Restoring Ventilatory Control Using an Adaptive Bioelectronic System

Siu, Ricardo; Abbas, James J.; Hillen, Brian; Gomes, Jefferson; Coxe, Stefany; Castelli, Jonathan; Renaud, Sylvie; Jung, Ranu

doi:10.1089/neu.2018.6358

Cited by 8 publications

(20 citation statements)

References 55 publications

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“…For the current open-loop DP system not responding to changes in equipment components and physiological needs, some researchers [81,82] have proposed to establish a closed-loop diaphragm pacing system relying on changes in respiratory airflow (Figure 12). Nevertheless, closed-loop DP has not yet appeared on the market and in clinical applications.…”

Section: Discussionmentioning

confidence: 99%

“…e PG/PS controller [81,83], containing two modules PG and PS, builds a closed-loop diaphragm pacing system. e pacing cycle is set in the PG module, and the PS module adaptively adjusts the stimulation parameters with the change of actual respiratory airflow to make ideal respiratory airflow.…”

Section: Discussionmentioning

confidence: 99%

“…e authors declare that they have no conflicts of interest. Figure 12: Animal model of closed-loop diaphragm pacing system [81]. e system controller adjusts the stimulation parameters online based on the error between the measured respiratory airflow and the ideal airflow.…”

Section: Conflicts Of Interestmentioning

confidence: 99%

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Restoration Methods of Respiratory Function for Spinal Cord Injury

Ren

Shi

et al. 2020

Mathematical Problems in Engineering

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Respiratory dysfunction caused by high spinal cord injury is fatal damage. Three treatment methods commonly used in the clinic, diaphragm pacing, mechanical ventilation, and respiratory muscle training, were chosen to explain the respiratory function reconstruction of spinal cord injury. The characteristics, research status, advantages, and disadvantages of these three treatment methods are reviewed. Diaphragm pacing technology has attracted much attention due to its price-friendly, efficient, and closer to physiological respiration. Therefore, the emphasis is on describing the characteristics of the stimulation waveform of diaphragm pacing and the mathematical correspondence between stimulation parameters (pulse interval, inspiratory time, etc.) and tidal volume. Meanwhile, it also briefly introduces that for patients with SCI with poor diaphragm pacing, intercostal muscle pacing can be used as the second option to restore respiratory function. Also, the development of electronic technology has promoted the emergence of closed-loop diaphragm pacing technology. Finally, we propose that the method of respiratory function reconstruction after spinal cord injury should pay more attention to physiology and the safety of surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Restoration Methods of Respiratory Function for Spinal Cord Injury

Ren

Shi

et al. 2020

Mathematical Problems in Engineering

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“…Hemi-diaphragmatic electromyograms ipsilateral to the spinal hemisection were used to confirm functional hemiparesis 20 . At experiment termination, the spinal cord tissue was harvested and later histologically assessed for hemisection verification 18 .…”

Section: Methodsmentioning

confidence: 99%

Autonomous control of ventilation through closed-loop adaptive respiratory pacing

Siu

Abbas

Fuller

et al. 2020

Sci Rep

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Mechanical ventilation is the standard treatment when volitional breathing is insufficient, but drawbacks include muscle atrophy, alveolar damage, and reduced mobility. Respiratory pacing is an alternative approach using electrical stimulation-induced diaphragm contraction to ventilate the lung. Oxygenation and acid–base homeostasis are maintained by matching ventilation to metabolic needs; however, current pacing technology requires manual tuning and does not respond to dynamic user-specific metabolic demand, thus requiring re-tuning of stimulation parameters as physiological changes occur. Here, we describe respiratory pacing using a closed-loop adaptive controller that can self-adjust in real-time to meet metabolic needs. The controller uses an adaptive Pattern Generator Pattern Shaper (PG/PS) architecture that autonomously generates a desired ventilatory pattern in response to dynamic changes in arterial CO2 levels and, based on a learning algorithm, modulates stimulation intensity and respiratory cycle duration to evoke this ventilatory pattern. In vivo experiments in rats with respiratory depression and in those with a paralyzed hemidiaphragm confirmed that the controller can adapt and control ventilation to ameliorate hypoventilation and restore normocapnia regardless of the cause of respiratory dysfunction. This novel closed-loop bioelectronic controller advances the state-of-art in respiratory pacing by demonstrating the ability to automatically personalize stimulation patterns and adapt to achieve adequate ventilation.

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“…Currently approved stimulators cannot adjust to meet increased respiratory demands, but adaptive closed‐loop systems under development may potentially individualize approaches to augment ventilation (Siu et al . 2019).…”

mentioning

confidence: 99%