1
|
Abbott M, Li Y, Brochard L, Zhang H. Precision Medicine Using Simultaneous Monitoring and Assessment with Imaging and Biomarkers to Manage Mechanical Ventilation in ARDS. INTENSIVE CARE RESEARCH 2023; 3:195-203. [PMID: 37664686 PMCID: PMC10471647 DOI: 10.1007/s44231-023-00045-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/24/2023] [Indexed: 09/05/2023]
Abstract
Acute respiratory distress syndrome (ARDS) has a ~ 40% mortality rate with an increasing prevalence exacerbated by the COVID-19 pandemic. Mechanical ventilation is the primary means for life-saving support to buy time for lung healing in ARDS patients, however, it can also lead to ventilator-induced lung injury (VILI). Effective strategies to reduce or prevent VILI are necessary but are not currently delivered. Therefore, we aim at evaluating the current imaging technologies to visualize where pressure and volume being delivered to the lung during mechanical ventilation; and combining plasma biomarkers to guide management of mechanical ventilation. We searched PubMed and Medline using keywords and analyzed the literature, including both animal models and human studies, to examine the independent use of computed tomography (CT) to evaluate lung mechanics, electrical impedance tomography (EIT) to guide ventilation, ultrasound to monitor lung injury, and plasma biomarkers to indicate status of lung pathophysiology. This investigation has led to our proposal of the combination of imaging and biomarkers to precisely deliver mechanical ventilation to improve patient outcomes in ARDS.
Collapse
Affiliation(s)
- Megan Abbott
- Keenan Research Centre for Biomedical Science, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON Canada
- Department of Physiology, University of Toronto, Toronto, ON Canada
| | - Yuchong Li
- The State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Laurent Brochard
- Keenan Research Centre for Biomedical Science, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON Canada
| | - Haibo Zhang
- Keenan Research Centre for Biomedical Science, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON Canada
- Department of Physiology, University of Toronto, Toronto, ON Canada
- The State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON Canada
| |
Collapse
|
2
|
Bayat S, Fardin L, Cercos-Pita JL, Perchiazzi G, Bravin A. Imaging Regional Lung Structure and Function in Small Animals Using Synchrotron Radiation Phase-Contrast and K-Edge Subtraction Computed Tomography. Front Physiol 2022; 13:825433. [PMID: 35350681 PMCID: PMC8957951 DOI: 10.3389/fphys.2022.825433] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
Synchrotron radiation offers unique properties of coherence, utilized in phase-contrast imaging, and high flux as well as a wide energy spectrum which allow the selection of very narrow energy bands of radiation, used in K-edge subtraction imaging (KES) imaging. These properties extend X-ray computed tomography (CT) capabilities to quantitatively assess lung morphology, and to map regional lung ventilation, perfusion, inflammation, aerosol particle distribution and biomechanical properties, with microscopic spatial resolution. Four-dimensional imaging, allows the investigation of the dynamics of regional lung functional parameters simultaneously with structural deformation of the lung as a function of time. These techniques have proven to be very useful for revealing the regional differences in both lung structure and function which is crucial for better understanding of disease mechanisms as well as for evaluating treatment in small animal models of lung diseases. Here, synchrotron radiation imaging methods are described and examples of their application to the study of disease mechanisms in preclinical animal models are presented.
