Abstract
The current methods of mechanical ventilation and pulmonary drug delivery do not account for the heterogeneity of acute respiratory distress syndrome or its dependence on gravity. The severe lung disease caused by severe acute respiratory distress syndrome coronavirus 2, coronavirus disease 2019, is one of the many causes of acute respiratory distress syndrome. Severe acute respiratory distress syndrome coronavirus 2 has caused more than three million deaths worldwide and has challenged all therapeutic options for mechanical ventilation. Thus, new therapies are necessary to prevent deaths and long-term complications of severe lung diseases and prolonged mechanical ventilation. The authors of the present report have developed a novel device that allows selective lobe ventilation and selective lobe recruitment and provides a new platform for pulmonary drug delivery. A major advantage of separating lobes that are mechanically heterogeneous is to allow for customization of ventilator parameters to match the needs of segments with similar compliance, a better overall ventilation perfusion relationship, and prevention of ventilator-induced lung injury of more compliant lobes. This device accounts for lung heterogeneity and is a potential new therapy for acute lung injury by allowing selective lobe mechanical ventilation using two novel modes of mechanical ventilation (differential positive end-expiratory pressure and asynchronous ventilation), and two new modalities of alveolar recruitment (selective lobe recruitment and continuous positive airway pressure of lower lobes with continuous ventilation of upper lobes). Herein the authors report their initial experience with this novel device, including a brief overview of device development; the initial in vitro, ex vivo, and in vivo testing; layout of future research; potential benefits and new therapies; and expected challenges before its uniform implementation into clinical practice.
Keywords: acute lung injury; acute respiratory distress syndrome; double-lumen tube; heterogeneous lung disease; lobar ventilation; lobe ventilation; mechanical ventilation; pulmonary drug delivery; regional ventilation; split ventilation; ventilator.
【저자키워드】 acute respiratory distress syndrome, mechanical ventilation, acute lung injury, double-lumen tube, heterogeneous lung disease, lobar ventilation, lobe ventilation, pulmonary drug delivery, regional ventilation, split ventilation, ventilator, 【초록키워드】 coronavirus disease, Respiratory distress syndrome, Coronavirus disease 2019, coronavirus, therapy, acute respiratory distress syndrome, mechanical ventilation, Ventilation, lung, Lung disease, Lung injury, in vitro, coronavirus 2, heterogeneity, acute lung injury, implementation, Lung diseases, Compliance, death, Complication, recruitment, in vivo, platform, Clinical practice, acute respiratory distress, Continuous Positive Airway Pressure, therapeutic option, respiratory distress, positive airway pressure, End-Expiratory Pressure, lower lobes, Ventilator-induced lung injury, Positive end-expiratory pressure, Ex vivo, severe acute respiratory distress syndrome, alveolar recruitment, ventilator, syndrome, lobe, heterogeneous, potential benefits, gravity, lobes, ventilator parameters, selective, lower lobe, lobar, Prevent, initial, caused, provide, potential benefit, cause, expected, ventilator parameter, 【제목키워드】 drug, pulmonary, delivery, novel, lobe,