TÚ B5.1

TÚ B5.1 Optimisation of artificial lung ventilation (Doc. Ing. Karel Roubík, Ph.D.)

The main aims of the research activities will comprise investigation, optimisation and technical support of unconventional regimens of artificial lung ventilation. These ventilatory techniques are called “protective regimens,” they are studied recently or in the phase of their experimental usage. Effective control and strategy of high frequency oscillatory ventilation, its monitoring, spontaneous breathing during high-frequency ventilation, investigation and technical assurance of tracheal gas insufflation will be the main topics of the research. Results are supposed to be directly applicable in the clinical practice.

Despite the huge number of modern ventilators and equipment for artificial lung ventilation, there is still a pending question about adequate selection of the ventilatory regimen and suitable ventilatory technique. This is supported by the fact that the mortality in the case of acute respiratory failure is 40 – 60 %. It is caused very often by conditions evoked by a ventilator, which are totally different from the original physiological ones. As a result, a disease called VILI (Ventilator-Induced Lung Injury) appears. Investigation of such ventilatory regimens that minimise incidence of VILI is of a big importance and interest worldwide. Especially high frequency oscillatory ventilation seems to be a promising alternative to the conventional ventilation because it uses very small tidal volumes and pressure amplitudes in the alveolar space. Other promising strategies are tracheal gas insufflation and intratracheal pulmonary ventilation, both belonging to the additional ventilatory techniques improving oxygenation and gas exchange while decreasing incidence of VILI. Nevertheless, these regimens are not effectives in all cases. Very often they are inefficient only because of insufficient knowledge about their functioning, principles, intrapulmonary conditions, gas exchange etc. and therefore because of their incorrect application. The described unsolved problems connected with the unconventional ventilatory regimens, design of their monitoring and definition of recommendation for their usage are the subjects of interest in this research project. The research will be conducted in co-operation with medical institutions (VU University Medical Centre, PICU, Amsterdam, The Nederland, University Hospital Kralovské Vinohrady, 3rd School of Medicine, UK and University Thomayer Hospital, IPVZ) that assures experimental verification of theoretical results, prompt reaction on new trends and research in the field of artificial lung ventilation and last but not least the direct application of the results in the clinical practice.

Research topics:
  • Design of a model of the respiratory system suitable for studying differences between conventional and unconventional ventilatory strategies, intrapulmonary conditions, etc.
  • Introduction of different pathologies into the model of the respiratory system with the aim to predict ventilatory efficacy in the particular cases.
  • Design of a new model for description and studying of gas exchange and gas flow during both conventional and unconventional ventilations and description of the main differences.
  • Experimental study of gas flow in the lungs. Optimisation of the gas-flow model according to the experimental results.
  • Investigation of other diagnostic methods of respiratory mechanics and ventilatory regimens, e.g. impedance methods, etc.
  • Detailed importance analysis of the mechanical parameters of the respiratory system, lungs, chest wall etc. for ventilatory regimens. Development of the methods of their measurement and evaluation.
  • Experiments and a clinical study for testing the theoretical results validity.
  • Development of Demand Flow System – a device allowing spontaneous breathing during high-frequency oscillatory ventilation HFOV
  • Definition of recommendations for clinical applications of selected unconventional ventilatory techniques.
The research team:

Karel Roubík, Assoc. Prof, M.Sc., Ph.D. (leader)

Martin Rožánek, M.Sc.

Vít Kopelent, M.Sc.

Richard Grünes, M.Sc.

Karel Bláha, M.Sc.

Roman Matějka, Jaroslav Marek, Tomáš Kubal (assistants)

Selected outputs of the project during the year 2005 and 2006:

  • van Heerde M., Roubik K., Kopelent V., Plötz B.F., Markhorst D.G.: Unloading work of breathing during high-frequency oscillatory ventilation: a bench study. Critical Care. 2006, vol. 10, no. 4, R103. ISSN 1364–8535. http://ccforum.com/content/10/4/R103
  • van Heerde, M., van Genderingen, H.R., Leenhoven, T., Roubík, K., Plotz, F.B. et al.: Imposed work of breathing during high-frequency oscillatory ventilation: a bench study. Critical Care. 2006, vol. 10, no. 1, s. 23–29. ISSN 1364–8535. http://ccforum.com/content/10/1/r23
  • Pachl, J., Roubík, K., Waldauf, P., Fric, M., Zábrodský, V.: Normocapnic High-frequency Oscillatory Ventilation Affects Differently Extrapulmonary and Pulmonary Forms of Acute Respiratory Distress Syndrome in Adults. Physiological Research. 2006, vol. 55, no. 1, s. 15–24. ISSN 0862–8408. http://www.biomed.cas.cz/physiolres/pdf/2006/55_15.pdf
  • Roubík, K., Rožánek, M., Kopelent, V., Jursa, T.: Principles and properties of protective unconventional lung ventilatory techniques. Acta Mechanica Slovaca. 2005, vol. 9, no. 2-A/2005, s. 165–168. ISSN 1335–2393.
  • Pachl, J., Roubík, K., Fric, M.: Normocapnic HFOV Affects Differently Extrapulmonary and Pulmonary ARDS. A+IC News Anaesthesiology & Intensive Care. 2004, vol. 2004, no. 54, s. 46–47. ISSN 1810–1887.
  • Roubík, K., Pachl, J.: Introduction of HFOV is more beneficial in adult patients with extrapulmonary form of acute respiratory distress syndrome. [abstract]. Acta Anaesthesiologica Scandinavica. 2005, vol. 49, no. 117, s. 43. ISSN 0001–5172.
  • Rožánek, M., Roubík, K.: Studying the Interaction between the Mechanical Properties of the Respiratory System and Artificial Lung Ventilation. [abstract]. Acta Anaesthesiologica Scandinavica. 2005, vol. 49, no. 117, s. 43. ISSN 0001–5172.