Abstract
High-frequency oscillatory ventilation (HFOV) is a commonly used therapy applied to neonates requiring ventilatory support during their first weeks of life. Despite its wide application, the underlying gas exchange mechanisms promoting the success of HVOF in neonatal care are not fully understood until today. In this work, a highly resolved computational lung model, derived from Magnetic Resonance Imaging (MRI) and Infant Lung Function Testing (ILFT), is used to reveal the reason for highly efficient gas exchange during HFOV, in the preterm infant. In total we detected six mechanisms that facilitate gas exchange during HFOV: (i) turbulent vortices in large airways; (ii) asymmetric in- and expiratory flow profiles; (iii) radial mixing in main bronchi; (iv) laminar flow in higher generations of the respiratory tract; (v) pendelluft; (vi) direct ventilation of central alveoli. The illustration of six specific gas transport phenomena during HFOV in preterm infants advances general knowledge on protective ventilation in neonatal care and can support decisions on various modes of ventilatory therapy at high frequencies.
Highlights
Preterm infants with structurally and functionally immature lungs often require prolonged assisted mechanical ventilation and deserve the most protective methods to reduce the side effects of ventilation therapy
None of the previously reported approaches was able to respect the mechanics of the respiratory system of the infant and the effect of tube leakage, which is common in neonatal ventilation
To assure clinically realistic airflow conditions in the High-frequency oscillatory ventilation (HFOV) model global flow monitoring is conducted at the proximal end of the endotracheal tube and visualised in Fig. 1a over six breathing cycles
Summary
Preterm infants with structurally and functionally immature lungs often require prolonged assisted mechanical ventilation and deserve the most protective methods to reduce the side effects of ventilation therapy. Eight potential mechanisms of gas exchange were suggested explaining oxygen delivery to the terminal lung regions even for tidal volumes much smaller than respiratory dead space[6]. While providing important first insights, the computational methods have not been available for investigations on HFOV in the preterm infant. Investigated gas transport during HFOV in the canine lung while the work in[7,8] was limited to artificial or imaging-based adult airway tree geometries. Patient, which governs the passive behaviour of the lung especially during expiration This novel computational lung model can be subjected to representative conditions of HFOV and is perfectly suited to reconfirm the previously hypothesised gas transport mechanisms in HFOV6
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