Visualising respiratory dysfunction during and after mechanical ventilation
14 september 2018
Antwerp University Hospital (UZA) - Auditorium Kinsbergen (route 12) - Wilrijkstraat 10 - 2650 EDEGEM
Prof P. Jorens & Prof M. Vercauteren
PhD defence Tom Schepens - Faculty of Medicine and Health Sciences
Presentation in Dutch
Respiratory dysfunction is a frequently encountered problem in the intensive care unit (ICU) and after general anaesthesia. This problem is the consequence of many factors that are often simultaneously present. Some of these factors are inherent to the disease of the patient, e.g. systemic inflammation and sepsis will impact the lungs and respiratory muscles. However, the way we ventilate and anaesthetize a patient also impacts his respiratory function, and we aimed to explore this interaction and effect on the diaphragm, lungs and airways. The diaphragm is the most important inspiratory respiratory muscle and was thus of prime interest for us. To archieve this, we aimed to visualize the effects using various diagnostic tools, including electromyography (EMG), ultrasound, CT scan images and biomarkers.
Furthermore, we have used animal models, trials in healthy volunteers and clinical studies for a translational approach to this complex problem. We discovered that the drugs we use during anaesthesia could affect respiratory muscle activity, possibly through the central control of breathing and neural drive to the muscles. Secondly, patients who were ventilated for several days had considerable diaphragm muscle atrophy, and absence of spontaneous breathing activity during mechanical ventilation has an important role in this process. Third, in patients with acute lung injury or acute respiratory distress syndrome, mechanical ventilation impacts both the lung tissue as well as the airways, distending some airways to a level that may be harmful. Finally, biomarkers like the red cell distribution width (RDW) can help us in predicting who is at risk for a deteriorating respiratory function.