Ventilation-induced Jet Suggests Biotrauma in Reconstructed Airways of the Intubated Neonate

Overview

Journal J R Soc Interface

Specialties Biology
Biomedical Engineering
Biophysics

Date 2020 Jan 9

PMID 31910775

Citations 7

Authors

Eliram Nof

Metar Heller-Algazi

Filippo Coletti

Dan Waisman

Josue Sznitman

Affiliations

Soon will be listed here.

Abstract

We investigate respiratory flow phenomena in a reconstructed upper airway model of an intubated neonate undergoing invasive mechanical ventilation, spanning conventional to high-frequency ventilation (HFV) modes. Using high-speed tomographic particle image velocimetry, we resolve transient, three-dimensional flow fields and observe a persistent jet flow exiting the endotracheal tube whose strength is directly modulated according to the ventilation protocol. We identify this synthetic jet as the dominating signature of convective flow under intubated ventilation. Concurrently, our wall shear stress analysis reveals a hitherto overlooked source of ventilator-induced lung injury as a result of jet impingement on the tracheal carina, suggesting damage to the bronchial epithelium; this type of injury is known as biotrauma. We find HFV advantageous in mitigating the intensity of such impingement, which may contribute to its role as a lung protective method. Our findings may encourage the adoption of less invasive ventilation procedures currently used in neonatal intensive care units.

Citing Articles

Gas transport mechanisms during high-frequency ventilation.

Scott T, Jacob C, Tingay D, Leontini J Respir Res. 2024; 25(1):446.

PMID: 39732676 PMC: 11682653. DOI: 10.1186/s12931-024-03049-w.

In vitro-in silico correlation of three-dimensional turbulent flows in an idealized mouth-throat model.

Nof E, Bhardwaj S, Koullapis P, Bessler R, Kassinos S, Sznitman J PLoS Comput Biol. 2023; 19(3):e1010537.

PMID: 36952557 PMC: 10072468. DOI: 10.1371/journal.pcbi.1010537.

Ventilation-induced epithelial injury drives biological onset of lung trauma in vitro and is mitigated with prophylactic anti-inflammatory therapeutics.

Nof E, Artzy-Schnirman A, Bhardwaj S, Sabatan H, Waisman D, Hochwald O Bioeng Transl Med. 2022; 7(2):e10271.

PMID: 35600654 PMC: 9115701. DOI: 10.1002/btm2.10271.

Human Multi-Compartment Platform for Emulating Respiratory Airborne Transmission: From Nose to Pulmonary Acini.

Nof E, Zidan H, Artzy-Schnirman A, Mouhadeb O, Beckerman M, Bhardwaj S Front Physiol. 2022; 13:853317.

PMID: 35350687 PMC: 8957966. DOI: 10.3389/fphys.2022.853317.

Effect of Bias Gas Flow on Tracheal Cytokine Concentrations in Ventilated Extremely Preterm Infants: A Randomized Controlled Trial.

Bach K, Kuschel C, Patterson N, Skwish H, Huth S, Phua H Neonatology. 2021; 118(3):332-339.

PMID: 33827091 PMC: 8491472. DOI: 10.1159/000515364.

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