Prematurity is a condition that affects the 5-18% of newborns and is one of the leading causes of morbidity and mortality (44-70% in Europe for extremely preterm babies). Although the mortality rate has decreased, as a result of medical advancements, it is essential to continue researching treatments in order to provide the best care for preterm infants. Respiratory support is essential to allow the baby to develop in the extrauterine environment, and identifying the best technique for each infant is crucial for a successful assistance. The goal of respiratory support is providing the best support to promote ventilation and gas exchange, in the least invasive way. In order to minimize the newborn’s effort during respiration and to best synchronize mechanical ventilation with spontaneous breaths, Neurally Adjusted Ventilatory Assist (NAVA) is the current state of art. It provides respiratory pressure to patients proportional to their inspiratory efforts, as measured by trans-oesophageal electromyography. Despite the great advantages, NAVA is an invasive technique that requires the positioning of an oesophageal catheter in the neonate to detect the electromyographic signal of the diaphragm, which is the main muscle involved in the respiratory act. Moreover, the catheter is very expensive and only available in a dedicated mechanical ventilator. Recent studies have demonstrated the possibility to use surface EMG of the diaphragm to detect the spontaneous breathing of preterm infants, but so far this information has never been used to trigger the ventilation. The goal of this project is to develop a mechanical ventilator with an integrated novel ventilation modality based on the acquisition of surface electromyography of the diaphragm, in order to provide inspiratory and expiratory pressures synchronous to the baby’s spontaneous respiratory efforts in a non-invasive way. The device was designed and developed at TechRes Lab of Politecnico di Milano integrating and improving the algorithm to detect triggers from surface electromyography developed at Amsterdam UMC Hospital. The device was validated in-vitro at Politecnico di Milano, and a preliminary in-vivo study, conducted at Amsterdam UMC, was performed on 4 newborns to provide the first results on the feasibility of this new ventilation modality.
La prematurità è una condizione molto diffusa che colpisce il 5-18% dei neonati e rappresenta una delle principali cause di morbidità e mortalità, che raggiunge il 44-70% in caso di neonati estremamente prematuri. Anche se il tasso di mortalità si è ridotto grazie ai progressi nella medicina, è essenziale continuare a cercare nuovi trattamenti per fornire la miglior cura possibile ai neonati. Il supporto respiratorio risulta essere fondamentale per permettergli di continuare il proprio sviluppo nell’ambiente extrauterino, e l’identificazione della migliore tecnica per ciascun neonato è essenziale per una efficace assistenza; l’obiettivo dovrebbe essere fornire il migliore supporto non invasivo per permettere al neonato di affrontare gli ultimi stadi del suo sviluppo. La ventilazione NAVA (Neurally Adjusted Ventilatory Assist) si basa sull’acquisizione dell’attività elettrica del diaframma, principale muscolo coinvolto nella respirazione. Essa consente di minimizzare lo sforzo del neonato durante la respirazione sincronizzando la ventilazione meccanica con i suoi respiri spontanei. Nonostante i grandi vantaggi della NAVA, questa è una tecnica invasiva che richiede il posizionamento di un catetere esofageo nel neonato. È inoltre costosa e disponibile solo su un ventilatore dedicato. Recenti studi hanno dimostrato la possibilità di utilizzare l’elettromiografia di superficie del diaframma per rilevare il respiro spontaneo di neonati, ma fino a oggi questa informazione non è mai stata usata per controllare la ventilazione. L’obiettivo di questo progetto di tesi è quello di sviluppare un ventilatore meccanico che integri una nuova modalità di ventilazione sincronizzata con l’attività diaframmatica di superficie, così da fornire le pressioni di inspirazione ed espirazione in maniera sincrona allo sforzo respiratorio del paziente. Il dispositivo è stato sviluppato al TechRes Lab del Politecnico di Milano integrando ed ottimizzando l’algoritmo sviluppato all’Amsterdam UMC, ed è stato validato in-vitro al Politecnico di Milano. È stato infine effettuato uno studio preliminare in-vivo presso l’Amsterdam UMC su quattro neonati per condurre una prima analisi sull’efficacia di questa nuova modalità di ventilazione.
A mechanical ventilator for delivering synchronized nIPPV to newborns based on surface electromyography of the diaphragm
Pieristè, Tommaso
2022/2023
Abstract
Prematurity is a condition that affects the 5-18% of newborns and is one of the leading causes of morbidity and mortality (44-70% in Europe for extremely preterm babies). Although the mortality rate has decreased, as a result of medical advancements, it is essential to continue researching treatments in order to provide the best care for preterm infants. Respiratory support is essential to allow the baby to develop in the extrauterine environment, and identifying the best technique for each infant is crucial for a successful assistance. The goal of respiratory support is providing the best support to promote ventilation and gas exchange, in the least invasive way. In order to minimize the newborn’s effort during respiration and to best synchronize mechanical ventilation with spontaneous breaths, Neurally Adjusted Ventilatory Assist (NAVA) is the current state of art. It provides respiratory pressure to patients proportional to their inspiratory efforts, as measured by trans-oesophageal electromyography. Despite the great advantages, NAVA is an invasive technique that requires the positioning of an oesophageal catheter in the neonate to detect the electromyographic signal of the diaphragm, which is the main muscle involved in the respiratory act. Moreover, the catheter is very expensive and only available in a dedicated mechanical ventilator. Recent studies have demonstrated the possibility to use surface EMG of the diaphragm to detect the spontaneous breathing of preterm infants, but so far this information has never been used to trigger the ventilation. The goal of this project is to develop a mechanical ventilator with an integrated novel ventilation modality based on the acquisition of surface electromyography of the diaphragm, in order to provide inspiratory and expiratory pressures synchronous to the baby’s spontaneous respiratory efforts in a non-invasive way. The device was designed and developed at TechRes Lab of Politecnico di Milano integrating and improving the algorithm to detect triggers from surface electromyography developed at Amsterdam UMC Hospital. The device was validated in-vitro at Politecnico di Milano, and a preliminary in-vivo study, conducted at Amsterdam UMC, was performed on 4 newborns to provide the first results on the feasibility of this new ventilation modality.| File | Dimensione | Formato | |
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TESI_Pieristè_Tommaso.pdf
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Descrizione: Tesi
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3.9 MB
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3.9 MB | Adobe PDF | Visualizza/Apri |
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Executive_Summary_Pieristè_Tommaso.pdf
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Descrizione: Executive Summary
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1.02 MB | Adobe PDF | Visualizza/Apri |
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https://hdl.handle.net/10589/203753