Collapse
Affiliation(s)
- Sam Bayat
- Univ. Grenoble Alpes, Inserm UA07 STROBE Laboratory, University of Grenoble Alpes, Grenoble, France.,Department of Pulmonology and Clinical Physiology, Grenoble University Hospital, Grenoble, France
| | - Luca Fardin
- European Synchrotron Radiation Facility, Grenoble, France
| | - José Luis Cercos-Pita
- Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Gaetano Perchiazzi
- Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Alberto Bravin
- Department of Physics, University of Milano-Bicocca, Milan, Italy
| |
Collapse
|
3
|
Functional lung imaging with synchrotron radiation: Methods and preclinical applications. Phys Med 2020; 79:22-35. [PMID: 33070047 DOI: 10.1016/j.ejmp.2020.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/30/2020] [Accepted: 10/03/2020] [Indexed: 01/05/2023] Open
Abstract
Many lung disease processes are characterized by structural and functional heterogeneity that is not directly appreciable with traditional physiological measurements. Experimental methods and lung function modeling to study regional lung function are crucial for better understanding of disease mechanisms and for targeting treatment. Synchrotron radiation offers useful properties to this end: coherence, utilized in phase-contrast imaging, and high flux and a wide energy spectrum which allow the selection of very narrow energy bands of radiation, thus allowing imaging at very specific energies. K-edge subtraction imaging (KES) has thus been developed at synchrotrons for both human and small animal imaging. The unique properties of synchrotron radiation extend X-ray computed tomography (CT) capabilities to quantitatively assess lung morphology, and also to map regional lung ventilation, perfusion, inflammation and biomechanical properties, with microscopic spatial resolution. Four-dimensional imaging, allows the investigation of the dynamics of regional lung functional parameters simultaneously with structural deformation of the lung as a function of time. This review summarizes synchrotron radiation imaging methods and overviews examples of its application in the study of disease mechanisms in preclinical animal models, as well as the potential for clinical translation both through the knowledge gained using these techniques and transfer of imaging technology to laboratory X-ray sources.
Collapse
|
4
|
The effects of pressure- versus volume-controlled ventilation on ventilator work of breathing. Biomed Eng Online 2020; 19:72. [PMID: 32933529 PMCID: PMC7491025 DOI: 10.1186/s12938-020-00815-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/04/2020] [Indexed: 12/03/2022] Open
Abstract
Background Measurement of work of breathing (WOB) during mechanical ventilation is essential to assess the status and progress of intensive care patients. Increasing ventilator WOB is known as a risk factor for ventilator-induced lung injury (VILI). In addition, the minimization of WOB is crucial to facilitate the weaning process. Several studies have assessed the effects of varying inspiratory flow waveforms on the patient’s WOB during assisted ventilation, but there are few studies on the different effect of inspiratory flow waveforms on ventilator WOB during controlled ventilation. Methods In this paper, we analyze the ventilator WOB, termed mechanical work (MW) for three common inspiratory flow waveforms both in normal subjects and COPD patients. We use Rohrer’s equation for the resistance of the endotracheal tube (ETT) and lung airways. The resistance of pulmonary and chest wall tissue are also considered. Then, the resistive MW required to overcome each component of the respiratory resistance is computed for square and sinusoidal waveforms in volume-controlled ventilation (VCV), and decelerating waveform of flow in pressure-controlled ventilation (PCV). Results The results indicate that under the constant I:E ratio, a square flow profile best minimizes the MW both in normal subjects and COPD patients. Furthermore, the large I:E ratio may be used to lower MW. The comparison of results shows that ETT and lung airways have the main contribution to resistive MW in normals and COPDs, respectively. Conclusion These findings support that for lowering the MW especially in patients with obstructive lung diseases, flow with square waveforms in VCV, are more favorable than decelerating waveform of flow in PCV. Our analysis suggests the square profile is the best choice from the viewpoint of less MW.
Collapse
|
5
|
Fodor GH, Balogh AL, Sudy R, Ivankovits-Kiss O, Babik B, Petak F. Dopamine ameliorates bronchoconstriction induced by histaminergic and cholinergic pathways in rabbits. Respir Physiol Neurobiol 2019; 259:156-161. [DOI: 10.1016/j.resp.2018.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/13/2018] [Accepted: 10/22/2018] [Indexed: 11/28/2022]
|
6
|
Walesa M, Bayat S, Albu G, Baudat A, Petak F, Habre W. Comparison between neurally-assisted, controlled, and physiologically variable ventilation in healthy rabbits. Br J Anaesth 2018; 121:918-927. [DOI: 10.1016/j.bja.2018.01.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 01/08/2018] [Accepted: 01/25/2018] [Indexed: 10/17/2022] Open
|
7
|
Liu G, Wu H, Li Z. Current views of complications associated with neonatal ventilation. Minerva Pediatr 2018; 72:60-64. [PMID: 29479941 DOI: 10.23736/s0026-4946.18.04822-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Infants born prematurely require external respiratory support device like ventilation for the purpose of life saving. However, these ventilation machines have complications that sometimes unfortunately result in morbidity. New ventilation techniques have been developed to prevent morbidity, but have yet to be fully evaluated. The present review article would discuss current aspects of this life saving gear especially for pediatric patients in clinical setting. Besides basic ventilation apparatus, advancements in the filed like proportional assist ventilation, volume targeted ventilation would be discussed.
