Development of new method of mechanical ventilation reducing transpulmonary pressure

• Project/Area Number: 15K10535
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Research Field: Anesthesiology
• Research Institution: Osaka University
• Principal Investigator: Uchiyama Akinori 大阪大学, 医学系研究科, 准教授 (00324856)
• Co-Investigator(Kenkyū-buntansha): 藤野 裕士 大阪大学, 医学系研究科, 教授 (50252672) ; 吉田 健史 大阪大学, 医学部附属病院, 医員 (50725520)
• Research Collaborator: YAMASHITA Tomonori ; KOYAMA Yukiko ; YOSHIDA Takeshi
• Project Period (FY): 2015-04-01 – 2018-03-31
• Project Status: Completed (Fiscal Year 2017)
• Budget Amount: ¥4,680,000 (Direct Cost: ¥3,600,000、Indirect Cost: ¥1,080,000); Fiscal Year 2017: ¥1,690,000 (Direct Cost: ¥1,300,000、Indirect Cost: ¥390,000); Fiscal Year 2016: ¥1,430,000 (Direct Cost: ¥1,100,000、Indirect Cost: ¥330,000); Fiscal Year 2015: ¥1,560,000 (Direct Cost: ¥1,200,000、Indirect Cost: ¥360,000)
• Keywords: 人工呼吸 / 自発呼吸 / 肺保護換気 / 重炭酸ナトリウム / トリメタロール / 呼吸性アシドーシス / PEEP / 肺傷害 / 二酸化炭素除去 / 気管チューブカフ圧 / 呼気補助 / 経肺圧 / ARDS / THAM

Outline of Final Research Achievements

Transpulmonary pressure PL (= airway pressure - intrathoracic pressure) is involved in the mechanical ventilation-associated lung injuries. PL is increased by a strong spontaneous breathing effort. The purpose of this study is to develop a method that can suppress spontaneous respiratory effort and reduce PL. Intravenous administration of alkalizing agents and adjustment of PEEP level were used for control of spontaneous respiratory effort. Sodium bicarbonate and THAM (tromethamine) were used as alkalizing agents. We used a rabbit model with respiratory failure. Administration of the alkalizing agents decreased minute ventilation. THAM has more effective than sodium bicarbonate. There was a possibility that THAM and sodium bicarbonate had a difference in the transition to cerebrospinal fluid. When PEEP during mechanical ventilation was set to a value that maximized pulmonary compliance, PL can be reduced and lung protection ventilation will be obtained.

Research Products

• [Presentation] 呼吸性アシドーシスに対するアルカリ投与の呼吸抑制作用の検討 (2017)
  • Author(s): 山下智範 内山昭則 小山有紀子 吉田健史 藤野裕士
  • Organizer: 第44回日本集中治療医学会学術集会
  • Place of Presentation: 札幌
  • Year and Date: 2017-03-09
• [Presentation] Spontaneous Breathing During Mechanical Ventilation Injures Dependent Lung (2017)
  • Author(s): Koyama Y, Yoshida T, Nakahashi S, Uchiyama A, kawaguchi, Yamamoto H, Kavanagh P.B, Fujino Y
  • Organizer: ATS(American Thoracic Society)International Conference 2017
  • Int'l Joint Research
• [Presentation] The impact of alkalizing agents on breathing effort in lung injury model rabbits (2017)
  • Author(s): Yamashita T, Koyama Y, Uchiyama A, Fujino Y
  • Organizer: ATS(American Thoracic Society)International Conference 2017
  • Int'l Joint Research
• [Presentation] 食道バルーンの臨床活用法 (経肺圧: PEEP と自発呼吸の観点から) (2016)
  • Author(s): 内山昭則
  • Organizer: 第38回呼吸療法医学会
  • Place of Presentation: 名古屋
  • Year and Date: 2016-07-16
  • Invited