Ventilation-induced jet suggests biotrauma in reconstructed airways of the intubated neonate

Eliram Nof, Metar Heller-Algazi, Filippo Coletti, Dan Waisman, Josué Sznitman

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

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 in silico 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.

Original languageEnglish (US)
Article number20190516
JournalJournal of the Royal Society Interface
Volume17
Issue number162
DOIs
StatePublished - Jan 1 2020

Bibliographical note

Funding Information:
This work was supported by the European Research Council (ERC) under the European Union's Horizon 2020 research and innovation programme (grant agreement no. 677772).

Publisher Copyright:
© 2020 The Authors. Published by the Royal Society under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/4.0/, which permits unrestricted use, provided the original author and source are credited.

Keywords

  • Biological fluid mechanics
  • Biotrauma
  • Lung injury
  • Neonates
  • Respiratory distress syndrome

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