到的临床相关类型的 SVA，因此可能成为未来对不同步的细胞和炎症影响进行研究的有用工具。
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