Perricone Federica, Tartarini Lorenzo, De Toni Lorenzo, Rovati Luigi, Mapelli Jonathan, Gandolfi Daniela
Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
Department of Engineering "Enzo Ferrari", University of Modena and Reggio Emilia, Modena, Italy.
Front Neurosci. 2025 Aug 28;19:1638547. doi: 10.3389/fnins.2025.1638547. eCollection 2025.
The transition from mechanical to physiological ventilation is a delicate step during the recovery from ECMO, in particular following severe respiratory failures. Since there is controversy on the optimal degree of mechanical ventilation support, the maintenance of physiological ventilation can be crucial to determine the balance between lung rest and lung recovery. We believe that the development of closed-loop control systems for mechanical ventilation, designed to maintain or restore physiological respiratory activity in patients supported by extracorporeal membrane oxygenation (ECMO) could contribute to achieve this goal. In our vision, the core of such a system could be a biologically inspired computational model of the respiratory neural control center, capable of simulating the respiratory rhythm required to efficiently eliminate CO₂ from the body. The outputs of the modeled respiratory rhythm (e.g., rate and pattern) would represent the patient's needs that should be ideally maintained to ensure proper CO₂ clearance. The use of a simulated respiratory rhythm to dynamically control a mechanical ventilator integrated with ECMO would ensure that ventilatory support is adjusted in real time to meet the physiological demands indicated by inputs delivered by external sensors. One of the key advantages of this system would be its use during weaning from ECMO. By simulating a target respiratory rhythm and gradually transferring the workload from ECMO to mechanical ventilation, the system could allow for a smoother and safer transition to spontaneous or assisted breathing.
从机械通气过渡到生理通气是体外膜肺氧合（ECMO）撤机过程中的一个微妙步骤，尤其是在严重呼吸衰竭之后。由于在机械通气支持的最佳程度上存在争议，维持生理通气对于确定肺休息和肺恢复之间的平衡可能至关重要。我们认为，开发用于机械通气的闭环控制系统，旨在维持或恢复接受体外膜肺氧合（ECMO）支持的患者的生理呼吸活动，可能有助于实现这一目标。在我们看来，这样一个系统的核心可能是一个受生物启发的呼吸神经控制中心计算模型，能够模拟有效排出体内二氧化碳所需的呼吸节律。模拟呼吸节律的输出（例如频率和模式）将代表患者的需求，理想情况下应维持这些需求以确保适当的二氧化碳清除。使用模拟呼吸节律动态控制与ECMO集成的机械通气将确保实时调整通气支持，以满足外部传感器输入所指示的生理需求。该系统的一个关键优势将是在ECMO撤机过程中的应用。通过模拟目标呼吸节律并逐步将工作负荷从ECMO转移到机械通气，该系统可以实现向自主呼吸或辅助呼吸的更平稳、更安全的过渡。
