Ratchet recruitment in the acute respiratory distress syndrome: lessons from the newborn cry

Gary F. Nieman; Jacob Herrmann; Joshua Satalin; Michaela Kollisch-Singule; Penny L. Andrews; Nader M. Habashi; David G. Tingay; Donald P. Gaver; Jason H. T. Bates; David W. Kaczka

doi:10.3389/fphys.2023.1287416

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Ratchet recruitment in the acute respiratory distress syndrome: lessons from the newborn cry

Journal article

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Ratchet recruitment in the acute respiratory distress syndrome: lessons from the newborn cry

Gary F. Nieman, Jacob Herrmann, Joshua Satalin, Michaela Kollisch-Singule, Penny L. Andrews, Nader M. Habashi, David G. Tingay, Donald P. Gaver, Jason H. T. Bates and David W. Kaczka

Frontiers in physiology, Vol.14, 1287416

11/01/2023

DOI: 10.3389/fphys.2023.1287416

PMCID: PMC10646689

PMID: 38028774

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Abstract

Patients with acute respiratory distress syndrome (ARDS) have few treatment options other than supportive mechanical ventilation. The mortality associated with ARDS remains unacceptably high, and mechanical ventilation itself has the potential to increase mortality further by unintended ventilator-induced lung injury (VILI). Thus, there is motivation to improve management of ventilation in patients with ARDS. The immediate goal of mechanical ventilation in ARDS should be to prevent atelectrauma resulting from repetitive alveolar collapse and reopening. However, a long-term goal should be to re-open collapsed and edematous regions of the lung and reduce regions of high mechanical stress that lead to regional volutrauma. In this paper, we consider the proposed strategy used by the full-term newborn to open the fluid-filled lung during the initial breaths of life, by ratcheting tissues opened over a series of initial breaths with brief expirations. The newborn’s cry after birth shares key similarities with the Airway Pressure Release Ventilation (APRV) modality, in which the expiratory duration is sufficiently short to minimize end-expiratory derecruitment. Using a simple computational model of the injured lung, we demonstrate that APRV can slowly open even the most recalcitrant alveoli with extended periods of high inspiratory pressure, while reducing alveolar re-collapse with brief expirations. These processes together comprise a ratchet mechanism by which the lung is progressively recruited, similar to the manner in which the newborn lung is aerated during a series of cries, albeit over longer time scales.

Details

Title: Subtitle: Ratchet recruitment in the acute respiratory distress syndrome: lessons from the newborn cry
Creators: Gary F. Nieman - SUNY Upstate Medical University
Jacob Herrmann - University of Iowa
Joshua Satalin - SUNY Upstate Medical University
Michaela Kollisch-Singule - SUNY Upstate Medical University
Penny L. Andrews - University of Maryland, Baltimore
Nader M. Habashi - University of Maryland, Baltimore
David G. Tingay - Royal Children's Hospital
Donald P. Gaver - Tulane University
Jason H. T. Bates - University of Vermont
David W. Kaczka - University of Iowa
Resource Type: Journal article
Publication Details: Frontiers in physiology, Vol.14, 1287416
DOI: 10.3389/fphys.2023.1287416
PMID: 38028774
PMCID: PMC10646689
NLM abbreviation: Front Physiol
ISSN: 1664-042X
eISSN: 1664-042X
Grant note: DOI: 10.13039/100000005, name: U.S. Department of Defense, award: W81XWH-20-1-0696 W81XWH-21-1-0507; DOI: 10.13039/100000002, name: National Institutes of Health, award: R01 HL142702; DOI: 10.13039/501100000925, name: National Health and Medical Research Council, award: ID2008212 ID1192676; DOI: 10.13039/501100004752, name: State Government of Victoria, award: Operational Infrastructure Support Program
Language: English
Date published: 11/01/2023
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Radiology; Anesthesia
Record Identifier: 9984507025002771

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