High-Frequency Oscillatory Ventilation and Ventilator-Induced Lung Injury: Size Does Matter.

摘要: Objectives The theoretical basis for minimizing tidal volume during high-frequency oscillatory ventilation may not be appropriate when lung tissue stretch occurs heterogeneously and/or rapidly. objective of this study was to assess the extent which increased heterogeneity contribute ventilator-induced injury in adults compared with neonates on size, using a computational model human lungs. Design Computational modeling study. Setting Research laboratory. Subjects High-fidelity, 3D models lungs, scaled various sizes representative neonates, children, and adults, varying severity. All were generated from one thoracic CT image healthy adult male. Interventions Oscillatory simulated each at frequencies ranging 0.2 40 Hz. Sinusoidal flow oscillations delivered airway opening distributed through lungs according regional parenchymal mechanics. Measurements main results Acinar assessed by coefficient variation magnitudes across all acini model. High-frequency simulations demonstrated increasing decreasing ratio deadspace total acinar volume, frequency above corner resonant frequency. Potential amplification greatest injured adult-sized higher quality factors indicating presence underdamped regions. Conclusions potential is enhanced or despite reduced volumes, especially due heterogeneous flow. should considered management.