Ventilator-associated injury (VAI) in chronic home mechanical ventilation: a project combining lab with clinics!

COPD Non-invasive ventilation

Dr. C.A. Brandsma
Prof. dr. M.L. Duiverman
Tji Gan

Nature of the research:
Combination of lab work and clinical research. A collaboration project between the department of pathology, pulmonary diseases/home mechanical ventilation/lung transplantation.

Fields of study:
pulmonology pathology

Background / introduction
Chronic Obstructive Pulmonary Disease (COPD) is a progressive inflammatory disease characterised by airway and lung parenchyma damage. With advanced disease, patients may develop chronic hypercapnic respiratory failure. At this stage, patients are severely disabled as they suffer from severe dyspnea with simple daily activities.

Home noninvasive (mask) ventilation with high-intensity ventilatory settings (HI-NIV) has been shown to be effective in these severe COPD patients. However, in patients being mechanically ventilated on the intensive care unit for diverse reasons, high-intensity ventilation, especially high tidal volumes, has been shown to result in ventilator associated lung and diaphragm injury. Whether this occurs in home high-intensity NIV, is completely unknown.
Research question / problem definition
The aims of the study are to get insight in the effects of long-term HI-NIV in severe COPD patients on the lungs; i.e. alveolar structure and damage and inflammation: and clinical outcomes after lung transplantation.
We will perform this studie by comparing the lungs of patients that were lung transplantated, as the explanted lungs are available. We will compare a group of patients that received NIV prior to lng transplantation with a group of patients who did not receive NIV.
There are 2 different work packages, which can be done seperately or both, depending on availabitity of the student.
First, the student will investigate in the lung pathology lab changes in the alveolar basal membrane due to damage of the epithelial barrier. We will investigate both histopathological changes as well as influx of inflammatory cells.
Second, the student will investigate clinical outcomes from an existing database available at the department of pulmonary diseases. The student will gather additional data from the electronic patient system.
Curley GF, Laffey JG, Zhang H, Slutsky AS. Biotrauma and ventilator-induced lung injury: Clinical implications. Chest. 2016;150(5):1109-1117.

Halbertsma FJ, Vaneker M, Scheffer GJ, van der Hoeven JG. Cytokines and biotrauma in ventilator-induced lung injury: A critical review of the literature. Neth J Med. 2005;63(10):382-392.
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