Collapse
Affiliation(s)
- Gang Liu
- Department of Neonatology, Xunzhou Children's Hospital, Xuzhou, China
| | - Hongwei Wu
- Department of Neonatology, Xunzhou Children's Hospital, Xuzhou, China
| | | |
Collapse
|
8
|
Porra L, Broche L, Dégrugilliers L, Albu G, Malaspinas I, Doras C, Wallin M, Hallbäck M, Habre W, Bayat S. Synchrotron Imaging Shows Effect of Ventilator Settings on Intrabreath Cyclic Changes in Pulmonary Blood Volume. Am J Respir Cell Mol Biol 2017; 57:459-467. [PMID: 28535074 DOI: 10.1165/rcmb.2017-0007oc] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Despite the importance of dynamic changes in the regional distributions of gas and blood during the breathing cycle for lung function in the mechanically ventilated patient, no quantitative data on such cyclic changes are currently available. We used a novel gated synchrotron computed tomography imaging to quantitatively image regional lung gas volume (Vg), tissue density, and blood volume (Vb) in six anesthetized, paralyzed, and mechanically ventilated rabbits with normal lungs. Images were repeatedly collected during ventilation and steady-state inhalation of 50% xenon, or iodine infusion. Data were acquired in a dependent and nondependent image level, at zero end-expiratory pressure (ZEEP) and 9 cm H2O (positive end-expiratory pressure), and a tidal volume (Vt) of 6 ml/kg (Vt1) or 9 ml/kg (Vt2) at an Inspiratory:Expiratory ratio of 0.5 or 1.7 by applying an end-inspiratory pause. A video showing dynamic decreases in Vb during inspiration is presented. Vb decreased with positive end-expiratory pressure (P = 0.006; P = 0.036 versus Vt1-ZEEP and Vt2-ZEEP, respectively), and showed larger oscillations at the dependent image level, whereas a 45% increase in Vt did not have a significant effect. End-inspiratory Vb minima were reduced by an end-inspiratory pause (P = 0.042, P = 0.006 at nondependent and dependent levels, respectively). Normalized regional Vg:Vb ratio increased upon inspiration. Our data demonstrate, for the first time, within-tidal cyclic variations in regional pulmonary Vb. The quantitative matching of regional Vg and Vb improved upon inspiration under ZEEP. Further study is underway to determine whether these phenomena affect intratidal gas exchange.
Collapse
Affiliation(s)
- Liisa Porra
- 1 Department of Physics, University of Helsinki, Helsinki, Finland.,2 Medical Imaging Center, Helsinki University Hospital, Helsinki, Finland
| | - Ludovic Broche
- 3 Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Sweden
| | - Loïc Dégrugilliers
- 4 Department of Pediatric Intensive Care, Amiens University Hospital, Amiens, France
| | - Gergely Albu
- 5 Anesthesiological Investigations Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - Iliona Malaspinas
- 5 Anesthesiological Investigations Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - Camille Doras
- 5 Anesthesiological Investigations Unit, University Hospitals of Geneva, Geneva, Switzerland
| | | | | | - Walid Habre
- 5 Anesthesiological Investigations Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - Sam Bayat
- 5 Anesthesiological Investigations Unit, University Hospitals of Geneva, Geneva, Switzerland.,7 University of Grenoble EA-7442 and Department of Clinical Physiology, Sleep and Exercise, Grenoble University Hospital, Grenoble, France
| |
Collapse
|