Protecting preemies and patients on ventilators

Critically ill patients who require ventilators are at risk for developing acute respiratory distress syndrome, a condition with a mortality rate higher than that of breast cancer in the United States. Four out of 10 of those patients who develop acute respiratory distress syndrome will not survive. Those who do may cope with lung problems forever.

Scientists from Upstate are leading efforts to prevent the syndrome from developing. Their research could prompt a change in the way patients all over the world are treated while they are on breathing machines, or ventilators.

Most patients who develop an acute lung injury do so within 48 hours of being connected to a ventilator and this can progress to acute respiratory distress syndrome. The current treatment is to reduce the volume of air delivered to the patient, which improves his or her survival rate by less than 10 percent.

An Upstate laboratory run by Gary Nieman, in collaboration with Nader Habashi, MD, from the R. Adams Cowley Shock Trauma Center in Baltimore, proposes a new strategy to prevent the development of acute respiratory distress syndrome. It is a type of ventilation, called airway pressure release ventilation, which lengthens the patient’s inspiration phase to open collapsed lung and shortens the patient’s exhalation phase to keeps the air sacs from collapsing. The trick is, caregivers must know what to look for so they can intervene ahead of the syndrome’s development.

“Timing of an intervention may be as critical as the intervention itself,” Nieman wrote with colleagues in the Journal of Trauma and Acute Care Surgery.

Research from his lab has shown that early intervention with airway pressure release ventilation blocks the development of acute respiratory distress syndrome and prevents swelling and inflammation in the lungs.

Now Nieman and Habashi– with assistance from Research Scientist Josh Satalin, and surgery residents Michaela Kollisch-Singule, MD, and Sumeet Jain, MD – are exploring whether this same strategy can save the lives of premature babies.

Human gestation lasts 40 weeks. Babies born before 37 weeks are likely to have organs that are not fully developed. The lungs are of particular concern because the body does not produce the surfactant they need in order to keep the lungs inflated until about week 28. The chance of survival is low for babies born before then.

The theory is that airway pressure release ventilation used on babies born as early as 25 weeks gestation could provide their bodies enough time to start producing the surfactant that will keep their lungs open and functioning for the rest of their lives.

Nieman can’t help the enthusiasm he feels for the research. “We are currently in the position to change how medicine is practiced within the next few years.”

Already, Nieman learned in July that Albany Medical Center has implemented the use of airway pressure release ventilation for all of its premature babies who weigh fewer than 1,000 grams.

“This is what basic science animal research is all about, and as you can imagine, our team is very excited about the potential benefit that these experiments will bring to the clinic.”

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