ALI, ARDS & Ventilator Research
Acute lung injury (ALI) and its most severe form, acute respiratory distress syndrome (ARDS), typically develop following an acute systemic (e.g. sepsis) or lung (e.g. pneumonia, aspiration, trauma) injury. These serious and life threatening conditions are characterized by a wide-spread lung inflammation, alveolar and capillary damage and dysfunction, as well as a long term build-up of scar tissue. From a lung function perspective, these lead to pulmonary edema formation, collapse of lung areas, poor blood oxygenation, and enhanced breathing efforts.
INTERVENTION AND MEASUREMENT DEVICE
The treatment of ARDS patients invariably involves mechanical ventilation as the level of blood oxygenation drops below critical values. While on one hand this can be beneficial for the patient, it also represents an aggravating risk factor as mechanical ventilation can also induce lung injury. Therefore in addition to studying the disease pathology associated with ARDS, researchers must also consider the impact mechanical ventilation can have on the respiratory system and how to best minimize it.
Being a highly programmable computer-controlled piston ventilator as well as a lung function measurement device, the flexiVent system has been selected by many research groups as a tool of choice in this research area. Several examples of this combination of functionalities as well as of the study design advantage that it provides can be found in the literature.
- Mouse Models of Acute Respiratory Distress Syndrome – Aeffner, F., et al. Toxicologic Pathology. 43(8), pp. 1074–1092. 2015.
- Relation between Respiratory Mechanics, Inflammation, and Survival in Experimental Mechanical Ventilation – Szabari, M. V. et al. American Journal of Respiratory Cell and Molecular Biology. 60(2), pp. 179–188. 2019
- FOXF1 maintains endothelial barrier function and prevents edema after lung injury – Cai, Y. et al. Science Signaling, 9(424), p. ra40. 2016.
- Leukotriene B4 receptor type 2 protects against pneumolysin-dependent acute lung injury – Shigematsu, M. et al. Scientific Reports. 6(1), p. 34560. 2016.
- Using injury cost functions from a predictive single-compartment model to assess the severity of mechanical ventilator-induced lung injuries – Mellenthin, M. M. et al. Journal of Applied Physiology. 127(1), pp. 58–70. 2019.
- Alveolar leak develops by a rich-get-richer process in ventilator-induced lung injury – Hamlington, K. L. et al. PLOS ONE. 13(3), p. e0193934. 2018.
- Ventilator-induced lung injury is aggravated by antibiotic mediated microbiota depletion in mice – Wienhold, S.-M. et al. Critical Care. 22(1), p. 282. 2018.
- Pulmonary Effects of Adjusting Tidal Volume to Actual or Ideal Body Weight in Ventilated Obese Mice – Guivarch, E. et al. Scientific Reports. 8(1), p. 6439. 2018.
- LPS-induced acute lung injury involves NF-kB–mediated downregulation of SOX18 – Gross, C. M. et al. American Journal of Respiratory Cell and Molecular Biology, 58(5), pp. 614–624. 2018.
- Emerging roles of calcium-activated K channels and TRPV4 channels in lung oedema and pulmonary circulatory collapse – Simonsen, U. et al. Acta Physiologica, Vol. 219, pp. 176–187. 2017.
CONTINUOUS VENTILATORY PATTERNS
Impaired pulmonary function develops as a result of ALI or ARDS. In preclinical disease models, the analysis of ventilatory patterns in conscious subjects could prove to be useful for the continuous tracking of disease progression over a given time period. Conscious monitoring with one of the various plethysmography techniques (unrestrained whole body plethysmography, double chamber plethysmography, or head-out plethysmography) is capable of tracking changes in a number of conventional parameters (i.e. tidal volume, respiratory rate, minute ventilation, peak inspiratory and expiratory flow, etc.) which could be used to follow the functional consequences of the lung injury. There are many examples in literature of the use of ventilatory parameters to track changes and monitor the effects of induced lung insults.
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